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Spirometry
Terms modified by Spirometry Selected AbstractsAccuracy of Spirometry in Diagnosing Pulmonary Restriction in Elderly PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Simone Scarlata MD OBJECTIVES: To compare the accuracy of a diagnosis of pulmonary restriction made using forced vital capacity (FVC) less than the lower limit of normal (LLN) with the criterion standard diagnosis made using total lung capacity (TLC) less than the LLN in an elderly population. DESIGN: Retrospective analysis. SETTING: A teaching hospital. PARTICIPANTS: Five hundred sixty-four ambulatory and acute care hospital patients aged 65 to 96 underwent complete pulmonary function evaluation. MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) of diagnosis of pulmonary restriction defined as FVC less than the LLN were calculated in the overall sample and after stratification according to bronchial obstruction. Expected PPV and NPV at different background prevalence of true pulmonary restriction (5% and 15%) were calculated using the Bayes theorem. RESULTS: Low sensitivity (0.32) and high specificity (0.95) were found, with an area under the receiver operating characteristic curve (AUC) of 0.89. In participants without bronchial obstruction, specificity was even higher, although sensitivity decreased to 0.28 (AUC=0.92). The PPV was good (0.81), whereas with a low to moderate a priori probability (prevalence from 5% to 15%) the NPV was fair (,0.89). CONCLUSION: A reduction in FVC below LLN cannot reliably identify true pulmonary restriction in elderly people, confirming previous findings in the adult population. Normal FVC, instead, can effectively exclude pulmonary restriction regardless of the presence of bronchial obstruction when the a priori probability is low or moderately high. [source] The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgeryPEDIATRIC ANESTHESIA, Issue 5 2006JAMES M. O'ROURKE FFARCSI Summary Background:, The objectives of this study were to assess whether children exposed to environmental tobacco smoke (ETS) present for surgery with poorer pulmonary function, and experience a more pronounced deterioration in pulmonary function following anesthesia and surgery, than non-ETS-exposed children. Methods:, Fifty-four children aged 5,15 years with a history of ETS exposure from one or both parents and 54 children with no such ETS history were included in the study. All participants were presenting for ambulatory surgery and were judged to conform to American Society of Anesthesiology class I or II. Spirometry was performed preoperatively, postoperatively in the recovery ward when the child met criteria for discharge (Aldrete score 8), and before discharge from the day ward. Results:, The ETS-exposed group had a significantly lower mean preoperative peak expiratory flow rate (PEFR) (9.5 points lower percent predicted, 95% confidence interval ,18.1 to ,1.0, P = 0.03). Although not statistically significant, they also had lower percent predicted baseline mean values of the other spirometric variables that were measured (forced expiratory volume in 1 s ,4.5%, P = 0.07; forced vital capacity ,4.1%, P = 0.10; forced expiratory flow between 25% and 75%,3.6%, P = 0.44). Pulmonary function tests (PFTs) performed in recovery were between 8% and 14% worse than preoperative values, but the results were similar in the two groups of children. PFTs performed before hospital discharge demonstrated an near-complete recovery to baseline values. Again the pattern was similar in exposed and nonexposed children. Conclusions:, Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia. [source] Effect of active smoking on asthma symptoms, pulmonary function, and BHR in adolescents ,PEDIATRIC PULMONOLOGY, Issue 10 2009S. Yoo MD Abstract Background Active smoking is known to increase asthma symptoms and bronchial hyper-responsiveness (BHR) while decreasing pulmonary function in adults, but few studies have addressed these issues in adolescents. Methods We conducted a cross-sectional survey involving questionnaires and assessment of urinary cotinine levels among 1,492 adolescents from three urban areas of South Korea. Current smoking was defined as having smoked more than 1 day in the prior 30 days or having urine cotinine levels ,100,ng/ml. Spirometry, skin tests, and methacholine challenge tests were performed on adolescents in Seoul (n,=,724). Results The prevalence of current smoking was 8.2% in boys and 2.4% in girls. Reports of wheeze and exercise-induced wheeze in the previous 12 months were more frequent in smokers than nonsmokers (15.2% vs. 8.5%, P,=,0.024, and 20.4% vs. 10.7%, P,=,0.004, respectively). In multiple logistic regression analysis, current smoking was found to be a significant risk factor for having wheezed in previous 12 months (OR,=,4.5, 95% CI 1.5,13.2) and having exercise-induced wheezing in previous 12 months (OR,=,8.7, 95% CI, 3.7,20.9). The subgroup analysis revealed that the FEV1/FVC was lower in smokers than nonsmokers (mean,±,SD, 105.1,±,8.6% vs. 107.8,±,7.8%, P,=,0.019). In contrast, there was no significant difference in BHR. The effect of smoking on asthma symptoms were more pronounced in non-atopic compared with atopic adolescents. Conclusion Current smoking was significantly associated with symptoms of asthma, such as having recent wheezing and recent exercise-induced wheezing, especially for non-atopics, in Korean adolescent population. Current smoking was further associated with lower pulmonary function, but not BHR. Pediatr Pulmonol. 2009; 44:954,961. ©2009 Wiley-Liss, Inc. [source] Using index of ventilation to assess response to treatment for acute pulmonary exacerbation in children with cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 8 2009FRACP, Paul D. Robinson MRCPCH Abstract Background The use of alternative more sensitive measures has become a focus of research in CF. The utility of indexes of ventilation, Lung Clearance Index (LCI) and peak aerobic capacity (peak VO2), were studied as assessment tools in gauging response to intravenous (IV) therapy in acute pulmonary exacerbation, in comparison to the more commonly used index of forced expiratory volume in 1,sec (FEV1). The utility of a previously published clinical score was further explored. Methods Patients aged 8,18 years admitted for IV antibiotic treatment of a pulmonary exacerbation were recruited. Spirometry, plethysmography, multiple breath nitrogen washout, exercise testing, and Cystic Fibrosis Clinical Score (CFCS) were performed on admission and prior to discharge. Results Twenty-eight patients were recruited, with a mean (range) age of 13.7 (8; 17) years, 16 female and 12 male. Mean (range) admission FEV1 was 61.4 (28; 92)% predicted, or z -score ,3.09 (,6.15; ,0.52), FVC 83.0 (38; 120)% predicted, or z -score ,1.71 (,5.66; ,1.17), and Shwachman,Kulczycki 68.9 (50; 90). FEV1 increased by 7.0% (P,<,0.01) from admission to discharge. Mean (range) admission LCI, 10.10 (6.87; 14.83), decreased by 3.8% (P,=,0.03). Mean (range) admission peak VO2 (ml/kg/min), 31.2 (23.4; 45.4), increased on discharge by 6.6% (P,<,0.01). Proposed clinical thresholds, based on the available variability data, highlighted the heterogeneity of response in lung function tests. Mean (range) admission CFCS, 26.5 (19; 39), decreased to 19.9 (13; 31) on discharge, a 25.2% improvement (P,<,0.01). CFCS demonstrated improvement in 27 of 28 patients. Changes in peak VO2 (r,=,,0.50, P,=,0.02) and LCI (r,=,0.48, P,=,0.01) correlated with CFCS change. Conclusions In children with mild-to-moderate CF, whilst statistically significant improvement in both LCI and peak VO2 were seen, heterogeneity of response was evident. The most consistent improvement was seen in CFCS. Correlation of LCI and peak VO2 with change in clinical score (CFCS) was seen. The full clinical significance of these changes in LCI and peak VO2 needs to be evaluated further with additional variability data. The CFCS may be useful in the assessment of response to treatment in CF but requires formal validation. Pediatr Pulmonol. 2009; 44:733,742. © 2009 Wiley-Liss, Inc. [source] The potential use of spirometry during methacholine challenge test in young children with respiratory symptomsPEDIATRIC PULMONOLOGY, Issue 7 2009Daphna Vilozni PhD Abstract Background The concentration of methacholine that causes a fall of 20% from baseline forced expiratory volume in the first second (PC20-FEV1) in the methacholine challenge test (MCT) is not usually considered a diagnostic tool in preschool children since PC20-FEV1 may not be achievable <6 years of age. Aim To assess the usefulness of various spirometry indices obtained during MCT in a large group of 3- to 6-year-old children with respect to their clinical diagnosis. Methods Standardized MCT (inhaled triple-concentration increments [0.057,13.925 mg] of methacholine solution) was performed by 84 children previously diagnosed with asthma (asthmatics) and 48 with prolonged cough (coughers). Spirometry was determined at baseline and between inhalations; PC20-FEV1 and PC25-FEV0.5 were calculated. Results PC20-FEV1 values were significantly less in the asthmatics than in the coughers (mean,±,SD was 3.21,±,4.32 vs. 22.35,±,3.66 ml/mg). Similarly, PC25-FEV0.5 was 1.48,±,3.08 in the asthmatics and 9.45,±,12.59 mg/ml/Mch in the coughers, P,<,0.0001. A cut-off at 4.0 mg/ml for PC20-FEV1 had 77.4% sensitivity and 75.0% specificity, a cut-off at 2.2 mg/ml for PC25-FEV0.5 had 73.8% sensitivity and 72.9% specificity, for clinical diagnosis of asthma. PC25-FEV0.5 also showed a correlation with age. Conclusions Our findings suggest that MCT can be performed in preschool children with various respiratory symptoms. PC25-FEV0.5 may be a better end-point parameter. Children with a clinical diagnosis of asthma respond to a lower MCT concentration than children with cough. Further studies are needed to determine airway responsiveness in healthy young children and to further assess the contribution of MCT to the clinical diagnosis in this age group. Pediatr Pulmonol. 2009; 44:720,727. © 2009 Wiley-Liss, Inc. [source] Bronchodilator effect of salbutamol from two different spacer devicesPEDIATRIC PULMONOLOGY, Issue 4 2006Albert M. Li MB Abstract Our aim was to compare the bronchodilator effect of salbutamol delivered via a new holding chamber (Volumatic Soft, VS) with that of an established device (Volumatic, V) in asthmatic children. Children with stable asthma were recruited. They inhaled 100 µg, and 10 min later, 300 µg of salbutamol aerosol delivered via VS or V on day 1, and vice versa on day 2. Spirometry was measured at baseline, 10 min after 100 µg, and 15 min after 300 µg of salbutamol were given. The preference for either device was assessed by visual analogue score. Forty-four children with a median age of 9.2 years (interquartile range, 8.0,10.7) completed the study. There were significant improvements in forced expired volume in 1 sec (FEV1) with time throughout the study period for both V and VS (linear and quadratic trend P,<,0.001). There was a statistically significant difference in postbronchodilator FEV1 between V and VS (P,=,0.013). VS gave an overall greater change in FEV1 than V, by 1.8%. The preference scores for V and VS were 7.0 (IQR 5.0,8.0) and 9.0 (IQR 8.0,10.0) (p,<,0.0005), respectively. In conclusion, comparable clinical efficacy was found for V and VS with respect to changes in FEV1 after salbutamol. Patients also showed a strong preference for the new device. Pediatr Pulmonol. © 2006 Wiley-Liss, Inc. [source] Body composition and respiratory function in healthy non-obese childrenPEDIATRICS INTERNATIONAL, Issue 5 2007FRANCISCO J. GONZALEZ-BARCALA Abstract Background: The purpose of the present paper was to evaluate the role that body composition plays in lung function, among healthy children and adolescents. Methods: Cross-sectional study was undertaken using sex- and age-stratified sampling among healthy children and adolescents aged 6,18 years. Spirometry was performed on every child who fulfilled inclusion criteria. Fat mass (FM) and fat-free mass (FFM) were calculated from triceps skinfold thickness and arm circumference. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95%CI) between low pulmonary function (PF) of schoolchildren and body composition expressed in FM and FFM. Calculations of OR imply that the outcome is dichotomous (low PF/normal PF), therefore those children who had parameters of pulmonary function below the 25th percentile were classed as cases and the rest of the subjects were considered as controls. Results: A total of 2408 children were included; 1270 (53%) of them were male and 1138 (47%), female. Among boys the increase of FFM was associated with an increase of forced expiratory volume in 1 s (FEV1). Among girls the increase of FFM was associated with an increase of FEV1, forced vital capacity, and peak expiratory flow. The increase in FM was associated with a decrease of spirometric parameters in both genders, with a stronger effect among boys. Conclusions: The present study confirms the negative effect of body fat on the PF of children and adolescents, even though obese subjects were excluded. The effect is different between boys and girls. [source] Effect of protective filters on fire fighter respiratory health: field validation during prescribed burnsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2009Annemarie J.B.M. De Vos MPH, ICCert Abstract Background Bushfire smoke contains a range of air toxics. To prevent inhalation of these toxics, fire fighters use respiratory equipment. Yet, little is known about the effectiveness of the equipment on the fire ground. Experimental trials in a smoke chamber demonstrated that, the particulate/organic vapor/formaldehyde (POVF) filter performed best under simulated conditions. This article reports on the field validation trials during prescribed burns in Western Australia. Methods Sixty-seven career fire fighters from the Fire and Emergency Services Authority of Western Australia were allocated one of the three types of filters. Spirometry, oximetry, self-reported symptom, and personal air sampling data were collected before, during and after exposure to bushfire smoke from prescribed burns. Results Declines in FEV1 and SaO2 were demonstrated after 60 and 120 min exposure. A significant higher number of participants in the P filter group reported increases in respiratory symptoms after the exposure. Air sampling inside the respirators demonstrated formaldehyde levels significantly higher in the P filter group compared to the POV and the POVF filter group. Conclusions The field validation trials during prescribed burns supported the findings from the controlled exposure trials in the smoke chamber. Testing the effectiveness of three types of different filters under bushfire smoke conditions in the field for up to 2 hr demonstrated that the P filter is ineffective in filtering out respiratory irritants. The performance of the POV and the POVF filter appears to be equally effective after 2 hr bushfire smoke exposure in the field. Am. J. Ind. Med. 52:76,87, 2009. © 2008 Wiley-Liss, Inc. [source] Occupational allergy and asthma among salt water fish processing workersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2008Mohamed F. Jeebhay MBChB Abstract Background Fish processing is a common economic activity in Southern Africa. The aim of this study was to determine the prevalence and host determinants of allergic symptoms, allergic sensitization, bronchial hyper-responsiveness and asthma among workers processing saltwater fish. Methods A cross-sectional study was conducted on 594 currently employed workers in two processing plants involved in pilchard canning and fishmeal processing. A modified European Community Respiratory Health Survey (ECRHS) questionnaire was used. Skin prick tests (SPT) used extracts of common airborne allergens, fresh fish (pilchard, anchovy, maasbanker, mackerel, red eye) and fishmeal. Spirometry and methacholine challenge tests (MCTs; tidal breathing method) used ATS guidelines. Results Work-related ocular-nasal symptoms (26%) were more common than asthma symptoms (16%). The prevalence of atopy was 36%, while 7% were sensitized to fish species and 26% had NSBH (PC20,,,8 mg/ml or ,12% increase in FEV1 post-bronchodilator). The prevalence of probable occupational asthma was 1.8% and fish allergic rhino-conjunctivitis 2.6%. Women were more likely to report work-related asthma symptoms (OR,=,1.94) and have NSBH (OR,=,3.09), while men were more likely to be sensitized to fish (OR,=,2.06) and have airway obstruction (OR,=,4.17). Atopy (OR,=,3.16) and current smoking (OR,=,2.37), but not habitual seafood consumption were associated with sensitization to fish. Conclusions Based on comparison with previous published studies, the prevalence of occupational asthma to salt water fish is lower than due to shellfish. The gendered distribution of work and exposures in fish processing operations together with atopy and cigarette smoking are important determinants of occupational allergy and asthma. Am. J. Ind. Med. 51:899,910, 2008. © 2008 Wiley-Liss, Inc. [source] Serum levels of matrix metalloproteinase-9, tissue inhibitors of metalloproteinase-1 and their ratio are associated with impaired lung function in the elderly: A population-based studyRESPIROLOGY, Issue 3 2010Inga S. ÓLAFSDÓTTIR ABSTRACT Background and objective: Matrix metalloproteinases (MMP) and their inhibitors, tissue inhibitors of metalloproteinases (TIMP), regulate homeostasis and turnover of the extra cellular matrix. The aim of this study was to investigate the associations of serum MMP-9 and TIMP-1 with lung function. Methods: Spirometry was performed in a population-based sample of 888 subjects aged 70 years. Serum MMP-9 and TIMP-1 concentrations were measured by ELISA. Results: Lower FEV1 values were associated with higher serum levels of MMP-9 (P = 0.001) and TIMP-1 (P < 0.001), and a higher ratio of MMP-9 to TIMP-1 (P = 0.02). These associations were significant after adjustment for gender, weight, height, BMI, current smoking, pack years of smoking and the time for which samples were frozen. After stratification for gender, the associations between FEV1 and MMP-9, TIMP-1, and their ratio, were significant in men but not in women. Conclusions: Lower FEV1 was significantly but weakly associated with higher serum levels of MMP-9, TIMP-1 and a higher MMP-9/TIMP-1 ratio. This association was stronger in men than in women, suggesting a possible role for extracellular matrix remodelling in the development of impaired lung function. These associations may also partly explain the association between low FEV1 and cardiovascular disease. [source] Plethysmography and impulse oscillometry assessment of tiotropium and ipratropium bromide; a randomized, double-blind, placebo-controlled, cross-over study in healthy subjectsBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 4 2006D. Singh Aims Spirometry, plethysmography and impulse oscillometry (IOS) measure different aspects of lung function. These methods have not been compared for their ability to assess long- and short-acting anticholinergic agents. We therefore performed a double-blind, placebo-controlled, four-way cross-over study in 30 healthy subjects. Methods Single doses of tiotropium bromide (Tio) 54 and 18 mcg, ipratropium bromide (IB) 40 mcg and placebo were administered. Specific conductance (sGaw), total lung capacity (TLC), inspiratory capacity (IC) and residual volume (RV) were measured using plethysmography, while IOS measured resistance (R5,25) and reactance (RF and X5). Pulmonary function was measured for 26 h post dose. Results Tio caused significant improvements in sGaw, forced expiratory voume in 1 s (FEV1), maximum mid-expiratory flow (MMEF) and R5,R25 at time points up to 26 h, with no clear differences between doses. IB improved the same parameters, but only up to 8 h. The weighted mean change (0,24 h) caused by Tio 54 mcg compared with placebo for FEV1 was 240 ml (95% confidence interval 180, 300), while for sGaw the ratio of geometric means (Tio compared with placebo) was 1.35 (1.28, 1.41). Neither drug caused consistent statistically significant changes in RF, forced vital capacity, TLC or IC over 26 h. RV was significantly improved from 8 to 24 h by Tio 54 mcg only. Conclusions In addition to spirometry, IOS resistance measurements and sGaw can distinguish between the effects of long- and shortacting anticholinergic effects in healthy subjects. [source] Airway cell and cytokine changes in early asthma deterioration after inhaled corticosteroid reductionCLINICAL & EXPERIMENTAL ALLERGY, Issue 8 2007Y. H. Khor Summary Background Back-titration of inhaled corticosteroid (ICS) dose in well-controlled asthma patients is emphasized in clinical guidelines, but there are few published data on the airway cell and cytokine changes in relation to ICS reduction. In our study, 20 mild-to-moderate persistent (inspite of low-moderate dose ICS treatment) asthmatic subjects prospectively rendered largely asymptomatic by high-dose ICS were assessed again by clinical, physiological, and airway inflammatory indices after 4,8 weeks of reduced ICS treatment. We aimed at assessing the underlying pathological changes in relation to clinical deterioration. Methods Patients recorded daily symptom scores and peak expiratory flows (PEF). Spirometry and airways hyperreactivity (AHR) were measured and bronchoscopy was performed with assessment of airway biopsies (mast cells, eosinophils, neutrophils, and T lymphoctyes), bronchoalveolar lavage (BAL) IL-5 and eotaxin levels and cellular profiles at the end of high-dose ICS therapy and again after ICS dose reduction. Baseline data were compared with symptomatic steroid-free asthmatics (n=42) and non-asthmatic controls (n=28). Results After ICS reduction, subjects experienced a variable but overall significant increase in symptoms and reductions in PEF and forced expiratory volume in 1 s. There were no corresponding changes in AHR or airways eosinophilia. The most relevant pathogenic changes were increased CD4+/CD8+ T cell ratio, and decreased sICAM-1 and CD18 macrophage staining (potentially indicating ligand binding). However, there was no relationship between the spectrum of clinical deterioration and the changes in cellular profiles or BAL cytokines. Conclusions These data suggest that clinical markers remain the most sensitive measures of early deterioration in asthma during back-titration of ICS, occurring at a time when AHR and conventional indices of asthmatic airway inflammation appear unchanged. These findings have major relevance to management and to how back-titration of ICS therapy is monitored. [source] Measurement of nitric oxide and 8-isoprostane in exhaled breath of children with atopic eczemaCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2009C. Zinelli Summary Background., Children with atopic eczema (AE) are at risk of developing asthma. Airway inflammation has been shown to be present before the onset of clinical asthma. Increased exhalation (forced expiration; FE) of nitric oxide (FENO) and 8-isoprostane seems to be a feature of bronchial inflammation in people with asthma. Aim., To determine whether the exhalation of these two molecules is increased in children with eczema, even in the absence of overt asthma. Methods., In total, 21 children with AE were recruited and compared with healthy controls. A questionnaire was completed to identify respiratory symptoms compatible with asthma. The severity of AE was graded clinically. Spirometry, FENO measurements and exhaled breath condensate collection for 8-isoprostane were performed. Results., The mean level of 8-isoprostane was similar for children with AE (2.33 ± 4.76 pg/mL) and controls (3.37 ± 3.43). FENO was increased in children with AE (mean 64.97 parts per billion) compared with the normal range, even in the absence of respiratory symptoms and in the presence of normal lung function. Conclusions., FENO but not 8-isoprostane levels in exhaled breath condensate are higher in children with AE without asthma. Our finding may indicate a predictive role for FENO for the development of asthma. [source] Exhaled Nitric Oxide Levels during Acute Asthma ExacerbationACADEMIC EMERGENCY MEDICINE, Issue 7 2005Michelle Gill MD Abstract Objectives: Fractional exhaled nitric oxide (FENO) has been shown in laboratory settings and trials of patients with stable asthma to correlate with the degree of airway inflammation. The authors hypothesized that the technique of measuring FENO would be reproducible in the setting of acute asthma in the emergency department (ED) and that the FENO results during ED visits would potentially predict disposition, predict relapse following discharge, and correlate with the National Institutes of Health (NIH) asthma severity scale and peak expiratory flow measurements. Methods: The authors prospectively measured FENO in a convenience sample of ED patients with acute exacerbations of asthma, both at the earliest possible opportunity and then one hour later. Each assessment point included triplicate measurements to assess reproducibility. The authors also performed spirometry and classified asthma severity using the NIH asthma severity scale. Discharged patients were contacted in 72 hours to determine whether their asthma had relapsed. Results: The authors discontinued the trial (n= 53) after a planned interim analysis demonstrated reproducibility (coefficient of variation, 15%) substantially worse than our a priori threshold for precision (4%). There was no association between FENO response and corresponding changes in spirometry or clinical scores. Areas under the receiver operating characteristic curves for the prediction of hospitalization and relapse were poor (0.579 and 0.713, respectively). Conclusions: FENO measurements in ED patients with acute asthma exacerbations were poorly reproducible and did not correlate with standard measures of asthma severity. These results suggest that using existing technology, FENO is not a useful marker for assessing severity, response to treatment, or disposition of acute asthmatic patients in the ED. [source] Clinical application of continuous spirometry with a pitot-based flow meter during equine anaesthesiaEQUINE VETERINARY EDUCATION, Issue 7 2010Y. P. S. Moens Summary This report documents the feasibility and clinical information provided by a new method for spirometric monitoring adapted for equine anaesthesia. Monitoring of ventilatory function was done with continuous spirometry during general anaesthesia of client-owned horses presented for various diagnostic and surgical procedures. An anaesthetic monitor with a spirometry unit for human anaesthesia was used. To allow the measurement of large tidal volumes, a remodelled larger version of the pitot tube- based flow sensor was used. This technology provided reliable spirometric data even during prolonged anaesthesia when water condensation accumulated in the anaesthetic circuit and the sensor. In addition to flow and volume measurement and respiratory gas analysis, the continuous display of flow-volume and pressure-volume loops offered visually recognisable information about compliance, airway resistance and integrity of the circuit. Continuous spirometry with this monitoring system was helpful in evaluating the efficacy of spontaneous ventilation, in adjusting intermittent positive pressure ventilation and detecting technical faults in the anaesthetic apparatus and connection with the patient. This adapted spirometry method represents a practical and reliable measuring system for use during equine anaesthesia. The variety of information provides an opportunity to optimise anaesthetic management in this species. [source] Quality of life in lung cancer patients: impact of baseline clinical profile and respiratory statusEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2007A. MOHAN md, assistant professor As cure is attainable in very few cases of lung cancer, the imperative issue is to make quality of life (QOL) as good as possible as part of the palliative care package. The aim of this paper was to evaluate the baseline QOL of lung cancer patients and observe its association with various clinical parameters and overall respiratory status. A total of 101 patients were administered the European Organization for Research and Treatment of Cancer core quality of life (EORTC QLQ-C30, version 3) questionnaire. Clinical profile and measures of respiratory status, including spirometry, measures of dyspnoea, and 6-min walk test, were recorded. Higher Karnofsky Performance Status (KPS) significantly correlated with better global health status (P < 0.001) and healthy level of functioning (P < 0.001). The cumulative symptom burden was significantly associated with global QOL (P = 0.01) and physical, role and cognitive function scales (P < 0.05). All dyspnoea measures negatively correlated with global QOL and functioning scales. Spirometric indices showed a positive correlation with all functional scales (P < 0.05) except social. In conclusion, lung cancer patients have unsatisfactory QOL, with the global health status and physical functions being most affected. Number of symptoms, KPS, dyspnoea and spirometry significantly affect QOL. [source] Circulating leptin and body composition in chronic obstructive pulmonary diseaseINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2005S. Karakas Summary Nutritional depletion and weight loss are two features of chronic obstructive pulmonary disease (COPD), and the association between low body mass index (BMI) and poor prognosis in patients with COPD is a common clinical observation. Mechanisms of weight loss are still unclear in COPD. Excessive energy expenditure partly due to increased work of breathing was shown, but other mechanisms have been searched for. Leptin is a hormone secreted by adipocytes that plays an important role in energy homeostasis and regulates body weight through control of appetite and energy expenditure. The aim of this study was to evaluate the association of circulating leptin levels and measures of body composition in COPD patients. Thirty male COPD outpatients (mean age 66.3 ± 8.4) and 20 controls (mean age 65.9 ± 10.8) were included in the study. After standard spirometry and body composition measurements, serum leptin concentration was measured by ELISA assay. COPD patients were grouped according to BMI. Mean BMI was 19.01 ± 2.26 kg/m2 in group 1 (COPD patients with low BMI), 26.85 ± 4.51 in group 2 COPD (COPD patients with normal/high BMI) and 27.64 ± 2.75 kg/m2 in healthy controls (group 3). Mean serum leptin concentration was 1.41 ± 1.86 ng/ml in group 1, 2.60 ± 1.38 ng/ml in group 2 and 2.82 ± 1.46 ng/ml in group 3 (p = 0.002). Leptin correlated to not only BMI but also body weight, waist circumference, triceps and biceps skinfold thickness and body fat percent (p < 0.05 for all). Results of this study suggest that the cause of weight loss is not increased circulating leptin in COPD. Instead, leptin remains regulated in COPD and further decreased in patients with low BMI, probably as a compensatory mechanism to preserve body fat content, which should be evaluated in further studies. [source] Chronic Obstructive Pulmonary Disease Diagnosis and Management in Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 6 2010Nalaka S. Gooneratne MD Chronic obstructive pulmonary disease (COPD) in older adults is a complex disorder with several unique age-related aspects. Underlying changes in pulmonary lung function and poor sensitivity to bronchoconstriction and hypoxia with advancing age can place older adults at greater risk of mortality or other complications from COPD. The establishment of the Global Initiative for Obstructive Lung Disease criteria, which can be effectively applied to older adults, has more rigorously defined the diagnosis and management of COPD. An important component of this approach is the use of spirometry for disease staging, a procedure that can be performed in most older adults. The management of COPD includes smoking cessation, influenza and pneumococcal vaccinations, and the use of short- and long-acting bronchodilators. Unlike with asthma, corticosteroid inhalers represent a third-line option for COPD. Combination therapy is frequently required. When using various inhaler designs, it is important to note that older adults, especially those with more-severe disease, may have inadequate inspiratory force for some dry-powder inhalers, although many older adults find the dry-powder inhalers easier to use than metered-dose inhalers. Other important treatment options include pulmonary rehabilitation, oxygen therapy, noninvasive positive airway pressure, and depression and osteopenia screening. Clinicians caring for older adults with an acute COPD exacerbation should also guard against prognostic pessimism. Although COPD is associated with significant disability, there is a growing range of treatment options to assist patients. [source] Respiratory Function as a Marker of Bone Health and Fracture Risk in an Older Population,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2009Alireza Moayyeri Abstract Identification of those at high risk of osteoporosis and fractures using clinically available tests beyond BMD measures is a major clinical challenge. We examined forced expiratory volume in 1 s (FEV1), an easily obtainable measure of respiratory function, as a clinical measure for fracture prediction. In the context of the European Prospective Investigation into Cancer-Norfolk Study, 8304 women and 6496 men 42,81 yr of age underwent a health check including spirometry and heel quantitative ultrasonography between 1997 and 2000 and were followed up for incident hip fractures until 2007. The main outcome measures were broadband ultrasound attenuation (BUA) of the heel (cross-sectional analysis) and hip fracture risk (prospective analysis). In multivariate regression models, a 1-liter increase in FEV1 was associated with a statistically significant 2.2-dB/MHz increase in BUA, independent of age, smoking, height, body mass index, history of fracture, and use of corticosteroids. Mean FEV1 was significantly lower among 84 women and 36 men with hip fracture compared with other participants. In multivariate proportional-hazard regression models, the relative risk (RR) of hip fracture associated with a 1-liter increase in FEV1 was 0.5 (95% CI, 0.3,0.9; p < 0.001) for both men and women. RR of hip fracture for a 1 SD increase in FEV1 was approximately equivalent to a 0.5 SD increase in BUA among women (1 SD among men) and an ,5-yr decrease in age among both men and women. Middle-aged and older people with low respiratory function are at increased risk of osteoporosis and hip fracture. FEV1, an easy, low-cost, and feasible clinical measure, may help improve the identification of high-risk groups. [source] Regional pulmonary pressure volume curves in mechanically ventilated patients with acute respiratory failure measured by electrical impedance tomographyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2006J. Hinz Background:, We hypothized, that in mechanically ventilated patients with acute respiratory failure, regional pressure volume curves differ markedly from conventional global pressure volume curves of the whole lung. Methods:, In nine mechanically ventilated patients with acute respiratory failure during an inspiratory low-flow manoeuvre, conventional global pressure volume curves were registered by spirometry and regional pressure volume curves in up to 912 regions were assessed simultaneously using electrical impedance tomography. We compared the lower (LIP) and upper (UIP) inflection points obtained from the conventional global pressure volume curve and regional pressure volume curves. Results:, We identified from the conventional global pressure volume curves LIP [3,11 (8) cmH2O] in eight patients and UIP [31,39 (33) cmH2O] in three patients. Using electrical impedance tomography (EIT), LIP [3,18 (8) cmH2O] in 54,264 (180) regions and UIP [23,42 (36) cmH2O] in 149,324 (193) regions (range and median) were identified. Lung mechanics measured by conventional global pressure volume curves are similar to the median of regional pressure volume curves obtained by EIT within the tomographic plane. However, single regional pressure volume curves differ markedly with a broad heterogeneity of lower and upper inflection points. Conclusion:, Lower and upper inflection points obtained from conventional global pressure volume curves are not representative of all regions of the lungs. [source] Comparison of perioperative spirometric data following spinal or general anaesthesia in normal-weight and overweight gynaecological patientsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2005B. S. Von Ungern-Sternberg Background:, There is limited data comparing the impact of spinal anaesthesia (SA) and general anaesthesia (GA) on perioperative lung function. Here we assessed the differences of these two anaesthetic techniques on perioperative lung volumes in normal-weight (BMI < 25) and overweight (BMI 25,30) patients using spirometry. Methods:, We prospectively studied 84 consenting patients having operations in the vaginal region receiving either GA (n = 41) or SA (n = 43). Both groups (GA and SA) were further divided into two subgroups each (normal-weight vs. overweight). We measured vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), midexpiratory (MEF25-75) and peak expiratory flow rates (PEFR) at the preoperative assessment (baseline), after premedication, after effective SA, and 20 min, 1 h, 2 h and 3 h after the operation (last measurement after patient mobilization). Results:, Premedication was associated with a small but significant decrease in lung volumes in direct correlation with BMI (,5%). Spinal anaesthesia resulted in a significant reduction in lung volumes in overweight as opposed to normal-weight patients. Postoperatively, lung volumes were significantly more reduced following GA than SA as indicated by differences in mean VC (SD) of ,12 (6)% vs. ,6 (5)% 20 min after the end of the operation in the normal-weight and ,18 (5)% vs. ,10 (5)% in the overweight patients. There was a significant impact of BMI on postoperative respiratory function, which was significantly more important in the GA group than in the SA group, and recovery of lung volumes was more rapid in the normal-weight patients than in the overweight patients, particularly in the SA group. Conclusion:, In gynaecological patients undergoing vaginal surgery, the impact of anaesthesia on postoperative lung function as assessed by spirometry was significantly less after SA than GA, particularly in overweight patients. [source] Passive smoking is a major determinant of exhaled nitric oxide levels in allergic asthmatic childrenALLERGY, Issue 4 2010Y. Laoudi To cite this article: Laoudi Y, Nikasinovic L, Sahraoui F, Grimfeld A, Momas I, Just J. Passive smoking is a major determinant of exhaled nitric oxide levels in allergic asthmatic children. Allergy 2010; 65: 491,497. Abstract Background:, Fraction of exhaled nitric oxide (FeNO) is considered, by some authors, to be a treatment follow-up parameter in allergic asthmatics. However, factors such as active smoking can influence NO production and must be taken into account in the interpretation of FeNO values. In children, the evidence in favour of an impact of passive smoking (PS) on FeNO values is controversial. The aim of this study was to evaluate the impact of chronic PS on FeNO in allergic asthmatic children. Methods:, Seventy nontreated allergic asthmatic children over 5 years of age, exposed and unexposed to PS, underwent measurement of FeNO, spirometry, and allergic tests (skin prick tests, total and specific serum IgE, and blood eosinophilia). Children were considered to be exposed to PS when at least 1 cigarette per day was declared to be smoked at home. Results:, Geometric mean FeNO value in 22 children exposed to PS was 26.3 ± 1.5 ppb vs 56.3 ± 1.7 ppb in 48 children unexposed (P < 0.001). After adjustment for age, blood eosinophilia, allergic sensitizations, total IgE, dust mite sensitization and asthma severity, multivariate analysis showed that PS exposure was negatively associated with FeNO values (P = 0.0001) and was the primary determinant of FeNO variations. Conclusion:, Passive smoking lowers FeNO, and might be a major determinant of FeNO levels in nontreated allergic asthmatic children. [source] Allergic asthma in patients with common variable immunodeficiencyALLERGY, Issue 4 2010R. C. Agondi To cite this article: Agondi RC, Barros MT, Rizzo LV, Kalil J, Giavina-Bianchi P. Allergic asthma in patients with common variable immunodeficiency. Allergy 2010; 65: 510,515. Abstract Background:, Many patients with common variable immunodeficiency (CVID) have a clinical history suggestive of allergic respiratory disease. However, in such individuals, the prevalence of asthma and the role of atopy have not been well established. The objective of this study was to evaluate pulmonary function and identify asthma in patients with CVID. We also investigated the role of IgE as a trigger of asthma in these patients. Methods:, Sixty-two patients diagnosed with CVID underwent spirometry, as well as skin prick testing and in vitro determination of serum-specific IgE levels for aeroallergens, together with bronchial provocation with histamine and allergen. Results:, The most common alteration identified through spirometry was obstructive lung disease, which was observed in 29 (47.5%) of the 62 patients evaluated. Eighteen (29.0%) of the 62 patients had a clinical history suggestive of allergic asthma. By the end of the study, asthma had been diagnosed in nine (14.5%) patients and atopy had been identified in six (9.7%). In addition, allergic asthma had been diagnosed in four patients (6.5% of the sample as a whole; 22.2% of the 18 patients with a clinical history suggestive of the diagnosis). Conclusion:, In this study, CVID patients testing negative for specific IgE antibodies and suspected of having allergic asthma presented a positive response to bronchial provocation tests with allergens. To our knowledge, this is the first such study. When CVID patients with a history suggestive of allergic asthma test negative on traditional tests, additional tests designed to identify allergic asthma might be conducted. [source] Risk factors for allergic rhinitis in Costa Rican children with asthmaALLERGY, Issue 2 2010S. Bunyavanich To cite this article: Bunyavanich S, Soto-Quiros ME, Avila L, Laskey D, Senter JM, Celedón JC. Risk factors for allergic rhinitis in Costa Rican children with asthma. Allergy 2010; 65; 256,263 DOI: 10.1111/j.1398-9995.2009.02159.x. Abstract Background:, Risk factors for allergic rhinitis (AR) in asthmatics are likely distinct from those for AR or asthma alone. We sought to identify clinical and environmental risk factors for AR in children with asthma. Methods:, We performed a cross-sectional study of 616 Costa Rican children aged 6,14 years with asthma. Candidate risk factors were drawn from questionnaire data, spirometry, methacholine challenge testing, skin testing, and serology. Two outcome measures, skin test reaction (STR)-positive AR and physician-diagnosed AR, were examined by logistic regression. Results:, STR-positive AR had high prevalence (80%) in Costa Rican children with asthma, and its independent risk factors were nasal symptoms after exposure to dust or mold, parental history of AR, older age at asthma onset, oral steroid use in the past year, eosinophilia, and positive IgEs to dust mite and cockroach. Physician-diagnosed AR had lower prevalence (27%), and its independent risk factors were nasal symptoms after pollen exposure, STR to tree pollens, a parental history of AR, inhaled steroid and short-acting ,2 agonist use in the past year, household mold/mildew, and fewer older siblings. A physician's diagnosis was only 29.5% sensitive for STR-positive AR. Conclusions:, Risk factors for AR in children with asthma depend on the definition of AR. Indoor allergens drive risk for STR-positive AR. Outdoor allergens and home environmental conditions are risk factors for physician-diagnosed AR. We propose that children with asthma in Costa Rica and other Latin American nations undergo limited skin testing or specific IgE measurements to reduce the current under-diagnosis of AR. [source] Impact of allergic rhinitis on asthma in children: effects on bronchodilation testALLERGY, Issue 2 2010M. Capasso To cite this article: Capasso M, Varricchio A, Ciprandi G. Impact of allergic rhinitis on asthma in children: effects on bronchodilation test. Allergy 2010; 65: 264,268 DOI: 10.1111/j.1398-9995.2009.02168.x. Abstract Background:, Relevant relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma and its reversibility is considered a diagnostic step for asthma diagnosis. Objective:, This study aimed at evaluating a large group of children with allergic rhinitis alone for investigating the degree of brochodilation and possible factors related to it. Methods:, Two hundred patients with allergic rhinitis and 150 normal subjects were consecutively evaluated. Clinical examination, skin prick test, spirometry, and bronchodilation test were performed in all patients. Results:, Rhinitics showed a significant FEV1 increase after bronchodilation test (P < 0.0001) in comparison both to basal values and to controls' levels. More than 20% of rhinitics had reversibility (,12% basal levels). Patients with reversibility had lower FEV1 levels, longer rhinitis duration, and perennial allergy. Conclusion:, This study highlights the close link between upper and lower airways and the relevance of performing bronchodilation test in patients with allergic rhinitis and these characteristics. [source] Matrix metalloproteinases-7, -8, -9 and TIMP-1 in the follow-up of diisocyanate-induced asthmaALLERGY, Issue 1 2010P. Piirilä Abstract Background:, Diisocyanate-induced asthma (DIA) is known to be associated with poor prognosis. We wished to clarify if matrix metalloproteinases (MMP)-7, -8 or -9 or tissue inhibitor of matrix metalloproteinases (TIMP-1) are associated with the functional or inflammatory outcome in DIA patients. Methods:, This is a longitudinal study where 17 patients with DIA diagnosed by a specific challenge test to diisocyanates were monitored. Exposure to diisocyanates was terminated seven (mean) months before the challenge test. The studies included spirometry, histamine challenge test and bronchoscopy. MMP-7, MMP-8, TIMP-1 [Enzyme-linked immunosorbent assay (ELISA)- and immunofluorometric assay-methods], MMP-9 (ELISA and zymography), interferon-gamma, tumour necrosis factor-alpha, interleukin-6, -8, -15, -17, CXCL-5/ENA-78, monocyte chemoattractant protein-1 and macrophage inhibitory factor (MIF) (ELISA) were assayed from bronchoalveolar lavage (BAL) fluid. Inhaled steroid therapy was initiated after the examinations, which were repeated at 6 months and at 3 years during the treatment. The results were compared with those of 15 healthy controls. Results:, Inhaled steroid medication increased BAL levels of MMP-9 and MMP-9/TIMP-1 and decreased MMP-7 and MMP-7/TIMP-1. The increase in MMP-9 levels was associated with a decline in the TH-2 type inflammation. Conclusions:, Our data suggest that reduced TH-2 type inflammation in DIA after inhaled steroid medication is reflected as elevated MMP-9 and MMP-9/TIMP-1 levels in BAL. MIF may be the inducer of MMP-9. This might point to some protective role for MMP-9 in DIA. [source] Under-report and underdiagnosis of chronic respiratory diseases in an African countryALLERGY, Issue 7 2009P. Martins Background:, Chronic respiratory diseases (CRD) are greatly underestimated. The aim of this study was to assess the burden associated with reported CRD and chronic obstructive pulmonary disease, as defined on the basis of various standardized criteria, by estimating their point prevalence in a sample of individuals attending the Primary Health Care (PHC) level and Emergency Room (ER) Departments in Cape Verde (CV) archipelago. The second aim of the study was to identify factors related to airways obstruction and reported CRD in this population. Methods:, A cross-sectional study was carried out in CV during 2 weeks. Outpatients aged more than 20 years seeking care at PHC level and ER answered a standardized questionnaire and were subjected to spirometry, independently of their complaint. Two criteria for airways obstruction were taken into account: forced expiratory volume (FEV1) <80% of the predicted value and FEV1/forced vital capacity (FVC) ratio <0.70. Results:, A total of 274 individuals with a satisfactory spirometry were included. 22% of the individuals had a FEV1 < 80%. Individuals older than 46 years had a higher risk of having airways obstruction. Asthma diagnosis (11%) had a clear association with airways obstruction. Smoking was a risk factor for a lower FEV1. Working in a dust place and cooking using an open fire were both related to chronic bronchitis and asthma diagnosis. Conclusion:, Under-report and underdiagnosis of chronic respiratory conditions seem to be a reality in CV just as in other parts of the world. To improve diagnosis, our results reinforce the need of performing a spirometry. [source] Adherence rate to inhaled corticosteroids and their impact on asthma controlALLERGY, Issue 5 2009L. Lasmar Background:, Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control. Methods:, A cohort concurrent study was carried out for 12 months with 122 asthmatic patients, aged 3,12 years, randomly selected in a pediatric pulmonology outpatient clinic, who received BDP free of charge. Adherence rates were verified by pharmacy records. Clinical control was assessed through a scoring system comprised four variables (nocturnal and morning symptoms, limitation of physical activities and exacerbations). Total score was 16 points. Patients whose score was below or equal to two were considered controlled (group 1), and patients whose score was above or equal to three were considered uncontrolled (group 2). For patients able to perform spirometry, we considered as controlled the patients with forced expiratory volume in 1 s (FEV1) equal to or above 80% of the predicted value, and as uncontrolled the patients with FEV1 below 80%. Results:, Fewer than half (40.3% maximum) of the 122 patients maintained asthma control. Median adherence rate of groups 1 and 2 were 85.5% and 33.8%, (P < 0.001) in the 4th month, 90.0% and 48.0% (P < 0.001) in the 8th month and 84.4% and 47.0% in the 12th month (P < 0.001), respectively. Conclusion:, In all periods, there were statistically significant differences in adherence rates for maintaining or not maintaining the asthma control. Optimal asthma control entailed adherence rate higher than 80%. Strategies for reducing asthma morbidity should include a regular monitoring of adherence to inhaled steroids. [source] Impact of allergic rhinitis on asthma: effects on bronchial hyperreactivityALLERGY, Issue 3 2009I. Cirillo Background:, Remarkable relationship exists between upper and lower airways. Bronchial hyperreactivity (BHR) is a paramount feature of asthma and may be considered a strong risk factor for the onset of asthma in patients with allergic rhinitis. Objective:, This study is aimed at evaluating the presence of BHR in a large group of patients with moderate-severe persistent allergic rhinitis alone, and at investigating possible risk factors related to severe BHR. Methods:, Three hundred and forty-two patients with moderate-severe persistent allergic rhinitis were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry and bronchial methacholine (MCH) test were performed in all patients. Results:, Twenty-two (6.4%) patients had severe BHR, 74 (21.6%) patients had mild BHR and 192 (56.2%) had borderline BHR; 54 (15.8%) patients had a negative MCH test. The logistic regression analysis evidenced that trees and house dust mites sensitization (ORAdj: 8.1), rhinitis duration > 5 years (ORAdj: 5.4) and FEV1 , 86% of predicted (ORAdj: 4.0) were significantly associated with severe BHR. The discriminative ability of this model is appreciably satisfactory, being the AUC = 0.90. Conclusion:, This study highlights the close link between upper and lower airways and the role of some risk factors, such as tree and mite sensitization, > 5-year duration, and , 86% FEV1 values, as risk factors for severe BHR in patients with moderate-severe persistent allergic rhinitis alone. Therefore, BHR is frequently present in patients with chronic rhinitis and should be suspected in the presence of defined risk factors. [source] Predictive value of allergy and pulmonary function tests for the diagnosis of asthma in elite athletesALLERGY, Issue 10 2007M. Bonini Background:, Asthma is frequently found in athletes, often associated with rhinitis and allergy. Aim:, To study the predictive value of allergy and pulmonary function tests for the diagnosis of asthma in athletes. Subjects and methods:, Ninety-eight national preOlympic athletes underwent an accurate medical examination including a validated questionnaire for asthma and rhinitis, spirometric recordings and skin prick testing with a panel of the most frequent inhalant allergens. Bronchodilator and/or exercise challenge were also performed in asthmatic subjects. Results:, Clinical asthma was present in 20.4% of athletes, rhinitis in 35.3% (in 21.4% of cases alone and in 13.9% associated with asthma). Positive prick tests were recorded in 44.4% of athletes (in 60.5% of asthmatics, in 95.2% of rhinitics and in 21.0% of nonasthmatic , nonrhinitic subjects). Mean spirometric values and distribution of abnormal values were not different among asthmatics, rhinitics and nonasthmatics , nonrhinitic patients. Skin-tests positivity was not related to the abnormal spirometric data found in individual cases. Provocation tests with bronchodilators or exercise did not appear sensitive enough to diagnose mild forms of asthma in subjects with normal basal spirometric values. Conclusions:, Allergy testing and spirometry should be performed routinely in athletes because of the high prevalence of allergy, rhinitis and asthma in this population. However, the predictive value of these tests and of the bronchial provocation tests performed in this study seems too low to document mild or subclinical asthma in athletes. [source] | |||||||||||||||||||||||||||||||