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Peak expiratory flow rate (PEFR) is the volume of air forcefully exhaled at maximum speed. This can be measured using a peak flow meter or a spirometry device. Peak flow meters are portable, inexpensive and widely available. The technique is non-invasive, carries no risk to the person, can be taught and learned quickly, and can easily be mastered by the patient. Published evidence for the use of peak expiratory flow rate (PEFR) and peak flow monitoring in asthma is limited, despite the use of the peak flow meter being documented in national and international guidelines for many years. National and international guidelines recommend the use of easily calibrated spirometers, which can provide accurate results with good technique, along with fractional exhaled nitrous oxide (FeNO) testing, which requires a greater analysis and interpretation of the results. Is the use therefore of the peak flow meter redundant? This article discusses the indications for use of peak flow meters, technique and clinical context. [ABSTRACT FROM AUTHOR]

BACKGROUND: Dynamic hyperinflation (DH) is a major pathophysiology of COPD that is directly related to dyspnea and exercise intolerance. Positive expiratory pressure (PEP) might reduce DH and dyspnea during exercise, but at present, there is insufficient evidence to conclude whether it is beneficial for DH, dyspnea, and exercise capacity in COPD. METHODS: A randomized crossover trial with concealed allocation was conducted in 37 moderate to very severe subjects with COPD (34 males, age 66.6 ± 7.4 y, FEV1% of predicted 56.3 ± 13.7). The experimental condition was conical-PEP breathing with a PEP of around 5 cm H2O during a spot marching exercise at a constant speed, inducing 71 6 9% age-predicted maximum heart rate to symptom limit or 25 min. The control condition was usual breathing. Exercise endurance time and end-exercise symptoms were recorded. Inspiratory capacity (IC) was measured pre-exercise and immediately post exercise. Cardiopulmonary function and breathlessness were monitored throughout the test and after 10 min of recovery. RESULTS: There were no complications or adverse effects during exercise with a conical-PEP mask. Conical-PEP showed longer exercise times than control (median 11.0 [interquartile range 7.7-17.0] min vs 8 [6.0-11.5] min, respectively, P < .001). Most stopped exercising because of breathlessness and leg fatigue. At the end of exercise, IC and breathlessness showed non-significant differences between the conditions, but breathlessness was significantly lower in conical-PEP (median 4 [1.5-5.0] than control 5 [3-6] on Borg scale at isotime for control [8 min]). CONCLUSIONS: Breathing with a 5 cm H2O conical-PEP mask improved exercise time (median 27.1% [0.6-52.9]) in subjects with COPD. The improvement in exercise with the conical-PEP mask was associated with slower development of breathlessness, possibly due to delays in DH development. [ABSTRACT FROM AUTHOR]

Objective: Previous research has demonstrated that pulmonary Daoyin could be an efficacious way to ameliorate the physical and psychological state of sufferers with chronic obstructive pulmonary disease (COPD) and bolster the quality of life. However, the results are not consistent. Thus, the objective of this research is to assess the impacts of pulmonary Daoyin in individuals with COPD. Methods: Relevant articles were searched in Web of Science, Cochrane Library, PubMed, EMBASE, SinoMed, CNKI, Wanfang, and VIP from database inception to January 2024. Results: There were a total of 15 randomized controlled trials (RCTs) included in this meta-analysis involving 1732 patients, of which 864 participated in the intervention group and 868 in the control group. When comparing with the control group, the COPD patients practicing pulmonary Daoyin demonstrated a significant improvement in 6 min walking distance (mean difference [MD] = 24.53, 95% confidence interval [CI] [18.55, 30.52], P <0 .00001), forced expiratory volume in the 1 s (FEV1) (MD = 0.39, 95% CI [0.18, 0.59], P = 0.0002), percentage of FEV1 to the predicted value (FEV1%) (MD = 5.35, 95% CI [3.22, 7.48], P < 0.0001), the forced vital capacity (FVC) (MD = 0.39, 95% CI [0.06, 0.73], P = 0.02), percentage of FVC to the predicted value (FVC%) (MD = 7.52, 95% CI [4.91, 10.13], P < 0.00001), the ratio of FEV1/FVC (MD = 4.95, 95% CI [0.91, 8.99], P = 0.02), peak expiratory flow rate (standardized MD = 0.98, 95% CI [0.74, 1.22], P < 0.00001), modified Medical Research Council (mMRC) scale (MD = -0.47, 95% CI [-0.89, -0.04], P =0.03), and Borg scale (MD =-0.65, 95% CI [-0.75, -0.55], P < 0.00001). Conclusions: Our findings may illuminate the influence of pulmonary Daoyin on exercise ability, breathlessness, and pulmonary function in COPD patients. More rigorous RCTs with larger samples and longer-term interventions will be required moving forward. [ABSTRACT FROM AUTHOR]

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document suggests that patients with chronic obstructive pulmonary disease (COPD) should be divided into a less symptomatic group. Moreover, single-inhaled drugs are recommended as initial inhalation therapy for them. However, many less symptomatic patients are provided double or triple-inhaled drugs as initial therapy in the real world. This study aimed to describe the inhalation prescriptions and compare the effects of different inhalation therapies on less symptomatic COPD patients. This was an observational study. Stable COPD patients were recruited and divided into a less symptomatic group including Groups A and C based on the GOLD 2019 document. We collected the data of inhalation therapies prescriptions. Then, the patients were classified into long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA, and LABA + LAMA + ICS groups. All the patients were followed up for 1 year to collect exacerbation and mortality data. We found that only 45.4% of patients in Group A and 43.6% of patients in Group C received reasonable inhalation therapy in reference to the GOLD document. In addition, the LAMA group had a higher forced expiratory volume in one second (FEV1), FEV1%pred, FEV1/forced vital capacity and peak expiratory flow compared with LABA + ICS, LABA + LAMA and LABA + LAMA + ICS groups. However, we did not find any significant differences of exacerbation, hospitalization and mortality during the follow-up among different inhalation therapies groups on less symptomatic COPD patients. Over half of the less symptomatic patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. In fact, the single inhaled drug of LAMA should be recommended and pulmonary function is not a good indicator for the choice of initial inhalation therapy in less symptomatic COPD patients. Over half of the less symptomatic COPD patients received inhalation therapy that were inconsistent with the GOLD document recommendations in a Chinese population in the real world. The clinicians should offer a single inhaled drug of LAMA to less symptomatic COPD patients and pulmonary function is not a good indicator for the choice of initial inhalation therapy. [ABSTRACT FROM AUTHOR]

Background: Substance use is a problem that affects people all over the world and is prevalent in different age groups. The lungs in particular, with their unique exposure to the environment and the bloodstream, are vulnerable to damage from substance use and can affect lung function. Efforts have generally focused on cigarettes, while there is little research on different substances of use. The study aimed to detect changes in pulmonary function tests in different substance users. Methods: An analytical cross-sectional study was carried out among different substance users at the Abdalaal Elidridi Psychiatric Hospital. A total of 60 adults were included: 16 cannabis users, 16 heroin users, 16 methamphetamine users, and 12 alcohol users. Participants used only one substance. Height and weight were measured, and BMI was calculated. For each participant, pulmonary function tests (PFTs) including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio and peak expiratory flow rate (PEFR) were measured using an electronic spirometer, and the results were compared with normal reference values for Sudanese subjects matched for age, sex, and height. Results: A high prevalence of lung function abnormalities (100.0%) is seen in all abusers. Obstructive lung disease is found in 80.0% of patients, and restrictive lung disease is found in 20.0% of cases. The measured FEV1/FVC ratio in different substance groups was lower than the expected normal values of (88.2 ± 2.9%). The mean FEV1/FVC ratio of alcohol was (83.6 ± 7.6%), for heroin, it was (77.3 ± 15.8%), for methamphetamine, it was (77.7 ± 17.8%) and for cannabis, it was (71.03 ± 11.3%), the latter was significantly lower than the other two groups (P < 0.001). Duration of substance use was inversely correlated with the FEV1/FVC ratio (r = -0.378, P 0.001), indicating that a longer duration of substance use correlates with lower FEV1/FVC ratios. Conclusions: Obstructive lung abnormalities are frequent in substance abusers. All types of substances have a major deleterious effect on PFTs and harm the respiratory system. More action should be taken to address the effects of substances on the lungs. Awareness, early detection, and intervention are essential. [ABSTRACT FROM AUTHOR]

Purpose: Subglottic stenosis, a rare condition of the upper airway, is frequently misdiagnosed as obstructive lung disease. The aim of this study was to investigate whether subglottic stenosis could be identified and distinguished from asthma and chronic obstructive pulmonary disease (COPD) using spirometry or the dyspnea index (DI). Methods: The study population included 43 patients with asthma, 31 patients with COPD and 50 patients with subglottic stenosis planned to undergo endoscopic intervention. All patients completed the DI and underwent dynamic spirometry registering both inspiratory and expiratory volumes and flows, including the expiratory disproportion index (EDI), the ratio of forced expiratory volume in 1 s to peak expiratory flow. One-way analysis of variance assessed the discrepancy of the variables among the study groups, and receiver operating curve (ROC) analysis determined the measurement with the best discriminatory power providing a cutoff value, maximizing both sensitivity and specificity. Results: The only statistically significant variables differing between all three groups were the EDI and the DI. The EDI showed an excellent area under the ROC curve (0.99, p < 0.001) with a cutoff value of 0.39 (98% sensitivity, 96% specificity), followed by DI (0.87, p < 0.001) with a cutoff score of > 25 (83% sensitivity and 78% specificity). Conclusion: In patients with dyspnea of unknown cause, an increase in EDI should arouse a suspicion of extrathoracic airway obstruction, advocating for further evaluation with laryngotracheoscopy. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio‐ecological model. Background: PA has been linked to poor long‐term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors. Design: Cohort study. Methods: We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group‐based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow‐up. A STROBE checklist was used to guide the reporting of this study. Results: Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow‐up. Conclusions: This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD. Relevance to Clinical Practice: It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA. No Patient or Public Contribution: A national cohort study was used and no patients or the public were involved in the design and implementation of this study. [ABSTRACT FROM AUTHOR]

Background: Diaphragmatic stretch technique, manual diaphragmatic release technique, and chest proprioceptive neuromuscular facilitation (PNF) have been suggested as an alternative method for the treatment of chronic obstructive pulmonary disease (COPD). Aims: The aim of this study was to compare the effects of diaphragmatic stretch and manual diaphragmatic release technique along with chest PNF on peak expiratory flow rate (PEFR), exercise capacity, dyspnea, chest expansion, and inspiratory pressure in mild-to-moderate COPD participants. Settings and Design: A randomized clinical trial took place on 30 subjects with COPD. Materials and Methods: Subjects were divided into two groups, of which Group A received a diaphragmatic stretch technique with chest PNF and Group B received a manual diaphragmatic release technique with chest PNF. Six-day intervention protocol was given to the participants of both the groups and PEFR, maximum inspiratory pressure, chest expansion, exercise capacity, and dyspnea were assessed before the intervention and after 6 days of intervention. Statistical Analysis: Normality of all continuous data was checked using the Kolmogorov–Smirnov test. Independent t-test was used to analyze the parameters between Group A and Group B. Comparison of difference in pre and post within group was done using independent t-test. Results: Data analyzed in Group A as well as in B, when compared within the group, showed highly significant improvements. When compared between the groups, both the groups showed no difference. Conclusion: The study concluded that there was statistical significance in improvement of PEFR, exercise capacity, dyspnea, chest expansion, and inspiratory pressure within both the groups, but significant changes were not seen between groups. Hence, diaphragmatic stretch and manual release technique along with chest PNF can be used as an alternative/adjunct for the treatment of COPD. [ABSTRACT FROM AUTHOR]

Pulmonary function testing (PFT) has a long and rich history in the definition, diagnosis, and management of COPD. For decades, spirometry has been regarded as the standard for diagnosing COPD; however, numerous studies have shown that COPD symptoms, pathology, and associated poor outcomes can occur, despite normal spirometry. Diffusing capacity and imaging studies have called into question the need for spirometry to put the "O" (obstruction) in COPD. The role of exercise testing and the ability of PFTs to phenotype COPD are reviewed. Although PFTs play an important role in diagnosis, treatment decisions are primarily determined by symptom intensity and exacerbation history. Although a seminal study positioned FEV1 as the primary predictor of survival, numerous studies have shown that tests other than spirometry are superior predictors of mortality. In years past, using spirometry to screen for COPD was promulgated; however, this only seems appropriate for individuals who are symptomatic and at risk for developing COPD. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to estimate the safety and efficacy of spray cryotherapy (SCT) in patients with chronic obstructive pulmonary disease (COPD). Methods: We recruited patients aged 40–80 years with a confirmed diagnosis of COPD without serious complications (defined as two consecutive years of chronic cough and cough for at least 3 months with lung function forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC] < 70% after inhaled bronchodilators and Global Initiative for Chronic Obstructive Lung Disease [GOLD] grade II–IV). The safety of this study was assessed by incidence of adverse events, and the efficacy was evaluated by St. George's Respiratory Questionnaire (SGRQ), COPD assessment test (CAT), Leicester Cough Questionnaire (LCQ) and changes in exercise capacity, histomorphology and lung function. Results: Eight patients eventually received three complete sessions of SCT, each lasting 41.10 ± 19.72 min. No adverse complications were recorded within 3 months after SCT. Clinically meaningful improvements in SGRQ, CAT, LCQ and exercise capacity were observed at 3 months after SCT: −15.75 ± 6.76 (95% confidence interval [CI] 10.10−21.40; p <.001), −6.88 ± 3.91 (95% CI 3.61−10.14; p =.002), −18.13 ± 13.81 (95% CI 6.58−29.67; p =.008) and 72.75 ± 33.11 (95% CI −100.43 to −45.07; p <.001), respectively. The density of airway epithelial goblet cells per unit area was significantly reduced (p <.05), and lung function parameters such as ∆FVC, ∆FEV1 and ∆ peak expiratory flow (∆PEF) were improved (p =.007,.021 and.012). Conclusions: SCT is a safe and effective strategy to provide a better quality of life for COPD patients. [ABSTRACT FROM AUTHOR]

Hyperbaric oxygen therapy (HBOT) is known to be associated with pulmonary oxygen toxicity. However, the effect of modern HBOT protocols on pulmonary function is not completely understood. The present study evaluates pulmonary function test changes in patients undergoing serial HBOT. We prospectively collected data on patients undergoing HBOT from 2016–2021 at a tertiary referral center (protocol registration NCT05088772). Patients underwent pulmonary function testing with a bedside spirometer/pneumotachometer prior to HBOT and after every 20 treatments. HBOT was performed using 100% oxygen at a pressure of 2.0–2.4 atmospheres absolute (203–243 kPa) for 90 minutes, five times per week. Patients' charts were retrospectively reviewed for demographics, comorbidities, medications, HBOT specifications, treatment complications, and spirometry performance. Primary outcomes were defined as change in percent predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and forced mid-expiratory flow (FEF25-75), after 20, 40, and 60 HBOT sessions. Data was analyzed with descriptive statistics and mixed-model linear regression. A total of 86 patients were enrolled with baseline testing, and the analysis included data for 81 patients after 20 treatments, 52 after 40 treatments, and 12 after 60 treatments. There were no significant differences in pulmonary function tests after 20, 40, or 60 HBOT sessions. Similarly, a subgroup analysis stratifying the cohort based on pre-existing respiratory disease, smoking history, and the applied treatment pressure did not identify any significant changes in pulmonary function tests during HBOT. There were no significant longitudinal changes in FEV1, FVC, or FEF25-75 after serial HBOT sessions in patients regardless of pre-existing respiratory disease. Our results suggest that the theoretical risk of pulmonary oxygen toxicity following HBOT is unsubstantiated with modern treatment protocols, and that pulmonary function is preserved even in patients with pre-existing asthma, chronic obstructive lung disease, and interstitial lung disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of acupuncture transcutaneous electrical nerve stimulation (acuTENS) on the reduction of dyspnoea during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A multicentric randomized control trial with masked patients and evaluators was carried out. During hospitalization, AECOPD patients received 45 min of acuTENS (experimental group) or sham acuTENS (controls) daily on 5 consecutive days. The trial was conducted at the Hospital del Mar, Barcelona, and Hospital Sant Joan de Déu, Manresa (both in Spain). Dyspnoea and peak expiratory flow were measured daily from the first to fifth days. Length of stay, readmissions at 3 months and adverse events were also analysed. Results: Finally, 19 patients with moderately to severely exacerbated COPD were included. Although some tendencies in dyspnoea during day 1 and length of hospital stay were found favouring acupuncture, no significant differences were shown between groups. Conclusions: The acuTENS intervention was feasible#well tolerated in AECOPD patients and no important side effects were reported. [ABSTRACT FROM AUTHOR]

Context: Chronic obstructive pulmonary disease (COPD), though a disease of the lung, the extrapulmonary manifestations contribute significantly to morbidity and mortality. Aim: This study aims to evaluate and compare the effects of two different thoracic kinesio taping techniques on pulmonary function, oxygen saturation, and exercise capacity in patients with COPD. Settings and Design: A randomized clinical trial was conducted across tertiary health-care hospitals in Belagavi, Karnataka. Subjects and Methods: A total of 42 participants aged 30-65 years (51.58 ± 10.21 years) participated in the study. All participants underwent baseline evaluations for pulmonary function, oxygen saturation, and exercise capacity, following which they were randomly allocated to one of the two intervention groups. Both groups, Group A (diaphragmatic taping) and Group B (intercostal muscle taping), were given intervention for 15 days, with the applied tape changed on every 3rd day. Postintervention evaluation was performed on the 15th day. Statistical Analysis: Mann-Whitney test was used for between-group comparison, and the Wilcoxon test was used for within-group comparison. Results: A significant improvement was noted in all parameters in Group A except forced expiratory volume in 6 s (FEV6) (P = 0.47) and FEV1/FEV6 (P = 0.301) ratio when compared with preintervention values. In Group B, all the parameters showed a significant improvement compared to preintervention values. The between-group comparison showed that only FEV1/FEV6 (P = 0.018) ratio showed a significant improvement. Conclusion: There is no significant difference between diaphragmatic taping and intercostal muscle taping technique. It was noted that both the techniques were equally effective in improving pulmonary function, oxygen saturation, and exercise capacity in COPD patients. Hence, thoracic kinesio taping, in addition to conventional physiotherapy treatment, can help in achieving better patient outcomes. [ABSTRACT FROM AUTHOR]

Breath sensor technology can be used in medical diagnostics. This study aimed to build a device to measure the level of hydrogen sulfide, ammonia, acetone and alcohol in exhaled breath of patients as well as healthy individuals. The purpose was to determine the efficacy of these gases for detection of obstructive lung disease. This study was conducted on a total of 105 subjects, where 60 subjects were patients of obstructive lung disease and 45 subjects were healthy individuals. Patients were screened by means of the Pulmonary Function Test (PFT) by a pulmonologist. The gases present in the exhaled breath of all subjects were measured. The level of ammonia (32.29 ± 20.83 ppb), (68.83 ± 35.25 ppb), hydrogen sulfide (0.50 ± 0.26 ppm), (62.71 ± 22.20 ppb), and acetone (103.49 ± 35.01 ppb), (0.66 ± 0.31 ppm) in exhaled breath were significantly different (p < 0.05) between obstructive lung disease patients and healthy individuals, except alcohol, with a p-value greater than 0.05. Positive correlation was found between ammonia w.r.t Forced Expiratory Volume in 1 s (FEV1) (r = 0.74), Forced Vital Capacity (FVC) (r = 0.61) and Forced Expiratory Flow (FEF) (r = 0.63) and hydrogen sulfide w.r.t FEV1 (r = 0.54), FVC (r = 0.41) and FEF (r = 0.37). Whereas, weak correlation was found for acetone and alcohol w.r.t FEV1, FVC and PEF. Therefore, the level of ammonia and hydrogen sulfide are useful breath markers for detection of obstructive lung disease. [ABSTRACT FROM AUTHOR]

Background: Patients suffering from combined obstructive and interstitial lung disease (O-ILD) represent a pathological entity which still has to be well clinically described. The aim of this descriptive and explorative study was to describe the phenotype and functional characteristics of a cohort of patients suffering from functional obstruction in a population of ILD patients in order to raise the need of dedicated prospective observational studies and the evaluation of the impact of anti-fibrotic therapies.Methods: The current authors conducted a retrospective study including 557 ILD patients, with either obstructive (O-ILD, n = 82) or non-obstructive (non O-ILD, n = 475) pattern. Patients included were mainly males (54%) with a mean age of 62 years.Results: Patients with O-ILD exhibited a characteristic functional profile with reduced percent predicted forced expired volume in 1 s (FEV1) [65% (53-77) vs 83% (71-96), p < 0.00001], small airway involvement assessed by maximum expiratory flow (MEF) 25/75 [29% (20-41) vs 81% (64-108), p < 0.00001], reduced sGaw [60% (42-75) vs 87% (59-119), p < 0.01] and sub-normal functional residual capacity (FRC) [113% (93-134) vs 92% (75-109), p < 0.00001] with no impaired of carbon monoxide diffusing capacity of the lung (DLCO) compared to those without obstruction. Total lung capacity (TLC) was increased in O-ILD patients [93% (82-107) vs 79% (69-91), p < 0.00001]. Of interest, DLCO sharply dropped in O-ILD patients over a 5-year follow-up. We did not identify a significant increase in mortality in patients with O-ILD. Interestingly, the global mortality was increased in the specific sub-group of patients with O-ILD and no progressive fibrosing ILD phenotype and in those with connective tissue disease associated ILD especially in case of rheumatoid arthritis.Conclusions: The authors individualized a specific functional-based pattern of ILD patients with obstructive lung disease, who are at risk of increased mortality and rapid DLCO decline over time. As classically those patients are excluded from clinical trials, a dedicated prospective study would be of interest in order to define more precisely treatment response of those patients. [ABSTRACT FROM AUTHOR]

Spirometry is a lung function test involving deep inhalation and forceful deep exhalation. It is widely used to obtain objective information about airflow limitation and to diagnose lung diseases. In contrast, tidal spirometry is based on normal breathing and therefore much more convenient, but it is hardly used in medical care and its relation with conventional (forced) spirometry is largely unknown. Therefore, the objective of this work is to reveal the relation between tidal and forced spirometry. Employing the strong correspondence between the forced flow-volume curves and the Tiffeneau-Pinelli (TP) index, we present a method to obtain (a) the expected tidal flow-volume curve for a given TP-index, and (b) the expected TP-index for a given tidal curve. For patients with similar values of the TP-index, the tidal curves show a larger spread than the forced curves, but their average shape varies in a characteristic way with varying index. Therefore, just as with forced curves, the TP-index provides a useful objective ranking of the average of tidal curves: upon decreasing TP-index the expiratory flow rate changes in that its peak shifts towards smaller expiratory volumes, and its post-peak part becomes dented. • The relation between tidal and forced spirometry is investigated. • Tidal curves of subjects at similar Tiffeneau-Pinelli index values vary significantly. • The average shape of tidal flow-volume curves varies smoothly with varying TP-index. • Tidal flow-volume curves can be classified by the expected TP-index. • The post-peak expiratory flow-volume curve becomes dented at decreasing TP-index. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and transforming growth factor-β (TGF-β) are important systemic inflammation-related factors that have been clinically clearly related to the pathogenesis and development of chronic obstructive pulmonary disease (COPD). However, their relationship with COPD combined with osteoporosis is rarely reported. OBJECTIVE: To explore the clinical significance of serum TNF-α, TGF-β and IL-6 levels in patients with COPD combined with osteoporosis. METHODS: A total of 120 COPD patients were selected as the research subjects in accordance with the principle of prospective case control. According to their bone mass, the patients were assigned into a COPD with normal bone mass group, a COPD with osteopenia group and a COPD with osteoporosis group (n=40 per group). The clinical data, serum TNF-α, TGF-β1, and IL-6 levels were compared among three groups. A correlation analysis was conducted between serum TNF-α, TGF-β1, IL-6 and lung function, bone mineral density, and bone metabolism in the COPD with osteoporosis group. Partial correlation analysis was used to analyze the relationship between serum TNF-α, TGF-β1, IL-6 and COPD combined with osteoporosis. The receiver operating characteristic curve was used to evaluate the diagnostic value of serum TNF-α, TGF-β1, and IL-6. The study protocol was implemented in line with the relevant ethics requirements of the Affiliated Hospital of Qinghai University. RESULTS AND CONCLUSION: Pearson correlation analysis showed that serum TNF-α and IL-6 in COPD with osteoporosis group were negatively correlated with the forced expiratory volume in one second as a percentage of the predicted value (FEVl%Pre), the ratio of the forced expiratory volume in one second to forced vital capacity (FEV1/FVC), and bone mineral density of the lumbar spine and femoral neck, as well as positively correlated with osteoprotegerin and degradation product of β-cross linked C-telope-ptide of type I collagen. The level of TGF-β1 was positively correlated with FEV1%Pre, FEV1/FVC, and bone mineral density of the lumbar spine and femoral neck, and negatively correlated with steoprotegerin and degradation product of β-cross linked C-telope-ptide of type I collagen (P < 0.05). After controlling lung function, bone metabolism, bone mineral density and other factors, serum TNF-α, TGF-β1, and IL-6 were still significantly correlated with COPD combined with osteoporosis (P < 0.05); the area under the receiver operating characteristic curve of serum TNF-α, TGF-β1, and IL-6 in the diagnosis of COPD with osteopenia and COPD with osteoporosis were 0.870 and 0.850, respectively. To conclude, serum levels of TNF-α, TGF-β1, and IL-6 are related to lung function and bone metabolism. The combined detection of the three can provide a reference for clinical evaluation of COPD combined with osteoporosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between serum vascular adhesion protein-1 (VAP-1), macrophage stimulating protein(MSP), stromal cellderived factor-1 (SDF-1) levels and pulmonary function, inflammatory factors and quality of life in patients with stable chronic obstructive pulmonary disease (COPD). Methods: 116 patients with stable COPD in our hospital from September 2018 to September 2020 were selected as the COPD group, and 100 healthy volunteers who had physical examination in our hospital during the same period were selected as the control group. The serum VAP-1, MSP, SDF-1 levels, pulmonary function indexes [Forced expiratory volume at 1 second(FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF)], inflammatory factors [interleukin-6(IL-6), interleukin-17 (IL-17), interleukin-22 (IL-22), tumor necrosis factor-α (TNF-α)] levels were compared between the two groups. According to the severity of patients with stable COPD, they were divided into mild group (n=53), moderate group (n=34) and severe group (n=29). The above indexes were compared among the three groups. The quality of life of the three groups was evaluated and compared by COPD assessment test(CAT), Pearson linear correlation analysis was used to analyze the correlation between serum VAP-1, MSP, SDF-1 levels and pulmonary function, inflammatory factors and CAT score. Results: The serum VAP-1,MSP, SDF-1, IL-6, IL-17, IL-22 and TNF-α levels in COPD group were higher than those in control group, while FEV1, FVC, FEV1/FVC and PEF were lower than those in control group (P<0.05). Serum VAP-1, MSP, SDF-1, IL-6, IL-17, IL-22, TNF-α levels and CAT score in the mild group were significantly lower than those in the moderate group and severe group, and the moderate group was lower than the severe group, while FEV1, FVC, FEV1/FVC, PEF in the mild group were higher than those in the moderate group and severe group, and the moderate group was higher than the severe group(P<0.05). Pearson linear correlation analysis indicated that serum VAP-1, MSP,SDF-1 levels were negatively correlated with FEV1, FVC, FEV1/FVC, PEF, and the three were negatively correlated with serum IL-6, IL-17, IL-22, TNF-α level and CAT score were positively correlated (P<0.05). Conclusion: The serum VAP-1, MSP and SDF-1 level in patients with stable COPD are significantly up-regulated, and the three are closely related to the patient’s pulmonary function,inflammatory factors and quality of life. Clinically, it is expected that the determination of serum VAP-1, MSP and SDF-1 levels, so as to assess the progress of patients with stable COPD. [ABSTRACT FROM AUTHOR]

Background: Mild expiratory flow limitation may not be recognized using traditional spirometric criteria based on the ratio of FEV1/FVC.Research Question: Does slow vital capacity (SVC) instead of FVC increase the sensitivity of spirometry to identify patients with early or mild obstructive lung disease?Study Design and Methods: We included 854 current and former smokers from the Subpopulations and Intermediate Outcome Measures in COPD Study cohort with a postbronchodilator FEV1/FVC ≥ 0.7 and FEV1 % predicted of ≥ 80% at enrollment. We compared baseline characteristics, chest CT scan features, exacerbations, and progression to COPD (postbronchodilator FEV1/FVC, < 0.7) during the follow-up period between 734 participants with postbronchodilator FEV1/SVC of ≥ 0.7 and 120 with postbronchodilator FEV1/SVC < 0.7 at the enrollment. We performed multivariate linear and logistic regression models and negative binomial and interval-censored proportion hazards regression models adjusted for demographics and smoking exposure to examine the association of FEV1/SVC < 0.7 with those characteristics and outcomes.Results: Participants with FEV1/SVC < 0.7 were older and had lower FEV1 and more emphysema than those with FEV1/SVC ≥ 0.7. In adjusted analysis, individuals with postbronchodilator FEV1/SVC < 0.7 showed a greater percentage of emphysema by 0.45% (95% CI, 0.09%-0.82%), percentage of gas trapping by 2.52% (95% CI, 0.59%-4.44%), and percentage of functional small airways disease based on parametric response mapping by 2.78% (95% CI, 0.72%-4.83%) at baseline than those with FEV1/SVC ≥ 0.7. During a median follow-up time of 1,500 days, an FEV1/SVC < 0.7 was not associated with total exacerbations (incident rate ratio [IRR], 1.61; 95% CI, 0.97-2.64), but was associated with severe exacerbations (IRR, 2.60; 95% CI, 1.04-4.89). An FEV1/SVC < 0.7 was associated with progression to COPD during a 3-year follow-up even after adjustment for demographics and smoking exposure (hazard ratio, 3.93; 95% CI, 2.71-5.72). We found similar results when we examined the association of prebronchodilator FEV1/SVC < 0.7 or FEV1/SVC less than the lower limit of normal with chest CT scan features and progression to COPD.Interpretation: Low FEV1 to SVC in current and former smokers with normal spirometry results can identify individuals with CT scan features of COPD who are at risk for severe exacerbations and is associated with progression to COPD in the future.Trial Registry: ClinicalTrials.gov; No.: NCT01969344T4; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Magnesium has been shown to have bronchodilator properties in asthma and chronic obstructive pulmonary disease (COPD). Therapeutic benefits of nebulized magnesium in asthma has been seen. The purpose of this study was to compare therapeutic benefits of nebulised magnesium sulphate as an adjuvant with normal saline in patients with COPD exacerbation. Methods: It was a randomized single blind interventional study of 172 cases of acute exacerbation of COPD presenting (AECOPD) with a peak expiratory flow rate (PEFR) <300 L/min measured 20 min after initial management. Patients received 5 mg salbutamol mixed with 3 ml isotonic magnesium sulphate or 3 ml normal saline on three occasions at 30 min intervals via nebulizer. The primary outcome measured was PEFR at 90 min and hospital admission, noninvasive or invasive ventilation and mortality were taken as secondary outcomes. Results: The mean PEFR were 86.3±11.9 l/min, 97.6±19.1 l/min and 99.6±15.2 l/min after nebulization with magnesium sulphate and 79.17±14.11 l/min, 90.17±18.27 l/min and 93.17±20.63 l/min at 30, 60 and 90 minutes respectively in normal saline group which were statistically significant differences. Total 91.9% were admitted in ward and 8.1% got admitted in Medical and intermediate intensive care units from magnesium group and 81.7% were admitted in ward and 18.3% required ICU admissions in saline group. Differences in ventilation and mortality were insignificant. Conclusion: Nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has therapeutic benefit on PEFR but no effect in terms of hospital admission, requirement of invasive or non-invasive ventilation and mortality. [ABSTRACT FROM AUTHOR]

Objectives: Forced oscillation technique (FOT) is becoming increasingly widespread measurement method used for assessment of lung function. In the present study, we attempted to assess FOT values in patients after lobectomy in comparison with IPF and COPD patients. Methods: Twenty‐two patients after lobectomy due to lung cancer stage I or II, 28 patients with idiopathic pulmonary fibrosis and 17 patients with chronic obstructive pulmonary disease were enrolled in the study. All patients performed spirometry (FEV1, FVC, FEV1/FVC, MEF50, MEF25, FEF25‐75, MIF50), plethysmography (Raw, TLC, RV, RV/TLC) and a test using the forced oscillation technique‐ resistance (R at 5Hz, 11Hz and 19Hz, inspiratory, expiratory and total), reactance (Xat 5Hz, 11Hz, inspiratory, expiratory and total), Fres and expiratory flow limitation (∆X). The ANOVA Kruskal‐Wallis test followed by a multiple comparison test were used to evaluate the differences in oscillatory parameters between‐groups. Results: Patients after lobectomy presented reduced X5, X11 and moderately increased R5, R11, R19, R5‐19, ∆X and Fres. Rinsp5 weresignificantly higher when compared with IPF patients (P = 0.001). In lobectomy patients R5, X5, X11, ∆X and Fres were significantly less affected when compared with patients with COPD (P < 0.05 for all values). R5‐19, which reflects small airways dysfunction, occurred to be similarly elevated as in COPD patients (0.5 vs 0.6 cmH2O/L/s).Abnormalities of reactance at 11Hz were observed more frequently than at 5Hz in all groups of patients. Conclusion: Patients after lobectomy due to lung cancer presented FOT abnormalities, which could be caused by lung parenchymal abnormalities following recent thoracic surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although FEV1 and FEV1/FVC are accepted as standard parameters in treatment follow-up, these parameters have a limited ability to predict clinical outcomes in patients with COPD. However, small airways dysfunction, which is determined by maximum mid-expiratory flow, is variable in the same stage of patients with COPD, even if their FEV1 and FEV1/FVC are similar. The aim of this study was to compare pulmonary function, the severity of perceived dyspnea, the severity of fatigue, physical activity level, and health-related quality of life based on the severity of small airways dysfunction in male subjects with moderate COPD. METHODS: The study consisted of 96 subjects with moderate COPD. Pulmonary function tests, the distance achieved on the 6- min walk test, the modified Medical Research Council Dyspnea Scale, the International Physical Activity Questionnaire - short form, the Fatigue Severity Scale, the St George Respiratory Questionnaire, and Short Form 36 questionnaire were evaluated in all subjects. After calculating the mean percent of predicted maximum mid-expiratory flow for the entire sample, subjects were divided into 2 groups: below average (Group 1, n = 54 subjects) and above average (Group 2, n = 42 subjects). RESULTS: There were no differences between the groups in age, body mass index, cigarette consumption, percent of predicted FEV1, and FEV1 /FVC (P = .55, .61, .19, .09, and .15, respectively). Scores from the Fatigue Severity Scale and the modified Medical Research Council dyspnea scale were significantly higher in Group 1 (P = .003 and P = .002, respectively); in addition, results from the 6-min walk test and the International Physical Activity Questionnaire - short form scores were significantly lower (P = .001 and P < .001, respectively). CONCLUSIONS: Increased small airways dysfunction led to increased perception of dyspnea and fatigue, as well as poor exercise capacity and health-related quality of life in male subjects with COPD. We suggest that it may be useful to consider the maximum mid-expiratory flow in addition to FEV1 and FEV1/FVC in the treatment and follow-up of male patients with moderate COPD. [ABSTRACT FROM AUTHOR]

Introduction: Patients with sleep-related breathing disorders (SRBD) have various structural and functional abnormalities of the upper airway during sleep which may get reflected on their pulmonary function tests. The aim of the study was to find the correlation between the spirometric indices and snoring, grades of apnea–hypoapnea index (AHI), and STOPBANG. There is scarcity of literature showing correlation of STOP BANG with spirometric variables. Material and Methods: Patient with SRBD fulfilling the inclusion and exclusion criteria were enrolled. The pretest probability sleep score STOPBANG and polysomnography (PSG) were calculated for all the patients. Spirometric indices like forced expiratory volume in one sec (FEV1), forced vital capacity (FVC), postbronchodilator ratio FEVI/FVC (PBDR), and peak expiratory flow rate (PEFR) were studied. Their association with snoring, different grades of obstructive sleep apnea (OSA), and STOPBANG were evaluated using statistical analysis. Results: A total of 70 patients were enrolled. Abnormalities of spirometric indices were found to be common in patients with SRBD but their association with snoring, grades of OSA, and STOPBANG were not statistically significant. There is no statistically significant correlation between body mass index (BMI) and grades of AHI. Conclusion: This study found no statistically significant correlation between spirometric parameters and STOPBANG and degree of AHI. Primary care physicians should be aware that obstructive lung disease does coexist with the sleep disordered breathing but as per this study, their statistically significant association needs further validation. [ABSTRACT FROM AUTHOR]

The Peak Expiratory Flow Rate (PEFR) is the maximum or peak flow rate that is attained during a forceful expiratory effort after taking a deep inspiration. It is expressed in liters per minute.The average Peak Expiratory Flow Rate of healthy young Indian females is 350 Liters/minute. The Pulmonary function tests (PFTs) are non invasive tests which help to diagnose patients with obstructive and restrictive lung diseases. Individuals with obesity are more susceptible to many conditions such as obstructive sleep apnea, pulmonary, cardiovascular, hepatic, renal diseases, metabolic alterations, and neoplasm. More than 23% of women are either overweight or obese which are higher value than the prevalence amongs men. In most of the studies, Wright's Peak Flow meter is best for assessing lung functions as it is cheaper and is also found that there is negative correlation between Body Mass Index and Peak Expiatory Flow Rate. PEFR values are found to be lower in females with higher body mass index. This indicates that high body mass index propose threat for airflow and lung functions in women. Deposition of subcutaneous adipose tissue gravely disturbs mechanics of our respiratory system and decrease in the respiratory compliance. Thus in subjects of high Body Mass Index, the chances of bronchial asthma is more. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

INTRODUCTION: Currently, the bronchodilator reversibility is not recommended to differentiate asthma from chronic obstructive pulmonary disease (COPD); however, physiopathological specificities of each disease contribute to the differences in response to the drug. OBJECTIVES: The objective of this study is to evaluate the differences in bronchodilator response between asthmatic and COPD patients and to determine which of the bronchodilation criteria have the best ability to detect the positive response in these patients. MATERIALS AND METHODS: This was a cross-sectional study. The sample included 104 patients with asthma or COPD who performed lung function tests between January and March 2018. The whole sample was analyzed according to postbronchodilator variation (Δ) of lung function parameters, and the postbronchodilator reversibility was characterized using a multiple bronchodilation criteria. The drug used in reversibility test was salbutamol. RESULTS: In this study, Δ forced-expiratory volume in the 1st s (ΔFEV1) and a Δ Raw was statistically higher in the group with asthma compared with the group with COPD. In the asthma group, the criteria ↓ functional residual capacity (FRC) ≥10%, ↓Raw ≥ 35%, ↑ forced expiratory flow between 25% and 75% of vital capacity (FEF25%-75%) ≥20% and ↑ FEV1 and/or ↑ forced vital capacity ≥12% and 200 mL were those that presented a greater capacity of detecting a positive response to bronchodilator. The criteria ↑ FEF25%-75%≥20% and ↓ FRC ≥ 10% were those that had the greater ability of detecting airway reversibility in COPD group. CONCLUSION: The analysis of postbronchodilator FEV1 and raw modifications as well as the using of a combination of multiple bronchodilation criteria contribute to a deeper characterization of bronchodilator reversibility in asthma and COPD. [ABSTRACT FROM AUTHOR]

Spirometry is one of the most basic of pulmonary function tests, and the measurements of this test, such as forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow, play an important role in the diagnosis of obstructive lung diseases, such as chronic obstructive pulmonary disease and asthma. The lack of point-of-care, primary care, and personalized applications prohibits individuals from monitoring their own lung conditions beyond the hospital visit. This article presents the design and development of a low-cost, portable, smartphone-enabled spirometer with an automatic disease classification system based on the spirometric signal using the convolutional neural network. The classification model was trained using data, stored in the device, and the best model was extracted with an accuracy of 98.98%, which outperforms other classification models, such as long short-term memory network, deep belief network, and stacked autoencoder. The pretrained model has been imported in the smartphone device for real-time classification of spirometry. [ABSTRACT FROM AUTHOR]

We previously demonstrated corticosteroid administration on the neonatal intensive care unit was associated with reduced lung function at 11 to 14 years of age in children born very prematurely. The objective of this observational study was to assess if lung function remained impaired at 16 to 19 years of age in those who had received postnatal corticosteroids and whether the trajectory of lung function with increasing age differed between those who had and had not received corticosteroids. One hundred and fifty-nine children born prior to 29 weeks of gestational age had comprehensive lung function measurements; 49 had received postnatal dexamethasone. Lung function outcomes were compared between those who had and had not received postnatal dexamethasone after adjustment for neonatal factors. Forced expiratory flow at 75%, 50%, 25% and 25–75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes (total lung capacity and residual volume) were assessed. The majority of results were significantly lower in those who received dexamethasone (between 0.61 to 0.78 standard deviations). Lung function reduced as the number of courses of dexamethasone increased. Between 11 and 14 years and 16 to 19 years, lung function improved in the unexposed group, but forced expiratory flow at 75% of the expired vital capacity and forced expiratory volume in one second deteriorated in those who had received postnatal corticosteroids (p = 0.0006). These results suggest that prematurely born young people who received postnatal corticosteroids may be at risk of premature onset of chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and severe diseases worldwide with high societal and health care costs. The pathogenesis of COPD is very complicated, and no curative treatment is available. Cellular senescence promotes the development of COPD. Type II alveolar epithelial cells (AECII) play a momentous role in lung tissue repair and maintenance of alveolar homeostasis. Sirtuin 1 (SIRT1), an antiaging molecule involved in the response to chronic inflammation and oxidative stress, regulates many pathophysiological changes including stress resistance, apoptosis, inflammation, and cellular senescence. This study aimed to investigate whether the pharmacological SIRT1 activator SRT2104 protects against AECII senescence in rats with emphysema. Our findings confirmed that SRT2104 administration reduced the pathological characteristics of emphysema and improved lung function parameters, including pulmonary resistance, pulmonary dynamic compliance, and peak expiratory flow. Moreover, SRT2104 treatment upregulated the expression of surfactant proteins A and C, SIRT1, and forkhead box O 3a (FoxO3a), decreased senescence-associated-β-galactosidase (SA-β-gal) activity, increased SIRT1 deacetylase activity, and downregulated the levels of p53 and p21. Therefore, SRT2104 administration protected against AECII senescence in rats with emphysema via SIRT1/FoxO3a and SIRT1/p53 signaling pathways and may provide a novel potential therapeutic strategy for COPD. [ABSTRACT FROM AUTHOR]

Keywords: biomarker; chronic obstructive pulmonary disease; cigarette smoking; preanalytical variability EN biomarker chronic obstructive pulmonary disease cigarette smoking preanalytical variability e138 e141 4 07/13/20 20200801 NES 200801 To the Editor, Biomarker tests in pulmonary medicine show great promise with regard to improving patient care, yet their translation into widely used clinical tests is a slow and rather ineffective process. In this study, we examined the acute effects of cigarette smoking on serum levels of surfactant protein D (SPD), which represents another promising and (predominantly) lung-derived COPD biomarker candidate. [Extracted from the article]

Background: Exertional dyspnea is a cardinal feature of chronic obstructive pulmonary disease (COPD) and a major cause of activity limitation. Although dual bronchodilation is more effective than bronchodilator monotherapy at improving resting pulmonary function, it is unclear to which extent this translates into superior relief of exertional dyspnea. Methods: We conducted a randomized controlled, double-blind, cross-over trial comparing indacaterol 110 µg/glycopyrronium 50 µg once daily (OD) with tiotropium 50 µg OD in patients with moderate to severe COPD and resting hyperinflation (functional residual capacity >120% of predicted value). The primary outcome was Borg dyspnea score at the end of a 3-min constant speed shuttle test after 3 weeks of treatment. Secondary outcomes included changes in Borg dyspnea score after the first dose of study medication, expiratory flows and lung volumes. Statistical analysis was conducted using a cross-over analysis of variance model with repeated measurements. Results: A total of 50 patients with COPD and a mean forced expiratory volume in 1 s of 54 ± 11% (mean ± SEM) predicted participated in the cross-over phase of the trial. Compared with baseline, there was a decrease in dyspnea after the first dose of medication with indacaterol/glycopyrronium [mean −1.00, 95% confidence interval (CI) −1.49 to −0.52] but not with tiotropium alone (mean −0.36, 95% CI −0.81 to 0.08). The reduction in dyspnea after the first dose was statistically significant between the two treatments (mean difference of −0.64, 95% CI −1.11 to −0.17). Despite indacaterol/glycopyrronium providing further bronchodilation and lung deflation throughout the trial, the reduction in dyspnea was not sustained at 3 weeks of treatment (mean between-treatment difference at 3 weeks of 0.09, 95% CI −0.44 to 0.61). Conclusion: In comparison with bronchodilator monotherapy, indacaterol/glycopyrronium provided greater immediate exertional dyspnea relief, although this difference was not sustained after 3 weeks of therapy despite evidence of further bronchodilation and lung deflation. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Background: The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated. Methods: Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality. Results: A total of 1194 patients (72.4±13.2 years, 59% men) were enrolled. PASP, E/e' and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0±12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD. Conclusions: The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD. [ABSTRACT FROM AUTHOR]

Objective. To improve pulmonary function, exercise capacity and quality of life of two women with Chronic Obstructive Pulmonary Disease (COPD). Material and Methods. Study of two clinical cases, both women. An intervention of 8 weeks was performed, in which the patients performed 3 weekly sessions, of which 1 was performed with supervision of the physiotherapist and 2 sessions were performed at home. The treatment sessions consisted of inspiratory muscle training with an inspiratory threshold and controlled breathing exercises with the pursed lip technique. Results. Quality of life of both women improved at the end of the study. In the woman with severe COPD, Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) increased after the intervention. The Peak Expiratory Flow (PEF) improved in both cases, but not the rest of the spirometric values. Dyspnea improved in the woman with moderate COPD but not in the case of the one with severe COPD. Finally, the distance walked in the 6MWT improved in both cases. Conclusions. The training of the inspiratory muscles together with the pursed lip technique positively influences quality of life and exercise capacity of two women with COPD. [ABSTRACT FROM AUTHOR]

Background: Area under expiratory flow–volume curve (AEX) is a useful spirometric tool in stratifying respiratory impairment. The AEX approximations based on isovolumic flows can be used with reasonable accuracy when AEX is unavailable. We assessed here pre- to post-bronchodilator (BD) variability of AEX4 as a functional assessment tool for lung disorders. Methods: The BD response was assessed in 4330 subjects by changes in FEV1, FVC, and AEX4, which were derived from FVC, peak expiratory flow, and forced expiratory flow at 25%, 50%, and 75% FVC. Newly proposed BD response categories (negative, minimal, mild, moderate and marked) have been investigated in addition to standard criteria. Results: Using standard BD criteria, 24% of subjects had a positive response. Using the new BD response categories, only 23% of subjects had a negative response; 45% minimal, 18% mild, 9% moderate, and 5% had a marked BD response. Mean percent change of the square root AEX4 was 0.3% and 14.3% in the standard BD-negative and BD-positive response groups, respectively. In the new BD response categories of negative, minimal, mild, moderate, and marked, mean percent change of square root AEX4 was − 8.2%, 2.9%, 9.2%, 15.0%, and 24.8%, respectively. Conclusions: Mean pre- to post-BD variability of AEX4 was < 6% and stratified well between newly proposed categories of BD response (negative, minimal, mild, moderate and marked). We suggest that AEX4 (AEX) could become a useful measurement for stratifying dysfunction in obstructive lung disease and invite further investigation into indications for using bronchodilator agents or disease-modifying, anti-inflammatory therapies. [ABSTRACT FROM AUTHOR]

Patients who have chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) share symptoms such as, dyspnoea, cough and wheeze. Differentiating these diseases in the ambulatory setting can be challenging especially in older adult smokers who are being treated with a variety of medications. The objective of this study was to test the value of adding a maximal inspiratory manoeuvre to basic spirometry to differentiate COPD and BA. One hundred forty-three COPD patients and 142 BA patients had measurements of maximal inspiratory and expiratory flow during routine spirometry. Parameters from these tests were used to assess diagnostic accuracy using receiver-operating characteristic (ROC) analyses followed by logistic regression. The association of two independent parameters were analyzed using linear regression analyses. Results show that forced expiratory volume in one second/forced vital capacity (FEV1/FVC%) <62.4 was the best independent predictor to diagnose COPD. The combination of FEV1/FVC% <62.4 and the ratio of peak inspiratory flow/maximal expiratory flow at 50% FVC (PIF/MEF50) >3.06 significantly predicted COPD. Post-test probability for prediction of COPD was 82.0% when patients had both parameters. When asthmatic patients with a smoking history were compared with COPD patients, FEV1/FVC% <63.4 and PIF/MEF50 >3.29 were both independent predictors of COPD. The post-test probability for COPD was 94.4% when patients had both parameters. The association between FEV1/FVC% and PIF/MEF50 was significantly different between COPD and BA. In conclusion, the addition of the maximal inspiratory effort to routine pulmonary function measurements provides a simple test to help differentiate COPD and BA. [ABSTRACT FROM AUTHOR]

Background: Standard spirometry cannot identify the predominant mechanism underlying airflow obstruction in COPD, namely emphysema or airway disease. We aimed at validating a previously developed methodology to detect emphysema by mathematical analysis of the maximal expiratory flow-volume (MEFV) curve in standard spirometry.Methods: From the COPDGene population we selected those 5930 subjects with MEFV curve and inspiratory-expiratory CT obtained on the same day. The MEFV curve descending limb was fit real-time using forced vital capacity (FVC), peak expiratory flow, and forced expiratory flows at 25, 50 and 75% of FVC to derive an emphysema severity index (ESI), expressed as a continuous positive numeric parameter ranging from 0 to 10. According to inspiratory CT percent lung attenuation area below - 950 HU we defined three emphysema severity subgroups (%LAA-950insp < 6, 6-14, ≥14). By co-registration of inspiratory-expiratory CT we quantified persistent (%pLDA) and functional (%fLDA) low-density areas as CT metrics of emphysema and airway disease, respectively.Results: ESI differentiated CT emphysema severity subgroups increasing in parallel with GOLD stages (p < .001), but with high variability within each stage. ESI had significantly higher correlations (p < .001) with emphysema than with airway disease CT metrics, explaining 67% of %pLDA variability. Conversely, standard spirometric variables (FEV1, FEV1/FVC) had significantly lower correlations than ESI with emphysema CT metrics and did not differentiate between emphysema and airways CT metrics.Conclusions: ESI adds to standard spirometry the power to discriminate whether emphysema is the predominant mechanism of airway obstruction. ESI methodology has been validated in the large multiethnic population of smokers of the COPDGene study and therefore it could be applied for clinical and research purposes in the general population of smokers, using a readily available online website. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of atorvastatin on pulmonary function, vascular endothelial function and inflammatory factors in elderly patients with chronic obstructive pulmonary disease (COPD) secondary to pulmonary hypertension (PH). 86 elderly patients with COPD secondary pH admitted to our hospital from March 2017 to September 2019 were divided into control group (n=43) and study group (n=43) according to the random number table method. The control group was given routine treatment, and the study group was treated with atorvastatin on this basis. The clinical effect, pulmonary function, vascular endothelial function and inflammatory factors levels in the two groups before treatment and after treatment were compared, and the adverse reactions of the two groups during the treatment were counted. The total clinical effective rate of the study group was 93.02%, which was significantly higher than that of the control group (76.74%) (P<0.05). forced vital capacity(VC), forced expiratory volume in the first second (FEV1 ), peak expiratory flow rate (PEF), forced expiratory volume in the first second (FEV1 /FVC) and nitric oxide(NO) of the two groups were higher than than before treatment, which in the research group were higher than the control group (all P<0.05). Endothelin-1 (ET-1), high sensitive C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were lower than before treatment, which in the research group were lower than the control group (all P<0.05). There were no adverse reactions in the two groups during the treatment. Conclusion: The therapeutic effect of atorvastatin on elderly patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease is satisfactory, which can improve the pulmonary function, vascular endothelial function and reduce the inflammatory response in elderly patients with chronic obstructive pulmonary disease secondary to pulmonary hypertension, which is suitable to popularize in clinical application. [ABSTRACT FROM AUTHOR]

Objective: Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution. Methods: We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days. Results: Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (PEmax) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2–61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34–4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50–3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18–2.63) were associated with increased risks of reinstitution, while PEmax > 30 cmH2O (HR 0.51, 95% CI 0.35–0.76) was associated with a decreased risk of reinstitution. Conclusions: The reinstitution of MV at the general ward is significant, with poor outcomes. The PEmax measured before unassisted breathing trial was significantly associated with the risk of reinstituting MV at the general wards. [ABSTRACT FROM AUTHOR]

Rationale: The role of PI (protease inhibitor) type Z heterozygotes and additional rare variant genotypes in the gene encoding alpha-1 antitrypsin, SERPINA1 (serpin peptidase inhibitor, clade A, member 1), in determining chronic obstructive pulmonary disease risk and severity is controversial.Objectives: To comprehensively evaluate the effects of rare SERPINA1 variants on lung function and emphysema phenotypes in subjects with significant tobacco smoke exposure using deep gene resequencing and alpha-1 antitrypsin concentrations.Methods: DNA samples from 1,693 non-Hispanic white individuals, 385 African Americans, and 90 Hispanics with ≥20 pack-years smoking were resequenced for the identification of rare variants (allele frequency < 0.05) in 16.9 kB of SERPINA1.Measurements and Main Results: White PI Z heterozygotes confirmed by sequencing (MZ; n = 74) had lower post-bronchodilator FEV1 (P = 0.007), FEV1/FVC (P = 0.003), and greater computed tomography-based emphysema (P = 0.02) compared with 1,411 white individuals without PI Z, S, or additional rare variants denoted as VR. PI Z-containing compound heterozygotes (ZS/ZVR; n = 7) had lower FEV1/FVC (P = 0.02) and forced expiratory flow, midexpiratory phase (P = 0.009). Nineteen white heterozygotes for five non-S/Z coding variants associated with lower alpha-1 antitrypsin had greater computed tomography-based emphysema compared with those without rare variants. In African Americans, a 5' untranslated region insertion (rs568223361) was associated with lower alpha-1 antitrypsin and functional small airway disease (P = 0.007).Conclusions: In this integrative deep sequencing study of SERPINA1 with alpha-1 antitrypsin concentrations in a heavy smoker and chronic obstructive pulmonary disease cohort, we confirmed the effects of PI Z heterozygote and compound heterozygote genotypes. We demonstrate the cumulative effects of multiple SERPINA1 variants on alpha-1 antitrypsin deficiency, lung function, and emphysema, thus significantly increasing the frequency of SERPINA1 variation associated with respiratory disease in at-risk smokers. [ABSTRACT FROM AUTHOR]

Automobile mechanics are constantly exposed to dust from the exhausts of petrol and diesel. We recruited 50 petrol two wheeler mechanics and subjected them to lung function tests. All were non-smokers without any respiratory symptoms. All mechanics were regular workers with a minimum of three years and at least an exposure of 5 hours of more per day. They were explained about the methodology and asked to attempt three times and the best of three were selected. The incidence of obstructive lung disease (FEV1/FVC<70%) was only 2%. But the incidence of reduction of effort independent MEF 25-75 in a significant manner is around 38% which coincided with reduction in PEFR values. ⁅FEV1 = Forced expiratory volume in 1 second. PEFR = peak expiratory flow rate. MEF (25-75) = mean forced expiratory flow between the 25% and 75% of the FVC.] We did not find any correlation with body mass index. We did not resort to analyses of deterioration of lung function with differing exposure years with a low sample size. We suggest that a regular PEFR with practice of established preventive measures may prevent the progress from asymptomatic illness to a symptomatic stage in such health workers. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a leading cause of disability and death of adults in the USA and worldwide. While environmental factors such as smoking and air pollution are major contributors to COPD, pediatric respiratory disease and more specifically early childhood wheezing are frequent predisposing factors. It is therefore possible that aggressive prevention and treatment of childhood respiratory illness may modify adult COPD risk. This article reviews some of the physiological factors that may explain the pediatric origins of childhood lung disease. One such factor is the "tracking" of normal lung function which occurs with growth. The maximal expiratory flow volume (MEFV) curve is an ideally suited tool to monitor tracking of airway function over the lifespan, as its relative effort independence makes it highly reliable. Study of the MEFV curve has demonstrated that individuals with similar lung volumes can have large differences in maximal flows, reflecting a disconnection between airway and lung growth ("dysanapsis"). Less than average airway size due to dysanaptic airway growth or airway remodeling may be independent risk factors for the development of COPD and the asthma/COPD overlap syndrome in adult life. There are intriguing early data suggesting that perhaps at least some of this risk is modifiable by improving asthma control with inhaled corticosteroids and minimizing asthma exacerbations. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) and Asthma patients exhibit exacerbation of symptoms in night hours and early morning. Temporal variability in airway caliber have been reported in past using peak expiratory flow rate which represents large airways caliber, while in COPD and Asthma, smaller airways are particularly affected. We studied circadian variability of airway caliber using Forced Expiratory Volume in the First Second (FEV1) and Mid Expiratory Flow rate. Methods: Male volunteers (18–26 years), having similar daily routine were recruited. Spirometry was performed at 5: 00, 8:00, 11:00, 14:00, 17:00, 20:00 and 23:00 h. Data from 104 subjects was analyzed for diurnal variability parameters viz., amplitude percent mean and standard deviation percent of mean. For circadian rhythm Cosinor curve was fitted and rhythm characteristics in terms of MESOR, Amplitude and Acrophase were determined. Results: Repeated measures ANOVA revealed significant differences in spirometric parameters measured at different time points during the day. In general, spirometric parameters follow a sinusoidal pattern and exhibit minimum values during night hours and maximum values during day time. FEV1 Cosinor rhythm was significant in 31% of subjects (Zero amplitude test). The distribution of acrophase revealed interindividual differences in chronophenotypes. Variability was minimum for FEV1% and maximum for FEF75 suggesting dynamic interplay of airway geometry and neuro-chemical influences. Conclusion: The presence of different chronophenotypes in normal subjects suggests that the nocturnal asthma may also be a different phenotype. Availability of portable spirometers and home monitoring thus may be required for ascertaining chronophenotype and tailoring chronotherapeutic interventions. [ABSTRACT FROM AUTHOR]