Search

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

A limited number of studies examine cognitive aging in Black or African American older adults. The purpose of this study was to explore the relationship between health-related fitness metrics, education, and cognition at baseline and over a 4-year follow-up in a sample of 321 Black or African American older adults in the Health and Retirement Study (HRS). Physical fitness was assessed with measures of gait speed, peak expiratory flow, grip strength, and body mass index. Global cognition was assessed with an adapted version of the Telephone Interview for Cognitive Status (TICS). Analyses of relative importance and hierarchical multiple regression were used to examine baseline cross-sectional relationships. Multiple logistic regression was used to examine prospective relationships with longitudinal cognitive status. Education was the strongest predictor of global cognition at baseline and follow-up. More years of education significantly increased the odds of maintaining cognitive status at 4-year follow-up. After accounting for education, gait speed was independently associated with baseline cognitive performance and accounted for additional variance. Grip strength, peak expiratory flow, and body mass index were not significantly associated with cognition. The results indicated that modifiable variables, including years of educational attainment and gait speed, were more strongly associated with global cognition than other modifiable variables including body mass index, grip strength, and peak expiratory flow. The lack of observed associations between other fitness variables and cognition may be attributable to the brief assessment methods implemented, which was necessitated by the large-scale, epidemiological approach of the HRS. [ABSTRACT FROM AUTHOR]

This study investigates the correlation between serum levels of YKL-40, LXRs, PPM1A, and TGF-β1 and airway remodeling and lung function in bronchial asthma patients. The study involved 80 bronchial asthma patients and 92 healthy individuals. Serum cytokines, airway remodeling, and lung function markers were compared across mild, moderate, and severe asthma cases using high-resolution CT, t-tests, ANOVA, and Pearson correlation analysis. Asthmatic patients exhibited higher levels of serum YKL-40, LXRα, LXRβ, TGF-β1, airway wall thickness (T)/outer diameter (D), and WA% of total cross-sectional area compared to controls. Conversely, their serum PPM1A, Peak Expiratory Flow (PEF), and Forced Expiratory Volume in 1 s (FEV1) were lower. Serum YKL-40 and TGF-β1 levels were positively correlated with T/D and WA%, and negatively correlated with PEF and FEV1. PPM1A levels were strongly associated with T/D, WA%, PEF, and FEV1. The severity of bronchial asthma is associated with increased serum levels of YKL-40, LXRα, LXRβ, and TGF-β1 and decreased PPM1A. The levels of YKL-40, PPM1A, and TGF-β1 have a significant correlation with airway remodeling and lung function. [ABSTRACT FROM AUTHOR]

Diagnosis of asthma can be confirmed based on variability in peak expiratory flow (PEF) or changes in forced expiratory volume in 1 s (FEV1) measured with spirometry. Our aim was to use methacholine challenge as a model of induced airway obstruction to assess how well relative changes in PEF reflect airway obstruction in comparison to relative changes in FEV1. We retrospectively studied 878 patients who completed a methacholine challenge test. To assess congruency along with differences between relative changes in FEV1 and PEF during airway obstruction, a regression analysis was performed, and a Bland & Altman plot was constructed. ROC analysis, sensitivity, specificity, positive and negative predictive values and κ‐coefficient were used to analyze how decrease in PEF predicts decrease of 10% or 15% in FEV1. The relative change in PEF was on average less than the relative change in FEV1. In the ROC analysis areas under the curve were 0.844 and 0.893 for PEF decrease to predict a 10% and 15% decrease in FEV1, respectively. The agreement between changes in PEF and FEV1 varied from fair to moderate. Airway obstruction detected by change in PEF was false in about 40% of cases when compared to change in FEV1. Change in PEF is not a very accurate measure of airway obstruction when compared to change in FEV1. Replacing peak flow metre with a handheld spirometer might improve diagnostic accuracy of home monitoring in asthma. [ABSTRACT FROM AUTHOR]

Objectives A growing body of research shows that early-life exposure to war has adverse effects on later-life health. Research has emphasized the importance of exposure timing implicating domain-specific developmental processes and associated critical/sensitive periods. This study looks at the impacts of early childhood war exposure and the repercussions for later-life physical and functional health, with a focus on time of exposure as a source of variability. Methods We use residential histories from the Survey of Health Ageing, and Retirement in Europe linked to external data on the location and timing of hostilities to examine the impact of early-life exposure to World War II on later-life physical and functional health. Results Exposure to war increases the risk of objective (grip strength, chair rise, and peak expiratory flow) and self-reported (mobility limitations and activities of daily living) measures of functional health. Effects are especially pronounced for those born during the war and for those with more prolonged exposures. There is little evidence that the impact of war is mediated by war-related hardships, socioeconomic conditions, health behaviors, or adult chronic disease. Discussion Our results suggest early-life exposure to war has a lasting impact on physical functional health. Exposure appears to largely operate via direct effects, indicative of altered initial development of physical capacity in early life. Because exposure was so pervasive among some cohorts of older individuals, understanding the health of present older European populations requires wrestling with the residual consequences of wartime exposure at the start of their lives. [ABSTRACT FROM AUTHOR]

Background: Obstructive adenoid enlargement is common in our environmentit, it manifests with nasal obstruction, persistent mouth breathing, snoring, sleep apnea, and daytime somnolence, which results in poor school performance. Fibreoptic nasopharyngoscopy has recently been recommended for the diagnosis of adenoid enlargement. It is, however, expensive and not readily available in a resource-constrained setting. Clinical symptomatology is invaluable to the physician, as it may be the only assessment tool available to a healthcare provider in a rural setting. However, some workers considered it unreliable and insufficient for the diagnosis of adenoid enlargement. Objectives: The research’s aim was to find out how reliable clinical symptoms are for diagnosing obstructive adenoid enlargement compared to fiberoptic nasopharyngoscopy. Materials and methods: This was a cross-sectional study among children with obstructive adenoid enlargement. Ethical approval and informed consent were given. A structured questionnaire was utelized to assess clinical symptomatology. A fiberoptic nasopharyngoscopic examination was carried out, and the data were analyzed. Results: This study recruited 79 (56.4%) men and 61 (43.6%) women within the age range of 2–10 years with a mean of 4.5 ± 2.5 years. The clinical symptomatology score correctly predicted 60% of endoscopic grade 1, 67.5% of endoscopic grade 2, and 78.9% of endoscopic grade 3 adenoid enlargement. There was a statistically significant association between clinical symptomatology score and fiberoptic endoscopic findings (χ² = 96.9, P-value = 0.000). Conclusion: This study found that the clinical symptomatology score is reliable in diagnosing obstructive adenoid enlargement. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of exercise-based pulmonary rehabilitation (PR) on lung function, muscle strength and functional performance in patients with post-COVID-19 symptoms. Methods: This is a quasi-experimental prospective study including 29 patients (aged 54 ± 11 years, 59% male) with post-COVID-19 persistent symptoms. Exercise training was performed during 6 weeks, twice a week, with each session consisting of aerobic, resistance, and inspiratory muscle training. Before and after exercise-based PR program, all patients were assessed for lung function, respiratory and peripheral muscle strength, and functional performance. Results: After exercise-based PR program, patients showed an improvement in lung function, including forced vital capacity, forced expiratory volume in one second, peak expiratory flow, and maximal voluntary ventilation (P < 0.05). Maximal respiratory pressures and upper limb muscle strength were increased (P < 0.05). Functional performance in timed up and go test, 1-min stair-climbing test, 1-min sit-to-stand test, and 6-min walk test were also improved (P < 0.05). Subgroup analyzes according to COVID-19 severity showed no significant difference in magnitude of response to the exercise-based PR program. Conclusion: Exercise-based PR improves lung function, respiratory and peripheral muscle strength, and functional performance in patients with persistent symptoms of COVID-19. These benefits were independent of disease severity. [ABSTRACT FROM AUTHOR]

Pediatric asthma is a common condition, and its exacerbations can be associated with significant morbidity and mortality. The role of nebulised magnesium as adjunct therapy for children with asthma exacerbations is still unclear. To compare clinical and functional outcomes for children with asthma exacerbation taking either nebulised magnesium sulfate added to standard medical therapy (SMT) versus SMT alone. PubMed, Embase, and Cochrane Library were systematically searched for randomised clinical trials (RCT) comparing the use of SMT with vs. without nebulised magnesium. The outcomes were respiratory rate, heart rate, % predicted peak expiratory flow rate (PEFR), % predicted forced expiratory volume (FEV1), peripheral O2 saturation, asthma severity scores, and need for intravenous (IV) bronchodilator use. Twelve RCTs and 2484 children were included. Mean age was 5.6 (range 2–17) years old, mean baseline % predicted FEV1 was 69.6%, and 28.66% patients were male. Children treated with magnesium had a significantly higher % predicted PEFR (mean difference [MD] 5.33%; 95% confidence interval [CI] 4.75 to 5.90%; p < 0.01). Respiratory rate was significantly lower in the magnesium group (MD -0.70 respirations per minute; 95% CI -1.24 to -0.15; p < 0.01). Need for IV bronchodilators, % predicted FEV1, heart rate, asthma severity scores, and O2 saturation were not significantly different between groups. Conclusion: In children with asthma exacerbation, treatment with nebulised magnesium and SMT was associated with a statistically significant, but small improvement in predicted PEFR and respiratory rate, as compared with SMT alone. What is Known: • Magnesium sulfate has bronchodilating properties and aids in the treatment of asthma exacerbation when administered intravenously. • There is no significant evidence of benefit of nebulised magnesium as an adjunct therapy to the standard medical treatment for children with asthma exacerbations. What is New: • Our study suggests nebulised magnesium sulfate may have a statistically significant, but small benefit in respiratory rate and peak expiratory flow rate. The addition of nebulised magnesium does not seem to increase adverse events. [ABSTRACT FROM AUTHOR]

Background: The relationship between lung function and sarcopenia remains ambiguous. The primary aim of this study was to investigate the potential association between lung function and sarcopenia in the older adults, as well as to examine the mediating role of cognitive function in this relationship. Methods: The participants were selected from a nationally representative population-based cohort in China. The peak expiratory flow (PEF) measurement was used to evaluate the lung function in older persons. The sarcopenia was diagnosed using the guidelines of the Asian Working Group for Sarcopenia (AWGS) in 2019. The Cox proportional hazard model was utilized to perform primary analyses of the relationship between PEF and sarcopenia. The mediating effect of cognitive function was evaluated using the counterfactual mediation method. Results: This cohort study included 4,011 older adults (average age, 66.6 years; 53.3% males). During a follow-up period of 3.86 years, 349 individuals were diagnosed with sarcopenia. After adjusting for potential confounders, each one-standard-deviation increase in PEF was associated with a 28% reduction in the risk of sarcopenia (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.63, 0.80). There was a significant mediation of cognition for the association between PEF and incident sarcopenia, and the proportion mediated was 12.2% (95% CI: 4.5%, 23.1%). Conclusions: Older adults with impaired lung function are more likely to develop sarcopenia. Nevertheless, cognition can explain only a small portion of this association. Thus, other potential pathways between lung function and sarcopenia must be elucidated. [ABSTRACT FROM AUTHOR]

Aspiration pneumonia is the leading cause of death in patients with Parkinson's disease. The incidence of silent aspiration is high in such patients owing to decreased pharyngeal and laryngeal sensation; thus, interventions for this condition may help prevent pneumonia. In this single-arm, open-label study, we used a cervical percutaneous interferential current stimulation device to activate pharyngeal and laryngeal sensory nerves. We evaluated its effectiveness in patients with Hoehn–Yahr stages 2–4 Parkinson's disease. The primary endpoint was the proportion of patients with a normal cough reflex after consuming 1% citric acid at the end of the intervention compared with baseline measurements. In total, 25 patients received neck percutaneous interferential current stimulation for 20 min twice weekly for 8 weeks. Afterward, the proportion of patients with a normal cough reflex after 1% citric acid consumption increased significantly (p = 0.001), whereas other indicators, such as tongue pressure, peak expiratory flow, and penetration or aspiration during videofluoroscopic examination, remained unchanged. A longer duration of illness, higher Unified Parkinson's Disease Rating Scale total scores, and higher levodopa equivalent daily doses were significantly associated with improved cough test outcomes. Hence, cervical percutaneous interferential current stimulation significantly improved cough reflexes and may improve silent aspiration. Trial Registration: Japan Registry of Clinical Trials, jRCTs062220013, first registered 09/05/2022. [ABSTRACT FROM AUTHOR]

Background: Achalasia is an esophageal motor disorder characterized by aperistalsis and the failure of the relaxation of the lower esophageal sphincter. We want to find out whether external compression or recurrent micro-aspiration of undigested food has a functional effect on the airway. Methods: The aim of this research was to analyze the influence of achalasia on the peak expiratory flow and flow–volume curve. All of the 110 patients performed spirometry. Results: The mean diameter of the esophagus was 5.4 ± 2.1 cm, and nine of the patients had mega-esophagus. Seven patients had a plateau in the inspiratory part of the flow–volume curve, which coincides with the patients who had mega-esophagus. The rest of the patients had a plateau in the expiration part of the curve. The existence of a plateau in the diameter of the esophagus of more than 5 cm was significant (p 0.003). Statistical significance between the existence of a plateau and a lowered PEF (PEF < 80) has been proven (p 0.001). Also, a statistical significance between the subtype and diameter of more than 4 cm has been proved. There was no significant improvement in the PEF values after operation. In total, 20.9% of patients had a spirometry abnormality finding. The frequency of the improvement in the spirometry values after surgery did not differ significantly by achalasia subtype. The improvement in FEV1 was statistically significant compared to the FVC values. Conclusions: Awareness of the influence of achalasia on the pulmonary parameters is important because low values of PEF with a plateau on the spirometry loop can lead to misdiagnosis. The recognition of various patterns of the spirometry loop may help in identifying airway obstruction caused by another non-pulmonary disease such as achalasia. [ABSTRACT FROM AUTHOR]

This article advocates for better nurse training and their active involvement in asthma care in Great Britain. Asthma care in Great Britain varies, with poor outcomes including preventable attacks, hospital admissions, and deaths. Nurses play a crucial role in asthma management but often lack adequate training. Emphasizing post-attack reviews and quality control, the article proposes a 7-step plan for primary care practices to improve asthma management and reduce attacks.

Purpose: Sensorimotor cough skill training (CST) has been shown to improve cough strength, as well as facilitate changes during training (i.e., motor performance) and generalization to untrained tasks (i.e., motor learning). However, there is a gap in our understanding of the effects of voluntary CST (without sensory stimuli) on motor performance and learning. Furthermore, the contribution of physiologic factors, such as lung volume, a driver of cough strength in healthy adults, and treatment-specific factors, such as biofeedback, remains unexamined. Method: Twenty individuals with Parkinson’s disease (PD) completed pre- and post-CST single voluntary, sequential voluntary, and reflex cough testing. Participants were randomized to biofeedback or no biofeedback groups. They completed one CST session involving 25 trials of voluntary coughs, with the treatment target set 25% above baseline peak flow. Participants were instructed to “cough hard” to exceed the target. In the biofeedback group, participants received direct visualization of the target line in real time. Results: Cough peak flow showed positive improvements in motor performance (β = .02; 95% credible interval [CI]: 0.01, 0.03) and learning (β = .26; 95% CI: 0.03, 0.47). Changes in lung volume from pre- to post-CST did not predict treatment response. No differences in treatment response were detected between the biofeedback groups. Conclusions: A single session of voluntary CST improved voluntary cough motor performance and learning. Although lung volume increased during CST, changes to lung volume did not predict treatment response. These findings demonstrate the potential of voluntary CST to improve motor performance and motor learning among individuals with PD and cough dysfunction. [ABSTRACT FROM AUTHOR]

Background: Comparatively little is known regarding the initial cardiorespiratory response of young racehorses to training. The objectives were to compare physiological parameters before and after introductory training and determine whether young Thoroughbreds show endoscopic signs of exercise-induced pulmonary hemorrhage (EIPH). Ten Thoroughbreds (20–23 months) underwent 12-weeks of introductory training, including weekly speed sessions. Two 600 m high-speed exercise tests (HSET) were performed following weeks 4 and 12 while wearing a validated ergospirometry facemask. Peak oxygen consumption (V̇O2pk) and ventilatory parameters (tidal volume, VT; peak inspiratory and expiratory flow, PkV̇I, PkV̇E; respiratory frequency, Rf; minute ventilation, V̇E) were measured. The ventilatory equivalent of oxygen (V̇E/V̇O2) and the aerobic and anaerobic contributions to energy production were calculated. Maximal heart rate (HRmax) and HR at maximal speed (HRVmax) were determined. Post-exercise hematocrit, plasma ammonia and blood lactate were measured. Evidence of EIPH was investigated via tracheobronchoscopy post-exercise. Results were compared (paired t-test, P < 0.05). Results: Horses were faster following training (P < 0.001) and V̇O2pk increased 28 ml/(kg total mass.min) (28 ± 16%; P < 0.001). Ventilatory (V̇E, P = 0.0015; Rf, P < 0.001; PkV̇I, P < 0.001; PkV̇E, P < 0.001) and cardiovascular parameters (HRmax, P = 0.03; HRVmax, P = 0.04) increased. The increase in V̇E was due to greater Rf, but not VT. V̇E/V̇O2 was lower (26 ± 3.6 vs 23 ± 3.7; P = 0.02), indicating improved ventilatory efficiency. Anaerobic contribution to total energy production increased from 15.6 ± 6.1% to 18.5 ± 6.3% (P = 0.02). Post-exercise hematocrit (P < 0.001), plasma ammonia (P = 0.03) and blood lactate (P = 0.001) increased following training. Horses showed no signs of EIPH. Conclusions: Young two-year-old Thoroughbreds responded well to introductory training without developing tracheobronchoscopic evidence of EIPH. [ABSTRACT FROM AUTHOR]

Background: Following years of pandemic severe acute respiratory syndrome coronavirus 2 infections labelled Covid-19, long lasting impairment summarized as post-Covid syndrome (PCS) challenges worldwide healthcare. Patients benefit from rehabilitation programs, but sex specific aspects of improvement remain little understood. The aim of the study was to assess whether women and men differ in response to outpatient pulmonary rehabilitation for PCS. Methods: 263 (54.4% female) patients partaking in outpatient pulmonary rehabilitation (OPR) due to PCS between March 2020 and July 2022 were included in a prospective observational cohort study. Outcomes were assessed at baseline and before discharge from OPR and included six-minute walking distance (6MWD), 1-second forced expiratory volume (FEV1), diffusion capacity for carbon monoxide, maximal inspiratory pressure (MIP), dyspnea (medical research council scale), and post-Covid functional status scale (PCFS). Sexspecific changes in outcomes following OPR were assessed by linear mixed model and presented as mean differences (MD) with 95% confidence intervals. Linear regression was applied to test whether 6MWD correlates with PCFS and the minimal clinically important difference (MCID) in 6MWD regarding an improvement of at least one point in PCFS was computed with logistic regression. Results: Significant improvement throughout OPR was observed for all outcomes (all p < 0.0001). Despite less severe Covid-19 infections, PCFS scores remained higher in females after OPR (p = 0.004) and only 19.4% of women compared to 38.5% of men achieved remission of functional impairment. At baseline as well as after OPR, females showed higher symptom load compared to men in dyspnea (p = 0.0027) and scored lower in FEV1 (p = 0.009) and MIP (p = 0.0006) assessment. Performance in 6MWD was comparable between men and women. An increase of 35 m in 6MWD was computed as minimal clinically important difference to improve functional impairment. Conclusion: Both subjective symptoms such as fatigue and dyspnea and objective impairment in performance in pulmonary function were more frequently observed among women. Despite improvement throughout OPR in both women and men, the sex-gap in symptom load could not be closed as women less often achieved remission from functional impairment due to PCS. Intensified treatment of these symptoms should be considered in women undergoing rehabilitation for PCS. Plain english summary: While female sex is protective during the acute infection of Covid-19, women are at increased risk of developing post-Covid syndrome (PCS) even after only mild Covid-19 infections. Severity and frequency of symptoms such as fatigue and shortness of breath are known to be higher in women compared to men. Many different rehabilitation protocols are used for PCS, but a knowledge gap regarding sex related differences in rehabilitation success remains. Both female and male patients with PCS undergoing outpatient pulmonary rehabilitation improved in the maximum walking distance achieved within 6 min and selfrated impairment in everyday living. Although women less frequently required inpatient treatment for acute Covid-19 infection, female patients with PCS showed higher impairment in everyday living, lower capacity of physical exercise and more frequent shortness of breath, fatigue and breathing muscle weakness. Only 19.4% of women compared to 38.5% of men achieved complete remission of impairment in everyday living. Our results show that women treated for PCS retain greater symptom burden and are at risk of unsuccessful rehabilitation, calling for more targeted treatment in female patients after Covid-19 infection. Highlights: Six weeks of outpatient pulmonary rehabilitation successfully improved 6-minute walking distance, pulmonary function and Covid-19 related functional limitations in daily living. Women achieved remission of functional limitations less often than men (19.4% vs. 38.5%). Women reported more severe dyspnea and showed greater impairment of maximal inspiratory pressure and forced expiratory volume compared to men. [ABSTRACT FROM AUTHOR]

Respiratory muscle weakness can impair cough function, leading to lower respiratory tract infections. These infections are an important contributor to morbidity and mortality in patients with neuromuscular disease. Mechanical insufflation-exsufflation (MIE) is used to augment cough function in these patients. Although MIE is widely used, there are few data to advise on the optimal technique. Since the introduction of MIE, the recommended pressures to be delivered have increased. There are concerns regarding the use of higher pressures and their potential to cause lung derecruitment and upper airway closure. What is the impact of high-pressure MIE (HP-MIE) on lung recruitment, respiratory drive, upper airway flow, and patient comfort, compared with low-pressure MIE (LP-MIE), in patients with respiratory muscle weakness? Clinically stable patients using domiciliary MIE with respiratory muscle weakness secondary to Duchenne muscle dystrophy, spinal cord injury, or long-term tracheostomy ventilation received LP-MIE (30/–30 cm H 2 O) and HP-MIE (60/–60 cm H 2 O) in a random sequence. Lung recruitment, neural respiratory drive, and cough peak expiratory flow were measured throughout, and patients reported comfort and breathlessness following each intervention. A total of 29 patients (10 with Duchenne muscle dystrophy, eight with spinal cord injury, and 11 with long-term tracheostomy ventilation) were included in this study. HP-MIE augmented cough peak expiratory flow compared with LP-MIE (mean cough peak expiratory flow HP-MIE 228 ± 81 L/min vs LP-MIE 179 ± 67 L/min; P =.0001) without any significant change in lung recruitment, neural respiratory drive, or patient-reported breathlessness. However, in patients with more pronounced respiratory muscle weakness, HP-MIE resulted in an increased rate of upper airway closure and patient discomfort that may have an impact on clinical efficacy. HP-MIE did not lead to lung derecruitment or breathlessness compared with LP-MIE. However, it was poorly tolerated in individuals with advanced respiratory muscle weakness. HP-MIE generates more upper airway closure than LP-MIE, which may be missed if cough peak expiratory flow is used as the sole titration target. ClinicalTrials.gov; No.: NCT02753959; URL: www.clinicaltrials.gov [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: Respiratory disorders are the most common cause of death in Parkinson's Disease (PD). Conflicting data exist on the aetiology of respiratory dysfunction in PD and few studies examine the effects of exercise-based interventions on respiratory measures. This study was conducted to better understand respiratory dysfunction in PD and to identify measures of dysfunction responsive to an integrative exercise programme. Objectives: The objectives were to compare baseline respiratory measures with matched, published population norms and to examine immediate and longer-term effects of a 12-week integrated exercise programme on these measures. Design: Twenty-three people with mild PD (median Hoehn & Yahr = 2) self-selected to participate in this exploratory prospective cohort study. Evaluation of participants occurred at three time points: at baseline; following the 12-week exercise programme and at 4-month follow-up. Outcome measures: Outcome measures included: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1/FVC ratio, Peak Expiratory Flow (PEF), Inspiratory Muscle Strength (MIP), Expiratory Muscle Strength (MEP), Peak Cough Flow (PCF), and Cardiovascular Fitness measures of estimated VO2 max and 6-Minute Walk Test (6MWT). Results: Compared to published norms, participants had impaired cough, reduced respiratory muscle strength, FEV, FVC, PEF and cardiovascular fitness. Post exercise intervention, statistically significant improvements were noted in MEP, cardiovascular fitness, and PEF. However only gains in PEF were maintained at 4-month follow-up. Conclusions: Significant respiratory dysfunction exists, even in the early stages of PD. Metrics of respiratory muscle strength, peak expiratory flow and cardiovascular fitness appear responsive to an integrative exercise programme. [ABSTRACT FROM AUTHOR]

Introduction. The diagnostic evaluation of the emergency severity index (ESI) in the triage of patients with cardiopulmonary complaints has a high sensitivity but a low specificity in the emergency department (ED). Therefore, triage scales with more accurate diagnostic evaluation are required. As a result, accuracy of the SINEH triage scale (SinTS) and the ESI was compared to compare mistriage of critically ill patients with cardiopulmonary complaints. Methods. This descriptive, analytical and cross-sectional study was conducted between December 2022 and April 2023. In this study, two nurses independently examined each patient using two triage scales. The admission unit and length of hospital stay were also recorded. The outcome was classified as high-risk admission (cardiac care unit and intensive care unit) and low-risk admission (internal unit or discharge from the ED). Undertriage and overtiage were defined as high-risk admission with triage level 3 and 4 and low-risk admission with triage level 1 or 2, respectively. A panel of experts evaluated content validity of SinTS and kappa designating agreement on relevance reported. The inter-rater reliability of two scales was also reported. Results. Finally, the study included 145 patients. The average age of the patients studied was 61.35 years. SinTS has a total mistriage of 29.63%, with 4.13% being undertriage and 25.5% being overtriage. In ESI, the total mistriage is 66.8%, with 1.3% being undertriage and 65.5% being overtriage. The undertriage of the two scales did not differ significantly by admission unit (p = 0.26), but the overtriage of the two methods did (p = 0.001). The sensitivity, specificity, and accuracy of SinTS were 86.3%, 63.37%, and 72.27%, respectively, while those of ESI were 95.4%, 5.94%, and 32.79%, respectively. Conclusion. SINEH triage scale has achieved the optimal accuracy in recognizing the acuity of the patients with chest pain and dyspnea by using SpO2, pressure of end-tidal carbon dioxide, troponin I, and peak expiratory flow. When triaging patients with chest pain and dyspnea, SinTS may exhibit a higher level of accuracy compared to ESI. More research is needed to improve accuracy of triage scales in patient with cardiopulmonary complaints. [ABSTRACT FROM AUTHOR]

Background: Adequate cough or exsufflation flow can indicate an option for safe tracheostomy decannulation to noninvasive management. Cough peak flow via the upper airways with the tube capped is an outcome predictor for decannulation readiness in patients with neuromuscular impairment. However, this threshold value is typically measured with tracheotomy tube removed, which is not acceptable culturally in China. The aim of this study was to assess the feasibility and safety of using cough flow measured with tracheostomy tube and speaking valve (CFSV) > 100 L/min as a cutoff value for decannulation. Study design: Prospective observational study conducted between January 2019 and September 2022 in a tertiary rehabilitation hospital. Methods: Patients with prolonged tracheostomy tube placement were referred for screening. Each patient was assessed using a standardized tracheostomy decannulation protocol, in which CFSV greater than 100 L/min indicated that the patients' cough ability was sufficient for decannulation. Patients whose CFSV matched the threshold value and other protocol criteria were decannulated, and the reintubation and mortality rates were followed-up for 6 months. Results: A total of 218 patients were screened and 193 patients were included. A total of 105 patients underwent decannulation, 103 patients were decannulated successfully, and 2 patients decannulated failure, required reinsertion of the tracheostomy tube within 48 h (failure rate 1.9%). Three patients required reinsertion or translaryngeal intubation within 6 months. Conclusions: CFSV greater than 100 L/min could be a reliable threshold value for successful decannulation in patients with various primary diseases with a tracheostomy tube. Trial registration: This observational study was not registered online. [ABSTRACT FROM AUTHOR]

Previous studies have evaluated the effectiveness of air filters in mitigating the symptoms of allergic rhinitis (AR). However, these studies have yielded inconsistent results. This systematic review and meta-analysis was conducted to assess the effectiveness of air filters for patients with AR. For this, we comprehensively searched the PubMed, Embase, and Cochrane Library databases to identify relevant articles. The results are presented in terms of standardized mean difference (SMD) and 95% confidence intervals (CI) values with the fixed-effects model (FEM) and random-effects model (REM). Eight randomized controlled trials were included in our meta-analysis. Of these, three had a parallel design and five had a crossover design. Regarding clinical outcomes, pooled analyses performed using patients' nighttime and daytime symptom scores revealed SMD values of −0.21 (95% CI: −0.35 to −0.07 (FEM) and −0.35 to −0.08 (REM)) and −0.16 (95% CI: −0.30 to −0.03 (both FEM and REM)), respectively. However, no significant changes were noted in the SMD values when assessing medication use, quality of life (QoL), or peak expiratory flow rate (PEFR). In conclusion, air filters may help alleviate symptoms associated with AR; however, their effects on medication use, QoL, and PEFR appear to be limited. This systemic review and meta-analysis is registered with CRD42022380560. [ABSTRACT FROM AUTHOR]

Background: Pulmonary function testing by barometric whole-body plethysmography (BWBP) is a long-established and well-accepted, non-invasive investigative procedure in cats. Hypothesis/Objectives: To evaluate, if different acclimatization times influence the measurement parameters of BWBP in healthy adult cats. Animals: 48 healthy adult cats. Methods: In the prospective observational study, healthy cats were placed in a measuring chamber and BWBP was performed over 30 minutes. Parameters obtained during the three measurement units of 10 minutes each (T1, T2 and T3) were compared. Results: All measurement parameters except for tidal volume per body weight changed significantly (p<0.05) over the three time periods. From T1-T2, the parameters minute volume per body weight (p<0.001), peak inspiratory flow per body weight (p<0.001), peak expiratory flow per body weight (p = 0.002), pause (p = 0.03), enhanced pause (p = 0.03) and quotient of peak expiratory flow divided by expiratory flow at end expiratory volume plus 50% tidal volume (p = 0.03) changed significantly. From the time interval T2-T3, only respiratory rate (p = 0.02), inspiratory time (p = 0.02), expiratory time (p = 0.04), and relaxation time (p = 0.01) changed significantly. All measurement parameters except for tidal volume per body weight changed significantly (p<0.05) between T1 and T3. Age had a significant influence on all parameters except for peak expiratory flow per body weight and peak inspiratory flow per body weight. The parameters were not influenced by sex. Conclusion and clinical importance: All measurement parameters except tidal volume per body weight were significantly affected by acclimatization time. Controlling for age and sex, there was still a significant influence of acclimatization time on all parameters except for tidal volume per body weight. Standardization of the acclimatization time for future studies would be appropriate in order to maintain comparability. [ABSTRACT FROM AUTHOR]

Background: Lung function throughout adulthood predicts morbidity and mortality even among adults without chronic respiratory disease. Diet quality may represent a modifiable risk factor for lung function impairment later in life. We investigated associations between nutritionally-rich plant-centered diet and lung function across early and middle adulthood from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Methods: Diet was assessed at baseline and years 7 and 20 of follow-up using the validated CARDIA diet history questionnaire. Plant-centered diet quality was scored using the validated A Priori Diet Quality Score (APDQS), which weights food groups to measure adherence to a nutritionally-rich plant-centered diet for 20 beneficially rated foods and 13 adversely rated foods. Scores were cumulatively averaged over follow-up and categorized into quintiles. The primary outcome was lung function decline, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC), measured at years 0, 2, 5, 10, 20, and 30. We estimated the association of APDQS with annual pulmonary function changes and cross-sectional differences in a repeated measures regression model, adjusting for clinically relevant covariates. Results: The study included 3,787 Black and White men and women aged 18–30 in 1985–86 and followed for 30 years. In multivariable repeated measures regression models, individuals in the lowest APDQS quintile (poorest diet) had declines in FEV1 that were 1.6 ml/year greater than individuals in the highest quintile (35.0 vs. 33.4 ml/year, ß ± SE per 1 SD change APDQS 0.94 ± 0.36, p = 0.009). Additionally, declines in FVC were 2.4 ml/year greater in the lowest APDQS quintile than those in the highest quintile (37.0 vs 34.6 ml/year, ß ± SE per 1 SD change APDQS 1.71 ± 0.46, p < 0.001). The association was not different between never and ever smokers (pint = 0.07 for FVC and 0.32 for FEV1). In sensitivity analyses where current asthma diagnosis and cardiorespiratory fitness were further adjusted, results remained similar. Cross-sectional analysis at each exam year also showed significant differences in lung function according to diet after covariate adjustment. Conclusions: In this 30-year longitudinal cohort study, long-term adherence to a nutritionally-rich plant-centered diet was associated with cross-sectional differences in lung function as well as slower decline in lung function, highlighting diet quality as a potential treatable trait supporting long-term lung health. [ABSTRACT FROM AUTHOR]

Background: At present, the need for vitamin C supplementation for pregnant smokers has not been fully studied. This study is aimed at investigating whether vitamin C supplementation for pregnant smoking women can improve the pulmonary function of their offspring. Methods: Four databases were searched from inception to April 1, 2023 for studies on the effect of vitamin C supplementation to pregnant smokers on the pulmonary function of their offspring. Meanwhile, the reference lists of relevant studies were manually searched. The risk of bias in the included studies was assessed using the Cochrane Collaboration tool, and the data was analyzed using STATA/SE 17.0. Results: Four randomized controlled trials (RCTs), all of high quality, were enrolled in this meta-analysis, including 787 pregnant women. The offspring of pregnant smokers who received vitamin C supplementation exhibited improved Forced Expiratory Flow between 25 and 75% (FEF25-75), FEF50, FEF75, and Forced Vital Capacity (FVC) compared to those who did not receive vitamin C supplementation. However, there was no statistically significant difference in Forced Expiratory Volume at 0.5 s (FEV0.5) and the ratio of FEV0.5 to FVC between the offspring of pregnant smokers who received vitamin C and the control group. Conclusion: Vitamin C supplementation for smoking pregnant women may enhance the pulmonary function of their offspring, particularly in FEF25-75, FEF50, FEF75, and FVC. Nevertheless, there are no significant differences in FEV0.5 and the FEV0.5/FVC ratio. These findings suggest that vitamin C supplementation has potential benefits for specific pulmonary function. Further studies are needed to comprehensively assess the effects of vitamin C on pulmonary function in the context of maternal smoking during pregnancy. [ABSTRACT FROM AUTHOR]

The dive response, or the 'master switch of life', is probably the most studied physiological trait in marine mammals and is thought to conserve the available O2 for the heart and brain. Although generally thought to be an autonomic reflex, several studies indicate that the cardiovascular changes during diving are anticipatory and can be conditioned. The respiratory adaptations, where the aquatic breathing pattern resembles intermittent breathing in land mammals, with expiratory flow exceeding 160 litres s−1 has been measured in cetaceans, and where exposure to extreme pressures results in alveolar collapse (atelectasis) and recruitment upon ascent. Cardiorespiratory coupling, where breathing results in changes in heart rate, has been proposed to improve gas exchange. Cardiorespiratory coupling has also been reported in marine mammals, and in the bottlenose dolphin, where it alters both heart rate and stroke volume. When accounting for this respiratory dependence on cardiac function, several studies have reported an absence of a diving‐related bradycardia except during dives that exceed the duration that is fuelled by aerobic metabolism. This review summarizes what is known about the respiratory physiology in marine mammals, with a special focus on cetaceans. The cardiorespiratory coupling is reviewed, and the selective gas exchange hypothesis is summarized, which provides a testable mechanism for how breath‐hold diving vertebrates may actively prevent uptake of N2 during routine dives, and how stress results in failure of this mechanism, which results in diving‐related gas emboli. What is the topic of this review?Current knowledge of the respiratory physiology in small cetaceans and its influence on cardiac function.What advances does it highlight?The selective gas exchange hypothesis is presented, which is a framework for how marine mammals manage gases during diving and is based upon the current understanding of cardiorespiratory coupling in breath‐hold diving vertebrates. [ABSTRACT FROM AUTHOR]

Background and Objective: Yogic breathing helps in reduction of stress and strain in the body. Right and left nostril breathings (RNB and LNB, respectively) have different effects on cardiorespiratory parameters. The study was performed to examine the effect of RNB exercise on cardiorespiratory parameters and reaction time in young, healthy human volunteers. Materials and Methods: In this prospective, interventional study, 110 young healthy volunteers underwent systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), respiratory rate (RR), vital capacity (VC), peak expiratory flow rate (PEFR), and reaction time (RT) examination before and after 2 weeks of performing 45 min of RNB exercise daily. Results: There was notable increment in SBP (113.39 ± 17.72 vs. 117.74 ± 10.83 mmHg, P = 0.002) and DBP (67.64 ± 10.32 vs. 71.27 ± 8.68 mmHg, P = 0.002). PR increased nonsignificantly (86.44 ± 12.65/min vs. 87.32 ± 13.43/min, P = 0.476). Significant decrease in RR (14.40 ± 2.48/min vs. 12.31 ± 2.23/min, P < 0.0001) was observed. VC (3.57 ± 0.57 vs. 3.82 ± 0.55 L/min, P < 0.0001) and PEFR (441.36 ± 50.22 vs. 468.91 ± 53.66 L/min, P < 0.0001) also increased significantly. Substantial reduction in auditory reaction time (ART) (165.58 ± 32.18 vs. 147.42 ± 23.39 ms, P < 0.0001) and visual reaction time (VRT) (191.04 ± 37.94 vs. 165.86 ± 28.74 ms, P < 0.0001) was seen. After engaging in cardiorespiratory exercise, the maximal heart rate (MHR) remained unchanged (P = 0.929). Conclusion: RNB results in increase in blood pressure, heart rate, VC, and PEFR and decrease in ART and VRT. Further studies in patients with cardiorespiratory diseases are necessary to understand its clinical utility. [ABSTRACT FROM AUTHOR]

This research aimed to explore the impact of plank exercise training (PET) on respiratory function, body composition, abdominis performance, and autonomic nervous system (ANS). Sixty‐one young adults participated and were divided into a control group (CG, n = 31) and an exercise group (EG, n = 30), wherein PET was administered 3 days per week for 12 weeks. After the experiment, the body composition of the CG deteriorated, whereas that of the EG improved (p < 0.001). The EG exhibited a reduction of ∼34% in the mean maximum displacement and a rise of ∼20% in the mean contraction time of the abdominis. The sit‐up in the EG demonstrated a significant increase of ∼55%. In the EG, there was a substantial increase in peak expiratory force by ∼24% and forced expiratory volume in 1 s by ∼14%, accompanied by a reduction in resting respiratory rate by ∼ −9%. When compared to the CG, these alterations were significant between the two groups (p = 0.001). In the EG, there was a significant decrease in resting heart rate by ∼2%, accompanied by a decrease in sympathetic nervous activity by ∼ −5% and by an increase in parasympathetic nervous activity by ∼5%. When compared to the CG, these alterations were significant between the two groups (p = 0.001). The findings of this study revealed that implementing PET in young adults, while controlling for dietary intake and physical activity, resulted in noteworthy changes in respiratory capacity. These changes were coupled with improvements in body composition, abdominal functions, and the ANS. Highlights: The plank exercise training (PET) resulted in a decrease in body weight, fat mass, body mass index, and waist‐to‐hip ratio, along with an increase in muscle mass over a 12‐week period.The PET led to a decrease in the maximum displacement and an increase in the contraction time, along with an improvement in abdominal muscle endurance.The peak expiratory flow and forced expiratory volume in 1 s exhibited increases as a result of the PET, accompanied by a notable decrease in resting respiratory rate.The PET led to a reduction in resting heart rate, influenced by a decrease in sympathetic nervous activity and an increase in parasympathetic nervous activity. [ABSTRACT FROM AUTHOR]

Aim: To find the effectiveness of abdominal muscle exercises on peak expiratory flow rate (PEFR) in college going obese females. Material and Methods:A total of 20 college going obese females were selected based on inclusion and exclusion criteria who did not receive any sort of exercise and went about their daily routines as usual. Abdominal exercise protocol will include crunches, hiprolls, double knee to chest movement, planks, flutter kicks. PEFR was measured using Peak flow meter. The maximum of the 3 similar trials were taken, and the mean of these trials were calculated, which gave us the final pre PEFR reading of each participant. After recording the pre peak expiratory flow rate all participant were given exercises for a period of 3 months, 4 days a week, 3 sets of each exercise with 10 repetitions per set which gives us post PEFR reading. Result: Statistical Analysis was done using paired group 't' test to compare pre and post peak expiratory flow rate, which is statically significant with (p <0.05). The pre intervention peak expiratory flow rate values were (226.50±40.04), whereas post intervention the value was (292 ± 38.61). Conclusion: When the effectiveness of Abdominal exercise on PEFR was checked using Peak Flow Meter, after 3 months of training, they showed significant improvement in PEFR reading. It shows that the Abdominal exercises are significantly effective in increasing respiratory muscle strength. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a chronic disease with microvascular and macrovascular complications. The pulmonary complications of diabetes mellitus have been poorly characterized. Pulmonary function tests (PFTs) are noninvasive tests that show how well the lungs are working. Objectives: The aim of this study is to compare pulmonary PFTs in type 2 diabetic and non diabetic patients undergoing elective major abdominal surgeries under general anesthesia. Materials & Methods: A total of 100 patients (50 diabetic & 50 non diabetic), undergoing elective major abdominal surgeries under general anesthesia were enrolled for the study. Pulmonary function tests were performed 60 minutes before and after the end of surgery. The PFTs recorded were FEV1, FVC, FEV1/FVC, FEF 25%, and Peak expiratory flow rate (PEFR). Results: Majority of the subjects (34% diabetic and 42% non diabetic) was 51-55 years age group, the mean age among diabetics was 52.9 ± 4.8 and non diabetic group were 51.3 ± 4.8 years. The male were slightly higher than female in both the groups. The mean age, gender and BMI of both the groups was not statistically different and both the groups were comparable at baseline. The pulmonary function test (FEV1, FVC, FEF 25%, and PEFR) were significantly reduced in diabetic subjects compared with non diabetic subject, except FEV1/FVC. Conclusion: The mean scores of FVC, FEV1, PEFR, and FEF 25% were significantly reduced among type 2 diabetic patients as compared to non-diabetic subjects, except FEV1/FVC ratio [ABSTRACT FROM AUTHOR]

Background: Largely unexplored, we investigated if lower lung function, impaired skin barrier function by transepidermal water loss (TEWL), eczema, and filaggrin (FLG) mutations in infancy were associated with asthma in early childhood. Methods: From the factorially designed randomized controlled intervention study PreventADALL, we evaluated 1337/2394 children from all randomization groups with information on asthma at age 3 years, and at age 3 months either lung function, TEWL, eczema, and/or FLG mutations. Lower lung function was defined as the time to peak tidal expiratory flow to expiratory time (tPTEF/tE) <0.25, and skin barrier impairment as a high TEWL >9.50 g/m2/h. Eczema was clinically observed, and DNA genotyped for FLG mutations. Asthma was defined as asthma‐like symptoms (≥3 episodes of bronchial obstruction) between age 2–3 years as well as a history of doctor‐diagnosed asthma and/or asthma medication use. Associations were analyzed in logistic regression models, presented with adjusted ORs (aOR) and 95% confidence intervals (CI). Results: Lower lung function and skin barrier impairment were associated with asthma in general; aOR (95% CI) 5.4 (2.1, 13.7) and 1.6 (1.1, 2.5), while eczema and FLG mutations were associated with asthma in children with atopic dermatitis or allergic sensitization only. Stratifying for sex, the risk of asthma was only increased in boys with lower lung function; aOR (95% CI) 7.7 (2.5, 23.6), and in girls with FLG mutations; aOR (95% CI) 3.5 (1.5, 8.2). Conclusion: Lower lung function and impaired skin barrier function in infancy may increase the risk of asthma at age 3 years. [ABSTRACT FROM AUTHOR]

Decrease in forced expiratory volume in one second (FEV1) of 10% or 15% in exercise challenge test is considered diagnostic for asthma, but a decrease of 15% in peak expiratory flow (PEF) is recommended as an alternative. Our aim was to assess the accuracy of different PEF cut‐off points in comparison to FEV1. We retrospectively studied 326 free running exercise challenge tests with spirometry in children 6−16 years old. FEV1 and PEF were measured before and 2, 5, 10 and 15 min after exercise. Receiver operating characteristics (ROC) analysis, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and ϰ‐coefficient were used to analyse how decrease in PEF predicts decrease of 10% or 15% in FEV1. In the ROC analysis, areas under the curve were 0.851 (p < 0.001) and 0.921 (p < 0.001) for PEF decrease to predict a 10% and 15% decrease in FEV1, respectively. The agreement between changes in PEF and FEV1 varied from slight to substantial (ϰ values of 0.199–0.680) depending on the cut‐points. Lower cut‐off for decrease in PEF had higher sensitivity and NPV, while higher cut‐off values had better specificity and PPV. Decrease of 20% and 25% in PEF seemed to be the best cut‐offs for detecting 10% and 15% decrease in FEV1, respectively. Still, a fifth of the positive findings based on PEF were false. Change in PEF is not a precise predictor of change in FEV1 in exercise test. The currently recommended cut‐point of 15% decrease in PEF seems to be too low and leads to high false positive rate. [ABSTRACT FROM AUTHOR]

Background: Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. Objectives: We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. Methods: Swallowing difficulty was described by 11 participants with APD. Penetration‐Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced‐reflex cough measures of flow, volume, and timing were analyzed. Results: While most participants did not have post‐swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = −0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). Conclusions: As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence is appearing that ozone has adverse effects on health. However, the association between long-term ozone exposure and lung function is still inconclusive. Objectives: To investigate the associations between long-term exposure to ozone and lung function in Chinese young adults. Methods: We conducted a prospective cohort study among 1594 college students with a mean age of 19.2 years at baseline in Shandong, China from September 2020 to September 2021. Lung function indicators were measured in September 2020 and September 2021, including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow at the 25th, 50th, and 75th percentile of the FVC (FEF25, FEF50, and FEF75) and mean flow rate between 25% and 75% of the FVC (FEF25-75) were measured. Daily 10 km×10 km ozone concentrations come from a well-validated data-fusion approach. The time-weighted average concentrations in 12 months before the lung function test were defined as the long-term ozone exposure. The associations between long-term ozone exposure and lung function indicators in Chinese young adults were investigated using a linear mixed effects model, followed by stratified analyses regarding sex, BMI and history of respiratory diseases. Results: Each interquartile range (IQR) (8.9 µg/m3) increase in long-term ozone exposure were associated with a -204.3 (95% confidence interval (CI): -361.6, -47.0) ml/s, -146.3 (95% CI: -264.1, -28.4) ml/s, and − 132.8 (95% CI: -239.2, -26.4) ml/s change in FEF25, FEF50, and FEF25-75, respectively. Stronger adverse associations were found in female participants or those with BMI ≥ 24 kg/m2 and history of respiratory diseases. Conclusion: Long-term exposure to ambient ozone is associated with impaired small airway indicators in Chinese young adults. Females, participants with BMI ≥ 24 kg/m2 and a history of respiratory disease have stronger associations. [ABSTRACT FROM AUTHOR]

Background: We previously reported in the "Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function" randomized clinical trial (RCT) that vitamin C (500 mg/day) supplementation to pregnant smokers is associated with improved respiratory outcomes that persist through 5 years of age. The objective of this study was to assess whether buccal cell DNA methylation (DNAm), as a surrogate for airway epithelium, is associated with vitamin C supplementation, improved lung function, and decreased occurrence of wheeze. Methods: We conducted epigenome-wide association studies (EWAS) using Infinium MethylationEPIC arrays and buccal DNAm from 158 subjects (80 placebo; 78 vitamin C) with pulmonary function testing (PFT) performed at the 5-year visit. EWAS were performed on (1) vitamin C treatment, (2) forced expiratory flow between 25 and 75% of expired volume (FEF25–75), and (3) offspring wheeze. Models were adjusted for sex, race, study site, gestational age at randomization (≤ OR > 18 weeks), proportion of epithelial cells, and latent covariates in addition to child length at PFT in EWAS for FEF25–75. We considered FDR p < 0.05 as genome-wide significant and nominal p < 0.001 as candidates for downstream analyses. Buccal DNAm measured in a subset of subjects at birth and near 1 year of age was used to determine whether DNAm signatures originated in utero, or emerged with age. Results: Vitamin C treatment was associated with 457 FDR significant (q < 0.05) differentially methylated CpGs (DMCs; 236 hypermethylated; 221 hypomethylated) and 53 differentially methylated regions (DMRs; 26 hyper; 27 hypo) at 5 years of age. FEF25–75 was associated with one FDR significant DMC (cg05814800), 1,468 candidate DMCs (p < 0.001), and 44 DMRs. Current wheeze was associated with 0 FDR-DMCs, 782 candidate DMCs, and 19 DMRs (p < 0.001). In 365/457 vitamin C FDR significant DMCs at 5 years of age, there was no significant interaction between time and treatment. Conclusions: Vitamin C supplementation to pregnant smokers is associated with buccal DNA methylation in offspring at 5 years of age, and most methylation signatures appear to be persistent from the prenatal period. Buccal methylation at 5 years was also associated with current lung function and occurrence of wheeze, and these functionally associated loci are enriched for vitamin C associated loci. Clinical trial registration ClinicalTrials.gov, NCT01723696 and NCT03203603. [ABSTRACT FROM AUTHOR]

Background: Patients with relapsing polychondritis (RP) sometimes experience upper airway collapse or lower airway stenosis, and bronchoscopy may provide a valuable typical image to confirm the diagnosis. This study aimed to identify potential risk factors associated with severe adverse effects during bronchoscopy. Methods: We performed a retrospective cohort study of 82 consecutive patients with RP hospitalized at Peking Union Medical College Hospital between January 1, 2012 and December 31, 2022. Clinical features and disease patterns were compared among patients with RP undergoing bronchoscopy with or without severe adverse effects. Binary logistic regression analysis was performed to identify the associated risk factors. Results: For patients with RP undergoing bronchoscopy with severe adverse effects, the forced vital capacity (FVC), forced vital capacity percent predicted values (FVC%), and peak expiratory flow were significantly lower (P = 0.001, P = 0.001, and P = 0.021, respectively) than those in the non-severe adverse effect subgroup. Binary logistic regression analysis revealed that low FVC% (odds ratio, 0.930; 95% confidence interval, 0.880–0.982; P = 0.009) was an independent risk factor for severe adverse events in patients undergoing bronchoscopy. Conclusions: Low FVC or FVC% suggests a high risk of severe adverse effects in patients with RP undergoing bronchoscopy. Patients with such risk factors should be carefully evaluated before bronchoscopy and adequately prepared for emergency tracheal intubation or tracheostomy. [ABSTRACT FROM AUTHOR]

Asthma is a common condition affecting millions of children globally. The main goal of this study is to assess factors related to asthma management, particularly atopy level and the impact of genetic variants of the vitamin D receptor (VDR) gene. Asthmatic children were enrolled in an outpatient respiratory clinic. Information on patients' medication adherence, medical and medication factors, and sociodemographic were gathered. Spirometry FEV1% and FVC% measurements, and the asthma control test were used to evaluate the severity of asthma, and genotyping of the VDR gene and radioallergosorbent test (RAST) were conducted. Regression analyses were conducted to evaluate variables associated with asthma control and spirometry measures. A total of 313 participants (67.4% males) were recruited in the current study. The mean age was 9.37 (±3.45) years. The mean score for adherence was 4.26 (±2.52), and only 46% of the participants had controlled asthma. Forward conditional stepwise binary regression showed that low and moderate Inhaled corticosteroids (ICS) dose (OR= 0.42 (95% CI 0.20–0.90), p = 0.026; OR = 0.371 (95% CI 0.2–0.72), p = 0.003, respectively) decreased the odds of being in the controlled asthma group, while higher inhaler score (OR = 2.75 (95% CI 2.17–3.49, p < 0.001)) increased the odds of being in the controlled asthma group. However, results found no association between VDR genotype and asthma control, spirometry values or hospitalization due to asthma. The results indicated that many of the asthma patients had poorly controlled asthma. Factors that were associated with poor asthma control included poor inhaler technique. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus Disease-2019 (COVID-19) impacts multiple organs like the kidneys, heart, and liver, but primarily affects the respiratory system, leading to symptoms such as cough with sputum production, fever, and in severe cases, respiratory failure. Research on Severe Acute Respiratory Syndrome (SARS)-Coronavirus-2 (CoV-2) has revealed impairments in lung function during the early recovery phase following COVID-19 infection. The aim is to understand the virus's impact and identify any obstructive, restrictive, or mixed pulmonary alterations in medical professionals six weeks after recovery. Aim: To assess Pulmonary Function Tests (PFTs) six weeks after COVID-19 recovery in health science students at a medical college in North Karnataka. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Physiology at Jawaharlal Nehru Medical College in North Karnataka, India, from January 2021 to December 2021. A total of 155 COVID-19-recovered health science students were included, and their anthropometry, physiological parameters, and pulmonary parameters were recorded. The "Spirometer Helios 401" was used to estimate an individual's PFT. Data were analysed using independent sample t-tests, with a p-value <0.05 considered statistically significant. Results: The mean age of the participants was 21.73±3.04 years. The Mean±Standard Devaiation (SD) of Forced Vital Capacity (FVC) (L), Forced Expiratory Volume (FEV) at the end of one second (L), Peak Expiratory Flow Rate (L), forced mid expiratory flow 25-75 (L/s), forced mid expiratory flow 25% (L/s), forced mid expiratory flow 50% (L/s), forced mid expiratory flow 75% (L/s), Inspiratory Reserve Volume (IRV) (L), Expiratory Reserve Volume (ERV) (L), Inspiratory Capacity (IC) (L), and Maximum Voluntary Ventilation (MVV) (L) ± SD of post-COVID-19 subjects were less compared to their corresponding predicted values. The Mean±SD of FEV1/FVC (%) and tidal volume (L) of COVID-19 recovered subjects were higher than their corresponding expected value. The FEV, Forced Expiratory Flow (FEF), and FEV1 values were significantly less in females compared to males. Conclusion: Coronavirus Disease-19-recovered subjects showed altered respiratory functions even after six weeks, with the majority having restrictive disease, followed by a mixed pattern and obstructive diseases, while the remaining showed no changes in lung function. Altered pulmonary functions in COVID-19 patients may be due to alveolar destruction or pulmonary interstitial fibrosis. [ABSTRACT FROM AUTHOR]

Introduction: We tested the hypothesis that breathing heliox, to attenuate the mechanical constraints accompanying the decline in pulmonary function with aging, improves exercise performance. Methods: Fourteen endurance-trained older men (67.9 ± 5.9 year, V ˙ O2max: 50.8 ± 5.8 ml/kg/min; 151% predicted) completed two cycling 5-km time trials while breathing room air (i.e., 21% O2–79% N2) or heliox (i.e., 21% O2–79% He). Maximal flow–volume curves (MFVC) were determined pre-exercise to characterize expiratory flow limitation (EFL, % tidal volume intersecting the MFVC). Respiratory muscle force development was indirectly determined as the product of the time integral of inspiratory and expiratory mouth pressure (∫Pmouth) and breathing frequency. Maximal inspiratory and expiratory pressure maneuvers were performed pre-exercise and post-exercise to estimate respiratory muscle fatigue. Results: Exercise performance time improved (527.6 ± 38 vs. 531.3 ± 36.9 s; P = 0.017), and respiratory muscle force development decreased during inspiration (− 22.8 ± 11.6%, P < 0.001) and expiration (− 10.8 ± 11.4%, P = 0.003) with heliox compared with room air. EFL tended to be lower with heliox (22 ± 23 vs. 30 ± 23% tidal volume; P = 0.054). Minute ventilation normalized to CO2 production ( V ˙ E/ V ˙ CO2) increased with heliox (28.6 ± 2.7 vs. 25.1 ± 1.8; P < 0.001). A reduction in MIP and MEP was observed post-exercise vs. pre-exercise but was not different between conditions. Conclusions: Breathing heliox has a limited effect on performance during a 5-km time trial in master athletes despite a reduction in respiratory muscle force development. [ABSTRACT FROM AUTHOR]

Background: A decline in forced expiratory volume (FEV1) is a hallmark of respiratory diseases that are an important cause of morbidity among the elderly. While some data exist on biomarkers that are related to FEV1, we sought to do a systematic analysis of causal relations of biomarkers with FEV1. Methods: Data from the population-based AGES-Reykjavik study were used. Serum proteomic measurements were done using 4782 DNA aptamers (SOMAmers). Data from 1479 participants with spirometric data were used to assess the association of SOMAmer measurements with FEV1 using linear regression. Bi-directional two-sample Mendelian randomisation (MR) analyses were done to assess causal relations of observationally associated SOMAmers with FEV1, using genotype and SOMAmer data from 5368 AGES-Reykjavik participants and genetic associations with FEV1 from a publicly available GWAS (n = 400,102). Results: In observational analyses, 530 SOMAmers were associated with FEV1 after multiple testing adjustment (FDR < 0.05). The most significant were Retinoic Acid Receptor Responder 2 (RARRES2), R-Spondin 4 (RSPO4) and Alkaline Phosphatase, Placental Like 2 (ALPPL2). Of the 257 SOMAmers with genetic instruments available, eight were associated with FEV1 in MR analyses. Three were directionally consistent with the observational estimate, Thrombospondin 2 (THBS2), Endoplasmic Reticulum Oxidoreductase 1 Beta (ERO1B) and Apolipoprotein M (APOM). THBS2 was further supported by a colocalization analysis. Analyses in the reverse direction, testing whether changes in SOMAmer levels were caused by changes in FEV1, were performed but no significant associations were found after multiple testing adjustments. Conclusions: In summary, this large scale proteogenomic analyses of FEV1 reveals circulating protein markers of FEV1, as well as several proteins with potential causality to lung function. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between body mass index (BMI), household fuel type, and peak expiratory flow (PEF) in middle-aged and elderly Chinese people aged 45 and above. Methods Based on the data of China Health and Retirement Longitudinal Study in 2013 and 2015, the BMI and PEF of the participants were measured and evaluated. Ac- cording to the self-reported household fuel types, cooking and heating fuels were divided into solid fuel and clean fuel. Lin- ear mixed model was used to analyze the relationships of BMI and household solid fuels using with PEF changes, and residential location was included as a random term. Subgroup analysis and interaction analysis were conducted by gender, urban-rural setting, smoking status, and fuels types. Results There was a significant correlation between the reduction of BMI and PEF (B=-1.33, 95%CI: -2.31 to -0.33). Compared with the group using clean fuel, the PEF of the group using solid fuel decreased faster than that of the group using clean fuel (cooking: B=-10.16, 95%CI: -16.78 to 3.55; heating: B=-10.13, 95% CI: -18.70 to -1.46). Solid fuels use for heating increased the magnitude of BMI-related PEF decline (interaction P= 0.030). Conclusion High BMI and solid fuel use are the risk factors for the reduction of PEF in the middle-aged and elderly in China, and there is an interaction between BMI and solid fuel for heating on the reduction of PEF. [ABSTRACT FROM AUTHOR]

Objectives: To quantitatively assess vascularity changes of acute septic hips in infants using Doppler ultrasonography. To compare these findings with asymptomatic hips, and establish a correlation for accurate diagnosis between these findings. Methods: In this prospective case–control study, we included all children under 1 year of age with a diagnosis of acute septic arthritis of the hip in the case group. For the control group, we enrolled apparently healthy, full-term neonates and infants not affected with any hip pathology. Doppler ultrasound of the medial femoral circumflex artery of the hip joint was done using a single Phillips HDI 5000 sonography machine. Following parameters were studied: peak systolic velocity (PSV), resistive index (RI), pulsatility index (PI), and systolic to diastolic ratio (SD ratio). Results: Doppler signals and spectral waveforms were obtainable in 100% of hips in both groups. A statistically significant difference was found between the cases and controls with respect to their PSVs, RIs, PIs and SD ratios. The most striking difference was found between the PSVs of the two groups, whose mean was 6.18 in the control group and 11.8 in the case group. No significant correlation between age/gender and any of the 4 parameters was found. Conclusion: Doppler parameters are useful in raising suspicion of onset in the diagnosis of septic arthritis. No correlation was found between age or gender and any parameter in control group. These baseline values can be held valid for all children below the age of 7 months. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate forced expiration based on transverse abdominis (TrA) stiffness by identifying the relationship between TrA stiffness and peak expiratory flow (PEF) in both younger and older adults. We also assessed the relationship between diaphragm thickness and PEF. A total of 31 younger (21.24 ± 2.73 years) and 34 older (71.35 ± 5.26 years) adults were included in the present study. TrA muscle stiffness was measured at rest and during abdominal bracing using shear wave elastography. Diaphragm thickness was measured during deep inspiration and expiration using B‐mode ultrasound, and respiratory function was assessed by measuring PEF using a spirometer. We found that TrA stiffness during bracing was significantly lower in older than younger adults (p < 0.05). Similarly, the difference in absolute stiffness of the TrA when bracing versus at rest was significantly lower in older than younger adults (p < 0.05). Additionally, TrA stiffness during bracing was positively associated with PEF in the younger group (r = 0.483), while a very weak correlation was found in the older group (r = 0.172). Similarly, PEF was moderately correlated with diaphragm thickness during expiration as well as during changes between inspiration and expiration in the younger group (r = 0.405 and r = 0.403); however, no significant correlation was found in the older group. These findings of the present study indicate that the variations in PEF between younger and older adults may be due to age‐associated changes in the musculoskeletal structure and muscle fibre type. [ABSTRACT FROM AUTHOR]

The aim of the present study was to define an initial angle called β and to assess its diagnostic value for identifying poor-quality maneuvers in spirometry testing in children. Furthermore, its predictive equation or normal value was explored. Children aged 4–14 years with respiratory symptoms who underwent spirometry were enrolled. Based on the efforts labeled during maneuvering and the quality control criteria of the guidelines, children were categorized into good-quality and poor-quality groups. According to ventilatory impairment, children in the good-quality group were divided into three subgroups: normal, restricted, and obstructed. Angle β was the angle between the line from the expiratory apex to the origin of coordinates and the x-axis of the maximal expiratory flow-volume (MEFV) curve. Demographic characteristics, angle β, and other spirometric parameters were compared among groups. The diagnostic values of angle β, forced expiratory time (FET), and their combination were assessed using receiver operating characteristic curves. Data from 258 children in the good-quality group and 702 healthy children in our previous study were used to further explore the predictive equation or normal value of angle β. The poor-quality group exhibited a significantly smaller angle β (76.44° vs. 79.36°; P < 0.001), significantly lower peak expiratory flow (PEF), FET, and effective FET (ETe), and significantly higher expiratory volume at peak flow rate (FEV-PEF) and ratio of extrapolated volume and forced vital capacity (EV/FVC) than the good-quality group. There was no significant difference in angle β among the normal, restricted, and obstructed groups. Logistic regression analysis revealed that smaller angle β and FET values indicated poor-quality MEFV curves. The combination of angle β < 74.58° and FET < 4.91 s had a significantly larger area under the curve than either one alone. The normal value of angle β of children aged 4–14 years was 78.40 ± 0.12°. Conclusions: Angle β contributes to the quality control evaluation of spirometry in children. Both angle β < 74.58° and FET < 4.91 s are predictors of poor-quality MEFV curves, while their combination offers the highest diagnostic value. What is Known: • A slow start is one of the leading causes of poor-quality maximal expiratory flow-volume (MEFV) curves, which is a particularly prominent issue among children due to limited cooperation, especially those younger than 6 years old. • It is relatively difficult to differentiate between ventilatory dysfunction and poor cooperation when a slow start occurs in children; therefore, there is an urgent need for an objective indicator that is unaffected by ventilatory impairment to evaluate quality control of spirometry. What is New: • The initial angle β, which was introduced at the ascending limb of the MEFV curve in the present study, has a certain diagnostic value for poor-quality MEFV curves in children. • Angle β < 74.58° is a predictor of poor-quality MEFV curves, and its combination with FET < 4.91 s offers a higher diagnostic value. [ABSTRACT FROM AUTHOR]

Idiopathic subglottic stenosis (iSGS) is a recurrent, chronic disease defined by fibroinflammatory narrowing of the subglottic airway. A key challenge in treatment is monitoring disease progression, which may be debilitating and unpredictable in its timing. Can the Subglottic Stenosis 6 (SGS-6) questionnaire be validated as a novel quality-of-life (QOL) instrument to monitor breathing, disease progression, and disease severity proactively in patients with iSGS? Panel data from 51 patients with iSGS were collected from January 2012 through June 2022, representing 1,684 patient encounters including routine office visits and treatment encounters. Subjective QOL scores (including the novel SGS-6 and established RAND-36 and EuroQol Five Dimensions [EQ-5D] Visual Analog Scale) and objective pulmonary function test (PFT) results were collected at each visit. Subjective SGS-6 QOL scores were repeated within 1 week of initial reporting. Panel regression analyses were performed to assess the relationship between SGS-6 scores, PFT results, and a patient's need for intervention. Minimal clinically important differences (MCIDs) for SGS-6 and peak expiratory flow percentage (PEF%) were assessed using receiver operating characteristic (ROC) curve analysis and a patient's need for intervention as the external anchor. Each one-point increase in SGS-6 score (of a maximum of 27) was associated with a 3.26% decrease in PEF%, a 1.93-point decrease in RAND-36 Physical Health composite score, a 1.27-point decrease in RAND-36 Mental Health composite score, and a 0.88-point decrease in EQ-5D Visual Analog Scale score. The intracorrelation coefficient for the SGS-6 composite score is 0.838 (95% CI, 0.770-0.888). Compared with patient baselines, SGS-6 scores were 4.66 points greater at the time of intervention with an MCID of 2.25 from a patient's baseline. The area under the ROC curve for SGS-6 and a patient's intervention point was 0.81. iSGS disease severity can be modeled using the SGS-6 questionnaire, offering physicians and patients a potentially new method of tracking disease progression and need for intervention remotely. [ABSTRACT FROM AUTHOR]

Background: Spirometry is a gold standard evaluation tool for determining an individual's lung function. It measures the amount of air inhaled and exhaled by a person in a given amount of time. It is useful for detecting obstructive and restrictive airway diseases, quantifying the degree of impairment or severity, assessing prognosis and operative risks, assessing health status prior to enrolment in a rehabilitation program, monitoring the effects of various environmental exposures, and studying the effect of drugs and treatment on pulmonary functioning. Objectives • To determine the PEFR levels in the study population. • To find out the PEFR levels in different age groups in the study population. • To find out the gender wise variations in PEFR levels in the study population. Material & Methods. Study design: Hospital based prospective cross-sectional study. Study period: 1 year. Study population: Patients attending to General Medicine with respiratory symptoms. Sample size: Study consisted a total of 1200 subjects. Sampling technique: Simple Random technique. Inclusion criteria: Individuals who were 15 and above 15 years of age of both genders were included. Study tools and data collection procedure: Weight was measured in kilograms without footwear. Height was measured in centimetres without footwear. Body surface area was determined by DuBois body surface area chart. PEFR was measured using mini wright peak flow meter high range model i.e.; range from 60-800 L/min. Before the test, the subjects were demonstrated how to use MWPFM correctly. Then three readings were taken in standing position. The gap between each reading was five minutes. Out of the three readings the highest reading was taken as the subjects PEFR value. Instrument mini wright peak flow meter that was used for this study. Results: The average PEFR in healthy young males (21-40 years) was about 518 ± 53.4 L/min and the least values were for above 50 years age group i.e.; 392 ± 59.5 L/min. In female population, the highest PEFR values were in 21-40 years age group i.e.; 351± 38.9 L/min and the lowest was in the age group above 50 years i.e.; 266 ± 49.7 L/min. Conclusion: From the present study, it can be concluded that, Gender, age and height were the significant determinants of PEFR in the healthy population group. There is a significant difference of PEFR values in males and females. PEFR shows a linear relationship with height in both males and females. PEFR is a simple yet effective tool for epidemiological surveys as it takes short time to perform and does not requires electric power and a spot reading can be directly taken from the dial of the instrument. [ABSTRACT FROM AUTHOR]

COVID-19 typically presents with flu-like symptoms due to the viral infection itself. The most severe cases are characterised by lung damage, an important factor in fatal outcome due to alveolar damage. In some cases, patients develop a long COVID with persistent symptoms of chest pain and fatigue. Causes, including organ damage or inflammation, are being investigated. Clinical outcomes are variable and permanent lung damage is not fully understood, while vaccination is effective against severe infection but its effect on respiratory function in mild cases remains uncertain. This retrospective study aims to analyse changes in lung function in HCWs who had COVID-19 between 2020 and 2022, comparing their spirometric test results before and after the pandemic and taking into account their vaccination status. 321 HCWs were included in the study. The study examined spirometric parameters both before and after the pandemic, and all measured outcomes except the FEV1/FVC ratio showed a significant decrease during the study period. We then assessed the association between SARS-CoV-2 infection and changes in lung function parameters, analysing infections in 2020, 2021 and 2022 separately. We found a statistically significant difference in Forced vital capacity (FVC) between infected and non-infected subjects in 2020 and 2021, but not in 2022. To evaluate the protective effect of SARS-CoV-2 vaccination on respiratory function, a linear regression analysis was performed using changes in FVC, Forced expiratory volume in 1 s (FEV1), FVC/FEV1 ratio and Peak expiratory flow (PEF) as dependent variables. The analysis showed that the decline in FVC was significantly lower in subjects who had been vaccinated prior to infection. The study concludes that subclinical SARS-CoV-2 infections in 2020 and 2021 worsened respiratory parameters (FVC and FEV1), but vaccination protected against these effects. Even healthy individuals with previous infections showed respiratory changes, with vaccination providing protection, especially for FVC decline. This highlights the importance of vaccinating healthcare workers against COVID-19. [ABSTRACT FROM AUTHOR]

This quasi-experimental study was aimed at investigating the effects of wearing an abdominal girdle belt on pulmonary function variables of postpartum women. 40 consenting postpartum women aged between 18 and 35 years were recruited from a post-natal clinic in Enugu, Nigeria. The participants were conveniently assigned into girdle belt and control groups (20 each). Their lung function (forced expiratory volume in first second[FEV1], and %FEV1, forced vital capacity[FVC], peak expiratory flow [PEF], forced expiratory flows [25th, 75th & 25–75th percentiles]) values were measured prior to and after eight weeks of the study intervention period for each participant. Data obtained were analysed using descriptive and inferential statistics. Following the intervention period, 19 and 13 participants completed the study in the girdle belt and control groups, respectively. The main results showed that both groups were comparable at baseline for all the study variables assessed (p > 0.05). Following the intervention period, only the PEF was significantly reduced in the girdle belt group compared to control group participants (p = 0.012). Thus, wearing girdle belts for an extended period of time has no effect on the lung function values of postpartum women. What is already known on the subject? Postpartum abdominal girdle belts are commonly utilised for resolution of abdominal protrusion and obesity after childbirth. Unfortunately, several adverse effects, including bleeding, compressive pain and discomfort and abnormally increased intra-abdominal pressure, have been associated with this practice. Consistent increase in intra-abdominal pressure of variable duration has been reported to affect pulmonary functions. What do the results of this study add? The study findings indicate that wearing girdle belts for eight weeks by postpartum women has no substantial effect on the pulmonary function variables. What are the implications of these findings for clinical practice and/or further research? Utilisation of abdominal girdle belts of equal or less than 8 weeks duration should not be discouraged for post-partum women due to fear of its potential negative impact on pulmonary function. [ABSTRACT FROM AUTHOR]

Background: Patients in the neurointensive care unit (NICU) fail extubation despite successful weaning from mechanical ventilation. Parameters currently used in the general intensive care unit do not accurately predict extubation success in the NICU. In this study, peak cough expiratory flow rate, ultrasound-based diaphragm function assessment, and comprehensive clinical scoring systems were measured to determine whether these new variables, in isolation or combination, could predict extubation failure successfully in the NICU. Methods: All adult patients extubated after 48 h of mechanical ventilation in the NICU of a single tertiary care center were recruited into the prospective cohort. The patient's cough peak expiratory flow rate (C-PEFR), diaphragm function, and clinical scores were measured before extubation. C-PEFR was measured using a hand-held spirometer, diaphragm function (excursion, thickness fraction, and diaphragm contraction velocity on coughing) was assessed using ultrasound, and the clinical scores included the visual pursuit, swallowing, age, Glasgow Coma Scale for extubation (VISAGE) and respiratory insufficiency scale–intubated (RIS-i) scores. The patients requiring reintubation within 48 h were considered as extubation failure. Univariate and multivariate logistic regression analyses were done to identify predictors of extubation failure. Results: Of the 193 patients screened, 43 were recruited, and 15 had extubation failure (20.9%). Patients with extubation failure had higher RIS-i scores (p < 0.001) and lower VISAGE scores (p = 0.043). The C-PEFR and diaphragm function (excursions and contraction velocity on coughing) were lower in patients with extubation failure but not statistically significant. The variables with p < 0.2 in univariate analysis (RIS-i, VISAGE, and diaphragm cough velocity) were subjected to multivariate regression analysis. RIS-I score remained an independent predictor (odds ratio 3.691, 95% confidence interval 1.5–8.67, p = 0.004). In a receiver operating characteristic analysis, the area under the curve for RIS-i was 0.963. An RIS-i score of 2 or more had 94% specificity and 89% sensitivity for predicting extubation failure. Conclusions: The RIS-i score predicts extubation failure in NICU patients. The addition of ultrasound-based diaphragm measurements to the RIS-i score to improve prediction accuracy needs further study. Clinical trial registration Clinical Trials Registry of India identifier CTRI/2021/03/031923. [ABSTRACT FROM AUTHOR]

Background. Early assessment of infant lung function (ILF) is necessary to improve our understanding of factors that determine long-term respiratory health. Objective. To identify predictors of lung function among infants aged 6 weeks, 6, 12 and 24 months, from low socioeconomic settings, enrolled within the Mother and Child in the Environment (MACE) study. Methods. ILF tests were performed assessing multiple breath washout and tidal breathing during spontaneous sleep. Several risk factors, relating to infant growth, maternal and environmental exposures, were assessed cross-sectionally against the lung function parameters in multivariable models for each age group. Results. Maternal smoking during pregnancy affected the ratio of time to peak expiratory flow, showing a decline across the age groups, while being statistically significant (β (95% confidence interval (CI)) at 6 weeks (-24.6% (-43.92 - -4.59)) and 12 months (-12.68 (-25.25 - -0.11)). Low birthweight was associated with a lower tidal volume at 6 weeks (-5.99 mL (-9.59 - -2.39)), 6 months (-15.02 mL (-22.48 - -7.57)) and 12 months (-23.7 mL (-35.55 - -11.85)), compared with those with normal birthweight. This was further observed for minute ventilation at 6 weeks (-157.78 mL/min (-338.95 - 23.38)), 6 months (-325.57 mL/min (-619.06 - -32.08)) and 12 months (-527.58 mL/min (-947.85 - -107.32)), though less evident at 24 months. Conclusion. Low birthweight was the main predictor for low tidal volumes and minute ventilation at 6 weeks, with smaller differences observed at 12 and 24 months. Lung function development early in life is primarily driven by infant size and postnatal growth factors, consistent with other studies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to determine the effect of deep breathing and coughing exercise training before surgery on respiratory functions and exercise tolerance in patients with open-heart surgery in the postoperative period. Background: The decrease in respiratory functions and activity tolerance of patients after open heart surgeries reveals the need to improve this situation with effective interventions. Methods: The quasi-experimental study was conducted with 80 patients undergoing open-heart surgery. Data were collected using the patient information form and the patient follow-up form. The patients were taught deep breathing and coughing exercises before the open-heart surgery and were supported in exercising regularly before and after the surgery. The patients' respiratory functions and exercise tolerance were measured and recorded via the patient follow-up form. Results: It was determined that the respiratory capacity, distance, time, and walking speed of the patients in the experimental group during the postoperative period were significantly higher than the control group. Conclusion: Substantially, deep breathing and coughing exercise training administered before surgery to patients undergoing open heart surgery improved respiratory functions and exercise tolerance in the postoperative period. It is recommended that nurses working in open-heart surgery clinics should plan deep breathing and coughing exercise training in the preoperative period and administer them regularly to the patients. Implications for research, policy, and practice: Patients who will undergo open heart surgery should be trained by nurses in the preoperative period. Nurses should teach these patients deep breathing and coughing exercises. In the postoperative period, it should be checked regularly whether the patients do exercises or not. What is already known about the topic? • It is important to teach and practice breathing exercises in patients who will have open heart surgery. • Respiratory training given by nurses in the preoperative period contributes to the management of the postoperative process. What this paper adds: • This article demonstrates the importance of preoperative education for patients undergoing open heart surgery. • In this study, it is shown that open heart surgery has a negative effect on the respiratory capacity and exercise tolerance of the patients. • In addition, in this study, it is shown that the respiratory capacity and exercise tolerance of the patients who were taught preoperative breathing exercises and who performed the exercises in the postoperative period increased in the postoperative period. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effects of different types of inhalant allergens on the lung functions of adult patients with bronchial asthma. Methods: This cross‐sectional study included a total of 47 adults diagnosed with bronchial asthma at the Respiratory Outpatient Department of Tianjin First Central Hospital. Patients were divided into non‐sensitized and sensitized groups based on the number of positive allergens detected and classified into four groups (the dust mite mixed group, animal dander mixed group, pollen‐mixed group, and mold mixed group) based on the type of positive allergen detected. They were tested for the serum concentration of allergen‐specific immunoglobulin E (sIgE) using a fluorescence immunoassay analyzer, and lung function was assessed using a pulmonary function testing machine. One‐way analysis of variance was used to compare normally distributed data, while the rank sum test was utilized for non‐normally distributed data. Results: There was no statistically significant difference in lung function indicators between these two groups (p >.05). There were statistically significant differences in forced expiratory volume in one second as a percentage of the predicted value (FEV1%pred) (p =.028), FEV1/forced vital capacity as a percentage of the predicted value; (FVC%pred) (p =.016), peak expiratory flow as a percentage of the predicted value (PEF%pred) (p =.001), forced expiratory flow at 50% of the predicted value of forced vital capacity (FEF50%pred) (p =.003), forced expiratory flow at 75% of the predicted value of forced vital capacity (FEF75%pred) (p =.023), and maximal midexpiratory flow (MM)EF75/25%pred (p =.002) among the four groups. The pollen‐mixed group had higher PEF%pred (pollen vs. animal dander, p =.067; pollen vs. dust‐mites, p =.008; pollen vs. molds, p =.001) and MMEF75/25%pred (pollen vs. animal dander, p =.048; pollen vs. dust‐mites, p =.003; pollen vs. molds, p =.001) than the other three groups. The pollen‐mixed group had higher FEF50%pred than the dust‐mites mixed group (p =.008) and molds‐mixed group (p =.001). The pollen‐mixed group had higher FEF75%pred (p =.005), FEV1%pred (p =.001), and FEV1/FVC%pred (p =.001) than the molds‐mixed group. Conclusion: Different inhalant allergens had different effects on lung functions in adults with asthma. [ABSTRACT FROM AUTHOR]