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Purpose: To develop and evaluate a theory on the frequent observation that cyclists prefer cadences (RPMs) higher than those considered most economical at submaximal exercise intensities via modeling and simulation of its mathematical description. Methods: The theory combines the parabolic power-to-velocity (v) relationship, where v is defined by crank length, RPM-dependent ankle velocity, and gear ratio, RPM effects on the maximal lactate steady state (MLSS), and lactate-dependent carbohydrate oxidation (CHO). It was tested against recent experimental results of 12 healthy male recreational cyclists determining the v-dependent peak oxygen uptake (VO2PEAKv), MLSS (MLSSv), corresponding power output (PMLSSv), oxygen uptake at PMLSSv (VO2MLSSv), and CHOMLSSv-management at 100 versus 50 per minute, respectively. Maximum RPM (RPMMAX) attained at minimized pedal torque was measured. RPM-specific maximum sprint power output (PMAXv) was estimated at RPMs of 100 and 50, respectively. Results: Modeling identified that MLSSv and PMLSSv related to PMAXv (IPMLSSv) promote CHO and that VO2MLSSv related to VO2PEAKv inhibits CHO. It shows that cycling at higher RPM reduces IPMLSSv. It suggests that high cycling RPMs minimize differences in the reliance on CHO at MLSSv between athletes with high versus low RPMMAX. Conclusions: The present theory-guided modeling approach is exclusively based on data routinely measured in high-performance testing. It implies a higher performance reserve above IPMLSSv at higher RPM. Cyclists may prefer high cycling RPMs because they appear to minimize differences in the reliance on CHO at MLSSv between athletes with high versus low RPMMAX. [ABSTRACT FROM AUTHOR]

Background: SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient‐reported outcome measures (PROMs) in individuals with Parkinson's disease (PD). Methods: This study included 157 participants with PD who underwent an intensive 8‐week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice‐related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index‐10 and communication effectiveness questionnaire. Results: The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs. Conclusion: These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed. WHAT THIS PAPER ADDS: What is already known on the subject: Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient‐reported outcome measures has not been extensively studied. What this paper adds to existing knowledge: This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non‐speech exhalation‐related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient‐reported outcome measures, with reduced voice‐related disability and improved communication efficiency. What are the potential or actual clinical implications of this work?: The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient‐reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD. [ABSTRACT FROM AUTHOR]

Background/Objectives: This systematic review evaluated the impact of nusinersen therapy on respiratory health and function in individuals with spinal muscular atrophy (SMA) and determined whether nusinersen improves pulmonary function, focusing on differences based on patient age and the timing of treatment initiation. Methods: A systematic search of PubMed, Ovid Medline, ScienceDirect, and Web of Science databases was conducted up to January 2024 in accordance with the PRISMA guidelines. Thirteen studies were included, comprising clinical trials, observational studies, and case series that focused on respiratory outcomes in SMA patients treated with nusinersen. The data on study design, participant characteristics, nusinersen intervention, respiratory outcomes, and adverse events were extracted. The Joanna Briggs Institute Critical Appraisal Tool was used to assess study quality. A narrative synthesis was conducted to address the heterogeneity of the studies. Results: This review found a general trend of improvement in pulmonary function, specifically in forced vital capacity (FVC), although the extent and duration of improvement varied across the studies. Peak cough flow (PCF) and peak expiratory flow (PEF) showed positive trends in some studies, although the results were not consistently significant. Respiratory function improvements were frequently observed, particularly in younger patients and those treated earlier. Conclusions: Nusinersen appears to enhance respiratory function and improve motor outcomes in SMA patients, especially with early treatment. However, further research is needed to fully understand its mechanisms and long-term effects on respiratory health in SMA. [ABSTRACT FROM AUTHOR]

Background/Objectives: Surgical pneumoperitoneum (PP) significantly impacts volume-controlled ventilation, characterized by reduced respiratory compliance, elevated peak inspiratory pressure, and an accelerated expiratory phase due to an earlier onset of the airway pressure gradient. We hypothesized that this would shorten expiratory time, potentially increasing expiratory flow rate compared to pneumoperitoneum conditions. Calculations were performed to establish correlations between respiratory parameters and the mean increase in expiratory flow rate relative to baseline. Methods: Mechanical ventilation parameters were recorded for 67 patients both pre- and post-PP. Ventilator settings were standardized with a tidal volume of 6 mL/kg, a respiratory rate of 12 breaths per minute, a PEEP of 3 cmH2O, an inspiratory time of 2 s, and an inspiratory-to-expiratory ratio of 1:1.5 (I:E). Results: The application of PP increased both peak inspiratory pressure and mean expiratory flow rate by 28% compared to baseline levels. The elevated intra-abdominal pressure of 20 cmH2O resulted in a 34% reduction in dynamic chest compliance, a 50% increase in elastance, and a 20% increase in airway resistance. The mean expiratory flow rate increments relative to baseline showed a significant negative correlation with elastance (p = 0.0119) and a positive correlation with dynamic compliance (p = 0.0028) and resistance (p = 0.0240). Conclusions: A PP of 20 cmH2O resulted in an increase in the mean expiratory flow rate in the conventional I:E ratio in the volume-ventilated mode. PP reduces lung and chest wall compliance by elevating the diaphragm, compressing the thoracic cavity, and increasing airway pressures. Consequently, the lungs and chest wall stiffen, requiring greater ventilatory effort and accelerating expiratory flow due to increased airway resistance and altered pulmonary mechanics. Prolonging the inspiratory phase through I:E ratio adjustment helps maintain peak inspiratory pressures closer to baseline levels, and this method enhances the safety and efficacy of mechanical ventilation in maintaining optimal respiratory function during laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Purpose: To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. Materials and methods: This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. Results: The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. Conclusion: Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection. IMPLICATIONS FOR REHABILITATION: The addition of the respiratory muscles function in the preoperative assessment, might contribute to predict prolonged hospital stay in patients submitted to lung resection surgery. Respiratory muscle strength might be included in a prehabilitation program for patients selected to lung resection surgery. The preoperative respiratory muscle strength increment might contribute to reduce economic cost related to prolonged hospital stay after pulmonary resection surgery. [ABSTRACT FROM AUTHOR]

Exogenous nitrate ingestion can improve exercise performance. This study investigated whether an isotonic beetroot drink could improve jump and sprint performance in active individuals. Twenty-three physically active participants (17 males, 6 females) (mean ± SD; age: 26 ± 4 years; body mass index: 22.4 ± 1.9 kg/m2) completed a double-blind, randomized, cross-over study where they consumed 570mL of either beetroot juice drink (BR) or isotonic beetroot juice drink (ISO-BR) three hours before performing countermovement (CMJ) and standing broad jump (SBJ) tests and a 30-second all-out sprint on a cycle ergometer. Both drinks contained equal nitrate (12.9 mmol) and carbohydrate (6.1g per 100mL) content but differed in osmolality (BR: 420 mOsm/kg vs. ISO-BR: 315 mOsm/kg). Salivary total nitrate and nitrite concentrations (NOx) 3 hours post-ingestion were significantly higher after consuming ISO-BR than BR. ISO-BR significantly improved peak power output compared to BR by 3.9% (ISO-BR: 11.4 ± 2.5 W/kg vs. BR: 11.0 ± 2.3 W/kg, p =.04) but not time to peak power (ISO-BR: 2.8 ± 1.7 s vs. BR: 2.9 ± 1.6 s, p =.62) or mean power output (ISO-BR: 7.3 ± 1.5 W/kg vs. BR: 7.3 ± 1.5 W/kg, p =.37). There were no significant differences in CMJ or SBJ between trials (p >.05). Sensory evaluation indicated that ISO-BR was preferred by 91% (n = 21) of participants compared with BR (average score; ISO-BR: 5.52 vs. BR: 3.52, p <.05). An ISO-BR drink improved peak power output during sprint cycling but not jump performance compared with BR alone, potentially via increased NOx. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Gestational diabetes mellitus (GDM) is known to be associated with certain respiratory impairments in offspring. However, the specific association between maternal GDM and childhood lung function remains unclear. We examined the association of maternal glycemia, as measured by oral glucose tolerance test (OGTT) values, with childhood lung function outcomes in a birth cohort. RESEARCH DESIGN AND METHODS: A follow-up study was conducted with 889 children aged 6 years whose mothers underwent a 75-g OGTT between 24 and 28 weeks of gestation. After adjusting for prenatal and postnatal factors, multivariable regression models were used to evaluate the relationship between maternal glycemia and offspring lung function. RESULTS: In total, 10.7% of the offspring were exposed to maternal GDM. Maternal GDM significantly reduced the z score of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and forced expiratory flow at 25–75% of FVC in children, with more pronounced effects in female offspring. Maternal 1- and 2-h post-OGTT glucose z scores and the sum of those z scores, but not those for fasting glucose, were inversely associated with several measures of children's lung function. Additionally, maternal GDM increased the risk of impaired lung function in children (odds ratio 2.64; 95% CI, 1.10–5.85), defined as an FVC <85% of the predicted value. There were no significant associations with FEV1/FVC. CONCLUSIONS: Maternal hyperglycemia was negatively associated with lung function in children, particularly among girls. Further studies are warranted to elucidate the underlying mechanisms of this association and to explore potential interventions to mitigate its effects. [ABSTRACT FROM AUTHOR]

Background: The association of lung function with the risk of developing prodromal and clinical-diagnosed Parkinson's disease (PD) and with the risk of mortality among individuals with PD remains unknown. Objective: To prospectively examine the associations of lung function with the risk of prodromal, clinical-diagnosed PD, and PD-related mortality in participants of the UK Biobank. Methods: Included were 452,518 participants free of PD at baseline. Baseline lung function, including forced expiratory volume in 1-s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and FEV1/FVC ratio, was assessed. Eight prodromal features were measured using self-reported diagnoses, hospital admission, and primary care data. Incident PD cases were identified using linkages with hospital admission, death register, and self-report. Vital status and date of death were provided by the UK National Health Service (NHS) and the NHS Central Register. We used Cox proportional hazard models to evaluate these associations. Results: Poor lung function was associated with higher risk of PD in a dose-response relationship: the adjusted hazard ratio comparing the lowest vs. the highest lung function quintile was 1.18 (95% CI, 1.02– 1.37) for FEV1, 1.14 (95% CI, 0.99– 1.29) for FVC, and 1.23 (95% CI, 1.08– 1.41) for PEF (p-trend <0.05 for all). Similar results were obtained for risk of prodromal PD and mortality among individuals with PD. Conclusions: The current study showed that individuals with poor lung function had a high future risk of prodromal and clinical PD and a higher rate of PD-related mortality. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cystic fibrosis (CF) patients frequently experience gut microbiota dysbiosis. Probiotic supplementation is a potential therapeutic approach to modify gut microbiota and improve CF management through the gut–lung axis. The aim of this study was to investigate the effect of Lactobacillus reuteri supplementation on pulmonary function test, respiratory symptoms and growth in CF patients. METHODS: A randomized, placebo‐controlled clinical trial was carried out on 40 children with CF aged from 6 to 20 years. Participants were designated to receive either L. reuteri or placebo daily for 4 months. Pulmonary function tests, weight, height and body mass index (BMI) z‐scores were measured pre and post treatment. RESULTS: The median baseline BMI of the patients was 16.28 kg m−2. A significant change in the probiotic group's BMI z‐score after the study period was observed (P = 0.034) but not for weight and height z‐scores (P > 0.05). After treatment, Pseudomonas aeruginosa grew in sputum cultures of seven in the placebo and one patient in the intervention group (P = 0.03) while at baseline it grew in the sputum of four patients in each group. There was no significant difference in forced expiratory volume in the first second, forced expiratory flow at 25–75% or forced vital capacity change between the two groups after the treatment period (P > 0.05). Additionally, no significant differences were found in pulmonary exacerbations, hospitalization frequencies or COVID‐19 infection between the two groups during the study (P > 0.05). CONCLUSION: The results suggest that L. reuteri supplementation may impact the growth of severely malnourished CF patients. Furthermore, it may be concluded that this strain might reduce P. aeruginosa in the sputum culture of CF patients. © 2024 Society of Chemical Industry. [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]

Background: Expiratory flow limitation (EFL) during tidal breathing and lung hyperinflation have been identified as major decisive factors for disease status, prognosis and response to therapy in obstructive lung diseases. Aim: To investigate the delta values between expiratory and inspiratory resistance and reactance, measured using respiratory oscillometry and its correlation with air trapping and symptoms in subjects with obstructive lung diseases. Methods: Four hundred and seventy‐one subjects (96 with chronic obstructive pulmonary disease [COPD], 311 with asthma, 30 healthy smokers and 34 healthy subjects) were included. Spirometry, body plethysmography and respiratory oscillometry measurements were performed and the differences between the expiratory and inspiratory respiratory oscillometry values (as delta values) were calculated. Questionnaires regarding symptoms and quality of life were administered. Results: Patients with COPD and healthy smokers had an increased delta resistance at 5 Hz (R5) compared with patients with asthma (p < 0.0001 and p = 0.037, respectively) and healthy subjects (p = 0.0004 and p = 0.012, respectively). Patients with COPD also had higher values of ΔR5–R19 than healthy subjects (p = 0.0001) and patients with asthma (p < 0.0001). Delta reactance at 5 Hz (X5) was significantly more impaired in COPD patients than in asthma and healthy subjects (p < 0.0001 for all). There was a correlation between the ratio of residual volume and total lung capacity and ΔR5 (p = 0.0047; r = 0.32), ΔR5–R19 (p = 0.0002; r = 0.41) and ΔX5 (p < 0.0001; r = −0.44), for all subjects. ΔX5 correlated with symptoms in COPD, healthy smokers and patients with asthma. In addition, ΔR5 correlated with asthma symptoms. Conclusion: EFL was most prominent in parameters measuring peripheral resistance and reactance and correlated with air trapping and airway symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lung volume measurements are important for monitoring functional aeration and recruitment and may help guide adjustments in ventilator settings. The expiratory phase of airway pressure release ventilation (APRV) may provide physiologic information about lung volume based on the expiratory flow-time slope, angle, and time to approach a no-flow state (expiratory time [TE]). We hypothesized that expiratory flow would correlate with estimated lung volume (ELV) as measured using a modified nitrogen washout/washin technique in a large-animal lung injury model. METHODS: Eight pigs (35.2 ± 1.0 kg) were mechanically ventilated using an Engström Carescape R860 on the APRV mode. All settings were held constant except the expiratory duration, which was adjusted based on the expiratory flow curve. Abdominal pressure was increased to 15 mm Hg in normal and injured lungs to replicate a combination of pulmonary and extrapulmonary lung injury. ELV was estimated using the Carescape FRC INview tool. The expiratory flow-time slope and TE were measured from the expiratory flow profile. RESULTS: Lung elastance increased with induced lung injury from 29.3 ± 7.3 cm H2O/L to 39.9 ± 15.1cm H2O/L, and chest wall elastance increased with increasing intra-abdominal pressures (IAPs) from 15.3 ± 4.1 cm H2O/L to 25.7 ± 10.0 cm H2O/L in the normal lung and 15.8 ± 6.0 cm H2O/L to 33.0 ± 6.2 cm H2O/L in the injured lung (P = .39). ELV decreased from 1.90 ± 0.83 L in the injured lung to 0.67 ± 0.10 L by increasing IAP to 15 mm Hg. This had a significant correlation with a TE decrease from 2.3 ± 0.8 s to 1.0 ± 0.1 s in the injured group with increasing insufflation pressures (ρ = 0.95) and with the expiratory flow-time slope, which increased from 0.29 ± 0.06 L/s² to 0.63 ± 0.05 L/s² (ρ = 0.78). CONCLUSIONS: Changes in ELV over time, and the TE and flow-time slope, could be used to demonstrate evolving lung injury during APRV. Using the slope to infer changes in functional lung volume represents a unique, reproducible, real-time, bedside technique that does not interrupt ventilation and may be used for clinical interpretation. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross-sectional study is to investigate the levels of NLRP3 in the serum and induced sputum of children with asthma and their potential association with lung function and disease severity. Methods: This cross-sectional study included 83 children with bronchial asthma who sought medical care at our hospital from May 2023 to February 2024. Portable spirometry was used to monitor lung function parameters, including forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow. The expression of C-reactive protein (CRP), interleukin (IL)-6, IL-1β, TNF-α, and Nod-like receptor family pyrin domain-containing 3 (NLRP3) in the serum and induced sputum were measured by enzyme-linked immunosorbent assay. Data analysis was performed using SPSS 25.0 and differences with P < 0.05 were considered statistically significant. Results: Children with asthma exhibited significantly elevated levels of serum NLRP3, CRP, IL-6, IL-1β, and TNF-α compared to healthy controls. In addition, children with moderate–severe asthma had significantly higher levels of serum and induced sputum NLRP3 and IL-1β compared to children with mild asthma. Spearman's correlation analysis revealed a positive correlation between induced sputum NLRP3 and IL-6. Moreover, induced sputum NLRP3 was negatively correlated with lung function parameters. The results of receiver operating characteristic curves showed that induced sputum NLRP3 could be used for diagnosing children with moderate–severe asthma, with an AUC was 0.758, cutoff value of 3.33 ng/mL, sensitivity of 66.1%, and specificity of 70.8%. Furthermore, the logistic regression analysis revealed that serum and induced sputum NLRP3, induced sputum IL-6 and IL-1β were risk factors for children with moderate–severe asthma. Conclusions: In this cross-sectional study, we found a significant increase in NLRP3 levels in induced sputum of children with asthma, which further increased in those with moderate–severe disease. The levels of NLRP3 in induced sputum could serve as potential biomarkers for assessing disease severity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Textile-sizing mill workers are exposed to various hazards in the sizing units during their working hours and are at risk of acquiring lung impairments due to the usage of sizing chemicals in the sizing process. OBJECTIVE: The main aim of this study is to assess the influence of cotton dust and sizing agents on lung function and breathing difficulties among Indian textile sizing mill workers. METHODS: This cross-sectional study was carried out at a textile-sizing mill from August 2022 to September 2022. A modified questionnaire based American Thoracic Society's standard was used to assess respiratory symptoms among sizing mill workers and the pulmonary function test was conducted Spirometry. The chi-square test was used to find the difference between respiratory symptoms and the t-test was used to find the difference between spirometric parameters. RESULTS: Textile sizing mill workers showed significant (P < 0.0001) decline in peak expiratory flow rate, forced vital capacity (FVC), ratio of FEV1 and forced vital capacity, and forced expiratory volume in 1 s (FEV1). There was an association between symptoms and duration of exposure to pulmonary abnormality. Sizing mill workers showed a significant decline in lung functions and an increase in pulmonary symptoms. As the service duration of exposure in terms of years increased, respiratory symptoms increased and spirometric abnormality also increased. CONCLUSION: This study confirms that sizing agents such as polyvinyl alcohol (PVA), emulsifier, wax, carboxymethyl cellulose (CMC), and starch used in sizing mills are also responsible for respiratory illness and lung impairment among textile workers. [ABSTRACT FROM AUTHOR]

Purpose: The correlation between body weight and health is a significant public health concern. While the adverse effects of obesity on pulmonary function are well-known, the impact of being underweight remains debated due to limited research. This study aimed to investigate the correlation between Body Mass Index (BMI) categories and lung function parameters. Results: A study of 3077 participants found significant differences in gender, age, height, and weight across various Body Mass Index (BMI) categories. The study found non-significant variations in forced expiratory flow (FVC) across BMI categories, with underweight individuals showing lower FVC compared to normal and overweight individuals. BMI significantly impacted mean forced expiratory flow during the middle half of FVC. A significant negative correlation was observed between age and FVC, FEV1, FEV1/FVC ratio, and FEF25-75. A significant positive correlation was observed between weight, height, and lung function parameters. Multiple regression analysis revealed a decrease in lung function with advancing age, while height showed significant positive associations. The study concluded that age, sex, smoking, height, and weight collectively explained 41.0% of the variance in FVC, FEV, and FEF25-75. [ABSTRACT FROM AUTHOR]

Obesity is a common public health issue worldwide, and its negative impact on lung function has garnered widespread attention. This study sought to investigate the possible association between a new obesity metric, the weight-adjusted waist index (WWI), and lung functions, providing a basis for the monitoring and protection of lung functions. We conducted a cross-sectional evaluation, analyzing data from adults in the U.S. gathered through the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. To explore the correlation between WWIs and lung functions, we utilized a multivariate logistic regression model with appropriate weighting to ensure accuracy. Smooth curve fitting also helped to confirm the linear nature of this relationship. Subgroup analyses were conducted to confirm the uniformity and dependability of the results. Our study included data from 13,805 adults in the United States. Multivariate linear regression analysis revealed that, in the fully adjusted model, higher WWIs were negatively correlated with forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and forced expiratory flow rate (FEF) 25%-75% (β = -0.63; 95% confidence interval [CI] [-0.71, -0.55]; β = -0.55; 95% CI [-0.62, -0.48]; β = -0.02; 95% CI [-0.03, -0.01]; β = -1.44; 95% CI [-1.65, -1.23]; β = -0.52; 95% CI [-0.65, -0.39], respectively). Additionally, when analyzing the WWI as a categorical variable, a significant downward trend in the FVC, FEV1, PEF, and FEF 25%-75% was observed from Q2 to Q4 as the WWI increased (trend P < 0.05). Subgroup analysis showed stronger associations between WWI and lung functions, particularly among younger, non-Hispanic white, male participants, and current smokers. Our results indicate that elevated WWI is strongly associated with declining lung functions, demonstrating the importance of long-term monitoring and tracking of WWIs. [ABSTRACT FROM AUTHOR]

Background: Beyond the acute phase, a considerable proportion of patients recovering from the coronavirus disease 2019 (COVID-19) experience long-term sequelae that profoundly impact their quality of life, particularly their physical fitness. This study aims to assess the effect of home-based breathing and chest mobility exercise on the cardiorespiratory functional capacity of long COVID with cardiovascular comorbidity. Methods: In this randomized, controlled, single-blind clinical trial, 46 long COVID with cardiovascular comorbidities were randomly assigned to either intervention or control group. The intervention group (n = 23) received additional home-based breathing and chest mobility exercise 3x/week for 12 weeks supervised by attending physicians, whereas the control group only received a home-based cardiac rehabilitation program. Baseline and post-intervention assessments consisted of laboratory (D-Dimer and CRP levels) and functional capacity, assessed through 6-minute walking test (6-MWT), exercise stress test's metabolic equivalents (METS), and predicted peak oxygen consumption (VO2 peak), peak expiratory flow rate (PEFR), peak cough flow (PCF), chest expansion, and EuroQoL's quality of life. Intention to treat analysis was performed. Results: At the 12th week, intervention subjects had significantly greater functional capacity with higher mean PEFR (p =.031) and PCF (p =.016). Similarly, 6-MWT was higher in the group receiving home-based breathing and chest mobility training (p =.032). The bottom part of the chest circumference was statistically different between the two groups (p =.01). METS and predicted VO2 peak were also higher in the intervention group. However, laboratory parameters and quality of life did not differ markedly (p >.05). Conclusions: Home-based respiratory and chest mobility exercise could be an adjunct to cardiac rehabilitation in long COVID with cardiovascular comorbidities for improving cardiorespiratory functional capacity. Trial registration: The study protocol was registered at http://ClinicalTrial.gov.id NCT05077943 (14/10/2021). [ABSTRACT FROM AUTHOR]

Background: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices—maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns—with weaning failure. Methods: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Results: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01–1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86–0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98–1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Conclusions: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study. [ABSTRACT FROM AUTHOR]

Introduction: Unregulated expiratory flow may contribute to ventilator-induced lung injury. The amount of energy dissipated into the lungs with tidal mechanical ventilation may be used to quantify potentially injurious ventilation. Previously reported devices for variable expiratory flow regulation (FLEX) require, either computer-controlled feedback, or an initial expiratory flow trigger. In this bench study we present a novel passive expiratory flow regulation device. Methods: The device was tested using a commercially available mechanical ventilator with a range of settings (tidal volume 420 ml and 630 ml, max. inspiratory flow rate 30 L/min and 50 L/min, respiratory rate 10 min−1, positive end-expiratory pressure 5 cmH2O), and a test lung with six different combinations of compliance and resistance settings. The effectiveness of the device was evaluated for reduction in peak expiratory flow, expiratory time, mean airway pressure, and the reduction of tidal dissipated energy (measured as the area within the airway pressure–volume loop). Results: Maximal and minimal reduction in peak expiratory flow was from 97.18 ± 0.41 L/min to 25.82 ± 0.07 L/min (p < 0.001), and from 44.11 ± 0.42 L/min to 26.30 ± 0.06 L/min, respectively. Maximal prolongation in expiratory time was recorded from 1.53 ± 0.06 s to 3.64 ± 0.21 s (p < 0.001). As a result of the extended expiration, the maximal decrease in I:E ratio was from 1:1.15 ± 0.03 to 1:2.45 ± 0.01 (p < 0.001). The greatest increase in mean airway pressure was from 10.04 ± 0.03 cmH2O to 17.33 ± 0.03 cmH2O. Dissipated energy was significantly reduced with the device under all test conditions (p < 0.001). The greatest reduction in dissipated energy was from 1.74 ± 0.00 J to 0.84 ± 0.00 J per breath. The least reduction in dissipated energy was from 0.30 ± 0.00 J to 0.16 ± 0.00 J per breath. The greatest and least percentage reduction in dissipated energy was 68% and 33%, respectively. Conclusions: The device bench tested in this study demonstrated a significant reduction in peak expiratory flow rate and dissipated energy, compared to ventilation with unregulated expiratory flow. Application of the device warrants further experimental and clinical evaluation. [ABSTRACT FROM AUTHOR]

Background: The impact of polycyclic aromatic hydrocarbons (PAHs) on lung function has garnered attention, but studies mostly focus on individual effect. This study investigates urinary PAH metabolites as biomarkers of exposure and assesses the relationships between single and combined exposures to nine urinary PAH metabolites and lung function in adults. Methods: Data from 4040 adults in the 2007–2012 National Health and Nutrition Examination Survey (NHANES) were analyzed. Weighted generalized linear models estimated the effects of individual PAH metabolites on lung function. Additionally, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) were employed to evaluate the combined impacts of multiple PAH metabolites. Results: Analyses of individual PAH metabolites revealed negative associations with lung function, excluding forced vital capacity (FVC). The WQS, qgcomp, and BKMR models consistently showed that exposure to multiple PAH metabolites was associated with lung function decrease. WQS indicated that 2-hydroxynaphthalene (2-NAP) was the largest contributor to the reductions in forced expiratory volume in 1 s (FEV1), FVC, peak expiratory flow (PEF), and forced expiratory flow from 25 to 75% of FVC (PEF25-75%). Additionally, 1-hydroxypyrene (1-PYR) was the primary PAH metabolite contributing to the decreases in FEV1/FVC and fractional exhaled nitric oxide (FeNO). The combined effect of urinary PAH metabolites did not affect FVC in the current smokers or FeNO in nonsmokers, but decreased FEV1/FVC in current smokers. Conclusion: This study strengthens the negative relationships between multiple PAH metabolites exposure and lung function in adults. Given the limitations of this study, including the lack of knowledge of other exposure pathways and the uncertainty of urinary metabolites, further research is necessary to explore the mechanisms underlying these associations and to address the limitations in exposure assessment. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Poor respiratory function, including low peak expiratory flow (PEF), is a risk factor for dementia. Motoric cognitive risk syndrome (MCR) is a predementia syndrome characterized by slow gait and subjective cognitive complaints. However, the association between PEF and MCR remains unclear. This study examined the cross‐sectional and longitudinal association between PEF and MCR.The National Health and Aging Trends Study (NHATS), which is a nationally representative cohort of adults ≥65 years of age in the United States, was analyzed from 2011 to 2017. Logistic regression and discrete‐time proportional hazards models tested the association of PEF standardized residuals (SR) at baseline with prevalent and incident MCR, respectively. The models adjusted for multiple sociodemographic and health‐related covariates.Among 5328 participants (57% women) included at baseline, lower PEF SR was associated with higher prevalence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30–50 percentile groups had significantly higher odds of prevalent MCR (OR 3.04 [95% CI 1.85, 5.01]; OR 2.06 [95% CI 1.19, 3.54], respectively). Over six years of follow‐up, lower PEF SR was also associated with higher incidence of MCR. Compared with the ≥80 PEF SR percentile group, the <30 and 30–50 percentile groups had significantly higher risk of incident MCR (HR 1.81 [95% CI 1.24, 2.66]; HR 1.55 [95% CI 1.02, 2.34], respectively).Lower PEF was associated with higher prevalence and incidence of MCR. Poor respiratory function should be further investigated as a potentially modifiable risk factor for MCR and cognitive decline. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly employed to support lung function in patients with acute respiratory failure (ARF). However, the long-term outcomes of the approach have not been encouraging when compared to those of conventional mechanical ventilation. Further, the long-term effects of ECMO on lung function and recovery are unclear. For this review, we examined the long-term lung function outcomes of patients with ARF treated with and without ECMO. Methods: We searched the Embase, CENTRAL, Web of Science, and PubMed sites for studies comparing long-term (≥ 6 months) pulmonary function test results in patients with ARF treated with and without ECMO published until January 2024. We conducted a meta-analysis for percentage predicted values. Results: We included five studies. Our meta-analysis showed similar values of forced vital capacity (FVC%) (MD, 0.47; 95% CI, -3.56–4.50) and forced expiratory flow in the first second % (MD, 1.79; 95% CI, -2.17–5.75) in patients with ARF treated with or without ECMO. The FEV1/FVC % values were slightly higher in patients treated with ECMO than in those without ECMO (MD, 2.03; 95% CI, 0.01–4.04; p-value = 0.05). According to the meta-analysis, the values for total lung capacity % (MD, -3.20; 95% CI, -8.83–2.44) and carbon monoxide diffusion capacity % (MD, -0.72; 95% CI, -3.83–2.39) were also similar between patients undergoing ECMO and those without it. Conclusion: The meta-analysis of a small number of studies with significant selection bias indicates that patients with ARF treated with ECMO may have comparable long-term pulmonary function recovery to those treated with conventional strategies. Further investigations including a larger number of patients and focusing on the long-term impact of ECMO are needed to supplement the current evidence. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo evaluate the impact of peak expiratory flow (PEF) monitoring using a smart peak flow (SPF) device on the quality of life (QoL) and satisfaction among children with asthma.This 3-month prospective cohort study enrolled 71 children aged 7 to 17 years with physician-diagnosed asthma. Participants used the SPF device twice daily, with measurements recorded automatically. Quality of life was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Adherence to PEF measurements and satisfaction with the device were evaluated.Seventy-one children (mean age 11.4 years) completed the study. Adherence to twice-daily PEF measurements decreased significantly over three months (from 50.0% at 1 month to 39.9% at 3 months, p < 0.001). Children with good adherence (38.0%) showed significant improvements in PAQLQ scores, while those with poor adherence (62.0%) did not. COVID-19 infection resulted in a significant decrease in %PEF rate and increased peak flow variability. Despite device-related issues, overall satisfaction was high (85.19% for good adherence users vs. 88.64% for poor adherence users, p = 0.671).Regular PEF monitoring improves QoL in children with asthma by enabling early detection of symptom changes and better management. However, maintaining adherence to regular PEF monitoring is challenging. Further research with control groups is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Background Objectives Method Results Conclusions When re‐learning a motor skill, practicing a variety of treatment targets promotes error processing and the exploration of motor control strategies, which initially disrupts accuracy during training (motor performance), but ultimately enhances generalization, retention, and transfer (motor learning). Cough skill training (CST) is feasible and efficacious to improve cough strength; however, previous studies have used the same practice target during training.Our goal was to examine the impact of CST with variable practice on motor performance, motor learning, and respiratory system adaptations.The study was a prospective three‐visit single group design. Twenty individuals with Parkinson's disease (PD) and concomitant dysphagia and dystussia completed two sessions of CST involving three randomized practice targets. Cough, lung volume, and airway clearance outcomes were assessed before and after treatment sessions with long‐term retention evaluated after 1 month.Peak expiratory flow rate improved after CST with variable practice for voluntary single (β = 0.35 L/s) and sequential (β = 0.22 L/s) cough, which were maintained after 1 month without treatment. The ability to expel material from the upper airway demonstrated a small magnitude of improvement (β = −1.87%). During CST, participants altered lung volume based on the treatment target and lung volume decreased during reflex cough after completing CST.Individuals with PD demonstrated improvements in several aspects of motor learning after two sessions of CST with variable practice. Increasing lung volume may not be an implicit strategy to upregulate voluntary cough strength in this treatment paradigm. The findings support the need for larger investigations exploring the potential benefits of this CST approach. [ABSTRACT FROM AUTHOR]

This project sought to educate providers on the benefits of lung protective ventilation (LPV), implement a LPV protocol in robotic surgery, and evaluate adherence to the protocol in the adult (≥ 18 years) robotic-assisted surgery population. This project used a pre/post quality improvement design with a retrospective chart review and periodic knowledge, attitude, and practice surveys over the course of 6 months. This project retrospectively reviewed electronic medical records to assess adherence to the LPV protocol. The type of surgery; ventilator settings including positive end-expiratory pressure, FiO2, tidal volume, SpO2, ventilator mode, compliance, driving pressure and peak pressure; patient height and weight; patient body mass index; and American Society of Anesthesiologists physical status classification were collected. Analyzed results compared baseline preeducation data and data collected at 3- and 6-months postimplementation. Adherence to the LPV protocol parameters of tidal volume (P < .001), respiratory rate (P = .014), and driving pressure (P < .001) within LPV limits improved with statistical significance from pre- to postimplementation. Provider confidence and knowledge increased from pre- to posteducation (P = .049). Adherence to a LPV protocol improved with education and information tools. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory exercise and flow breathing spirometer is an exercise of importance for patients with upper abdominal surgery. The incentive spirometry technique was used to encourage the patient to take maximum and long inspiration, and slow deep breathing using a device to measure flow or sound. With this background the present study aim is to compare the effect of deep breathing exercise, flow and volume incentive spirometry, on pulmonary function and diaphragm excursion, following laparoscopic surgery. Method and Method: We compare methods perform deep Breathing Exercise with methods to Perform Incentive Spirometry making three groups A 40 patients, B 40 patients, C control 40 patients. Pulmonary function tests, Forced Vital Capacity, Forced Expiratory Volume in the first second, Peak Expiratory Flow Rate. These were taken on the preoperative day Day1, 1st and the 2nd postoperative day, for all groups, day 2 and 3 respectively. Results: There was a statistically significant decrease in Forced Vital Capacity (FVC) in the 1st and 2nd postoperative day when compared with the preoperative period in all groups. In all groups there was a statistically significant decrease in Forced Expiratory Volume at the end of the first second (FEV1) on the 1st and 2nd post-operative day when compared to the preoperative period. Conclusions: The main purpose of this study is to compare deep breathing exercise, Flow incentive spirometry. In our study we found that deep breathing exercise and incentive spirometry improve lung function in patients undergoing laparoscopic cholecystectomy surgery. [ABSTRACT FROM AUTHOR]

Background and Purpose: To examine the respiratory and functional benefits of manual diaphragmatic release for Cleaning‐Laborers Exposed to Occupational Hazards. Methods: A randomized controlled trial of 36 participants aged 35–45 years was randomly allocated into two groups. The experimental group (n = 18); received manual diaphragm release along with respiratory training exercises, and the control group (n = 18); received respiratory training exercises only. Three times/week for 12 consecutive weeks. The serum immunoglobulin E level, pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) rate (PEF)], chest wall mobility, and 6 min walk‐test performance were assessed pre‐ and post‐intervention. Results: There was a greater decline in serum immunoglobulin levels (p = 0.003; Partial η2 = 0.23) and enhancement in pulmonary functions [FEV1 (p = 0.025, Partial η2 = 0.14), FVC (p = 0.017, Partial η2 = 0.16), FEV1/FVC (p = 0.028, Partial η2 = 0.13), and PEF (p = 0.012, Partial η2 = 0.17) in the experimental group. Further, there was a greater increase in chest mobility at the xiphoid level (p = 0.002, Partial η2 = 0.25) in the experimental group, but this was not the case at the axillary level (p = 0.29, Partial η2 = 0.03). Still, the 6 min walk‐test performance improved more significantly in the experimental group (p = 0.002, Partial η2 = 0.24). Conclusion: The diaphragmatic release technique may offer a promising approach for mitigating distressing respiratory symptoms, enhancing immune function, and improving 6 min walk‐test performance among cleaning laborers with work‐related respiratory hazards. Trial registration: The study was retrospectively registered at XXX (ID: NCT05802355). [ABSTRACT FROM AUTHOR]

Objective: To investigate the mechanism of Morin hydrate (MH) on pyroptosis of alveolar epithelial cells in rats with chronic obstructive pulmonary disease (COPD) by inhibiting nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)/cysteinyl aspartate specific proteinase-1 (Caspase-1)/IL-1β signaling pathway. Methods: COPD model rats were established by smoking method, which were randomly divided into model group (COPD group), low, medium and high doses MH groups (MH-L, MH-M, MH-H groups) (50, 100, 200 mg/kg) and positive control group (dexamethasone group, DXMS, 0.09 mg/kg), another 10 healthy rats were taken as normal control group (NC group). Pulmonary function indexes [tidal volume (TV), forced vital capacity (FVC) and peak expiratory flow rate (PEF)] were measured; HE staining was used to observe pathological changes of lung tissue; pyroptosis of alveolar epithelial cells was observed by immunofluorescence double staining; levels of inflammatory factors in bronchoalveolar lavage fluid (BALF) were detected by ELISA; levels of NLRP3, Caspase-1, gasdermin D (GSDMD) and IL-1β mRNA were detected by RT-qPCR; protein expressions of SP-C, NLRP3, C-Caspase-1, GSDMD, GSDMD-N and IL-1β in lung tissue were detected by Western blot. Results: Compared with COPD group, pathological changes of lung tissue including lumen stenosis, mucus secretion and bronchial epithelial cell necrosis in DXMS group and MH groups were significantly improved, the pulmonary function indexes (TV, FVC, PEF) were increased obviously (P<0.05), and increased in turn in MH-L, MH-M, MH-H groups (P< 0.05); levels of TNF-α, IL-6, IL-8, immunofluorescence expressions of NLRP3 and C-Caspase-1, and mRNA levels of NLRP3, Casdoi: pase-1, GSDMD, IL-1β, protein levels of NLRP3, C-Caspase-1, GSDMD, GSDMD-N and IL-1β were decreased obviously, while SP-C protein expression was gradually increased (P<0.05). Conclusion: MH can inhibit the NLRP3/Caspase-1/IL-1β signaling pathway, the release of inflammatory factors and pyroptosis by it, and alleviate lung pathological changes in COPD rats. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a chronic inflammatory condition affecting the airways, characterized by an exaggerated response of the trachea-bronchial system to various stimuli. This condition leads to significant narrowing of the airways, which can be alleviated through medication or may resolve spontaneously Therefore, this study focuses on arterial blood gas analysis in patients experiencing acute severe asthma and chronic bronchial asthma upon hospital admission, with particular attention to acid-base status, PaO2, PaCO2, and HCO3- levels. Aim and Objectives: To compare arterial blood gas analysis of acute severe bronchial asthma with chronic bronchial asthma. Materials and Methods: A cross-sectional study was conducted involving 50 asthmatic patients aged between 20 and 75 years, who presented at a tertiary care hospital over a 12-month period. The study excluded pregnant women, children, smokers, and individuals with other respiratory conditions. The entire procedure was thoroughly explained to each patient, and informed consent was obtained. Results: P-value for comparison pf Ph in between the groups was <0.05 which was statistically significant in between the groups. P-value for comparison of mean PaCO2 levels in between the groups was <0.05 which is statistically significant in between the groups. P-value for comparison if PaO2levels in between the groups was > 0.05 which was statistically insignificant in between the groups. Conclusion: It is important to note that arterial blood gas analysis alone does not adequately reflect the severity of an asthma attack; it should be supplemented with further assessments, including Peak Expiratory Flow Rate (PEFR) and Forced Expiratory Volume in one second (FEV1), in conjunction with a clinical evaluation of signs and symptoms. [ABSTRACT FROM AUTHOR]

Background: Household air pollution arising from combustion of unclean fuels during cooking activities causes serious respiratory health effects. This study investigated patterns of household cooking fuel use and its effect on respiratory health status of women and children. Methods: A cross-sectional study was conducted in rural households of Ballabgarh, Haryana during December 2019 to January 2020 among 18–45 years old women and their children having age between 6 and 59 months. A total of 450 households were selected using simple random sampling. Cooking fuel use was categorised as unclean (Wood, dung cakes, crop residues) and clean (LPG and electricity). The classification of mixed fuel use (predominantly unclean or clean) was based upon duration of unclean fuel use ≥ 2.5 h per day. The clinical history and physical examination was done using a semi-structured questionnaire. Assessment of respiratory health status of women participants was done using peak expiratory flow meter and presence of pneumonia in children was evaluated as per Integrated Management of Neonatal and Childhood Illnesses (IMNCI) guidelines. Results: Overall use of unclean cooking fuels was predominant in 59.6% of households and 71.8% of households had mixed fuel use. Only clean fuel use was in 11.3% of households. Nasal stuffiness, breathing difficulty and cough were observed among 13.1%, 10.5% and 8.5% among women while the common respiratory symptoms in children were cough (27.8%) and runny nose (22.9%). As compared to clean fuels, women using unclean fuels were more likely to have any respiratory symptom (aOR 3.0, 95% CI: 1.5-6.0) and impaired pulmonary functions (adjusted OR 1.9, 95% CI: 1.2–2.9). Cooking fuel use was not associated with respiratory symptoms and presence of pneumonia in children living in the households. Conclusion: Cooking with unclean fuel continues to be prevalent in the households of rural Ballabgarh and adversely affects the respiratory health of women indicating strengthening of initiatives promoting clean fuel use. [ABSTRACT FROM AUTHOR]

We sought to determine the repeatability of EFL in healthy adults during incremental cycle exercise. We hypothesized that the repeatability of EFL would be "strong" when assessed as a binary variable (i.e., absent or present) but "poor" when assessed as a continuous variable (i.e., % tidal volume overlap). Thirty‐two healthy adults performed spirometry and an incremental cycle exercise test to exhaustion on two occasions. Standard cardiorespiratory variables were measured at rest and throughout exercise, and EFL was assessed by overlaying tidal expiratory flow‐volume and maximal expiratory flow‐volume curves. The repeatability of EFL was determined using Cohen's κ for binary assessments of EFL and intraclass correlation (ICC) for continuous measures of EFL. During exercise, n = 12 participants (38%) experienced EFL. At peak exercise, the repeatability of EFL was "minimal" (κ = 0.337, p = 0.145) when assessed as a binary variable and "poor" when measured as a continuous variable (ICC = 0.338, p = 0.025). At matched levels of minute ventilation during high‐intensity exercise (i.e., >75% of peak oxygen uptake), the repeatability of EFL was "weak" when measured as a binary variable (κ = 0.474, p = 0.001) and "moderate" when measured as a continuous variable (ICC = 0.603, p < 0.001). Our results highlight the day‐to‐day variability associated with assessing EFL during exercise in healthy adults. [ABSTRACT FROM AUTHOR]

Background: Expiratory flow limitation (EFL) can be detected using oscillometric reactance and is associated with a worse clinical presentation in chronic obstructive pulmonary disease (COPD). Reactance can show negative swings upon exhalation, which may develop at different rates between patients. We propose a new method to quantify the rate of EFL development; the EFL Development Index (ELDI). Methods: A retrospective analysis of data from 124 COPD patients was performed. Data included lung function tests, Impulse Oscillometry (IOS), St Georges Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) scale and COPD Assessment Test (CAT) score. Fifty four patients had repeat data after 6 months. Twenty two patients had data recorded after 5 days of treatment with long acting bronchodilator therapy. EDLI was calculated as the mean expiratory reactance divided by the minimum expiratory reactance. Results: The mean ELDI was used to categorise patients with rapid onset of EFL (> 0.63; n = 29) or gradual onset (≤ 0.63; n = 34). Those with rapid development had worse airflow obstruction, lower quality of life scores, and greater resting hyperinflation, compared to those with gradual development. In patients with EFL, ELDI correlated with symptoms scores, airflow obstruction, lung volumes and gas diffusion. Both EFL and ELDI were stable over 6 months. EFL and EDLI improved with bronchodilator treatment. Conclusions: COPD patients with rapid EFL development (determined by ELDI) had worse clinical characteristics than those with gradual EFL development. The rate of EFL development appears to be associated with clinical and physiological characteristics. Take home message: We propose a new method of quantifying the rate of EFL development (EFL Development Index; ELDI), and report that those with rapid EFL development upon exhalation have worse physiological and clinical characteristics. [ABSTRACT FROM AUTHOR]

Aim: Aging is a major cause of cognitive dysfunction. It has also been reported that respiratory function may influence cognitive dysfunction. However, few studies have examined the relationship between cognitive function and respiratory function among community‐dwelling older adults. This study aims to determine the relationship between respiratory function, assessed using spirometry, and mild cognitive impairment (MCI) in community‐dwelling older adults. Methods: This study included 419 participants aged 73 ± 1 years and 348 participants aged 83 ± 1 years from the SONIC cohort study (Septuagenarians Octogenarians Nonagenarians Investigation with Centenarians Study). Respiratory function was evaluated using %Vital Capacity (%VC), Forced Expiratory Volume 1 s (FEV1)/Forced Vital Capacity (FVC), and %Peak Expiratory Flow (%PEF). Airflow‐limitation presence and stages were classified using FEV1/FVC. Cognitive function and MCI were assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA‐J). Results: The MoCA‐J score exhibited a declining trend as the airflow‐limitation stage increased among study participants in the 83 ± 1 age group. The presence of airflow limitation was associated with MCI in the 83 ± 1 age group. Among the indicators of each respiratory function, low %PEF was found to be associated with an increased rate of MCI. Furthermore, low %VC has also been suggested to be associated with an increased rate of MCI in the 83 ± 1 age female group. Conclusions: Advanced airflow‐limitation stages may exacerbate cognitive dysfunction in community‐dwelling older adults. The presence of airflow limitation and low %VC may also be associated with cognitive dysfunction in older women. Consequently, reduced respiratory function may potentially be associated with MCI in community‐dwelling older adults. Geriatr Gerontol Int 2024; 24: 1001–1007. [ABSTRACT FROM AUTHOR]

Objective: Current monitoring methods of asthma, such as peak expiratory flow testing, have important limitations. The emergence of automated acoustic sound analysis, capturing cough, wheeze, and inhaler use, offers a promising avenue for improving asthma diagnosis and monitoring. This systematic review evaluated the validity of acoustic biomarkers in supporting the diagnosis of asthma and its monitoring. Data sources: A search was performed using two databases (PubMed and Embase) for all relevant studies published before November 2023. Study selection: 27 studies were included for analysis. Eligible studies focused on acoustic signals as digital biomarkers in asthma, utilizing recording devices to register or analyze sound. Results: Various respiratory acoustic signal types were analyzed, with cough and wheeze being predominant. Data collection methods included smartphones, custom sensors and digital stethoscopes. Across all studies, automated acoustic algorithms achieved average accuracy of cough and wheeze detection of 88.7% (range: 61.0 − 100.0%) with a median of 92.0%. The sensitivity of sound detection ranged from 54.0 to 100.0%, with a median of 90.3%; specificity ranged from 67.0 to 99.7%, with a median of 95.0%. Moreover, 70.4% (19/27) studies had a risk of bias identified. Conclusions: This systematic review establishes the promising role of acoustic biomarkers, particularly cough and wheeze, in supporting the diagnosis of asthma and monitoring. The evidence suggests the potential for clinical integration of acoustic biomarkers, emphasizing the need for further validation in larger, clinically-diverse populations. [ABSTRACT FROM AUTHOR]

Despite the association of neighborhood quality with poorer adult health, limited research has explored the association between neighborhood disadvantage, e.g. Area Deprivation Index (ADI), and older Black adults' health, prospectively. This observational study examined the association between ADI and changes in longitudinal physical health within older Black adults. The analytic sample (n = 317) included data from waves 1 & 2 of the Baltimore Study of Black Aging: Patterns of Cognitive Aging (BSBA-PCA). Study variables included the Area Deprivation Index (ADI), objective (e.g. average heart rate) and subjective (e.g. activities of daily living) measures of physical health. Multiple linear regression models were conducted controlling for sociodemographic and social support characteristics. Participants living in more disadvantaged neighborhoods, based on national and state ADIs, were more likely to have a decreasing heart rate even after adjusting for covariates. Likewise, participants reporting increasing levels of ADL difficulty were living in a neighborhood with greater disadvantage based on national and state ADI rankings. Significant social support received and ADI (national and state) interactions were observed for average heart rate. The findings suggest that research on the effect of neighborhood quality and social support can enhance our understanding of its impact on older Black adults' health prospectively. [ABSTRACT FROM AUTHOR]

Introduction: Acute exacerbations of chronic obstructive pulmonary disease are associated with high morbidity and mortality. Telemonitoring may reduce the frequency of hospitalization. The aim of this study was to investigate the effect of telemonitoring on hospitalization rates for acute exacerbations of chronic obstructive pulmonary disease. Methods: Patients were recruited during hospitalization and equally randomized to telemonitoring or usual care. Telemonitoring participants recorded symptoms and monitored oxygen saturation, heart rate, peak expiratory flow, and body weight. Alerts were generated if readings breached thresholds. Acute exacerbations of chronic obstructive pulmonary disease hospitalizations during the 6 months intervention were compared using logistic regression, and time to first hospitalization was assessed using Cox proportional hazard modeling. The incidence rates for acute exacerbations of chronic obstructive pulmonary disease hospitalization were compared using a negative binomial regression model with between-group comparisons expressed as incidence rate ratios. The telemonitoring group was used as reference. Results: A total of 222 patients were randomized. 37/112 (33%) in the control group and 31/110 (28%) in the telemonitoring group experienced acute exacerbations of chronic obstructive pulmonary disease hospitalization during the intervention period, odds ratio of 1.26, confidence interval 0.71–2.23, p = 0.4. No difference was seen in time to first hospitalization, hazard ratio 1.23, CI 0.77–1.99, p = 0.4. The number of hospitalizations in the intervention period was 66 in the control group and 42 in the telemonitoring group, with incidence rate ratio 1.42, confidence interval 1.04–1.95, p = 0.03. Adjustment for dyspnea score, smoking, and cohabitation status did not change the results, incidence rate ratio 1.44, confidence interval 1.05–1.99, p = 0.02. Discussion: Patients who received telemonitoring experienced significantly fewer acute exacerbations of chronic obstructive pulmonary disease hospitalizations, although the overall risk of having at least one hospitalization and the time to first hospitalization was similar between the two groups. [ABSTRACT FROM AUTHOR]

A study published in the journal Diabetes, Obesity & Metabolism examined the effects of a weight-loss program combined with respiratory muscle training (RMT) on weight and cardiovascular risk in adults with obesity. The study found that participants who followed the program experienced significant improvements in weight management and biomarkers, such as blood pressure and blood glucose levels. Compliance with the program was linked to positive outcomes. The study suggests that a combination of portion control and RMT could be an effective approach for weight loss and improving cardiovascular health in individuals with obesity. However, the study had limitations, including a small sample size and lack of a control group. [Extracted from the article]

Background: This study investigates the correlation between different blood groups and pulmonary function, hypothesizing that certain blood groups may exhibit unique pulmonary function profiles, potentially influencing susceptibility to respiratory conditions, thereby providing valuable insights for personalized medicine and improving patient care in respiratory health. Aims and Objectives: The aim of this research is to explore the correlation between different blood groups and pulmonary function, with the objective of identifying unique pulmonary function profiles across blood groups, thereby potentially influencing susceptibility to respiratory conditions, and providing valuable insights for personalized medicine to improve patient care in respiratory health. Materials and Methods: This study, approved by the Institutional Ethics Committee, involved 102 healthy male and female individuals aged 18-20 years, with no known lung diseases. Participants were informed about the study's aims, objectives, risks, and benefits, and their voluntary consents were obtained. Blood groups were determined, and basic information was collected. Pulmonary function was assessed using a computerized spirometer developed by RMS company, performing tests including forced vital capacity (FVC), forced expiratory volume in first second (FEV1)/FVC, forced expiratory flow rate (FEFR), FEF 25-75, and maximum voluntary ventilation (MVV). Faulty procedures were repeated for accuracy, and data were analyzed using single-factor analysis of variance with MedCalc v22.023, considering P > 0.05 as not significant, P < 0.05 as significant, and P < 0.001 as highly significant. Results: The results of our study indicate significant associations between certain blood groups and various pulmonary function test parameters. The highest obtained FVC was found in the B- blood group, with a significant association (P = 0.041). However, no significant association was found between the percent FVC and blood group (P = 0.924). The FEV1/FVC ratio showed a significant association with the blood group for both obtained and percent values (P = 0.001 and P = 0.002, respectively). The obtained FEF 25-75 showed a strong association with the blood group (P = 0.013), but no association was found for percent FEF 25-75 (P = 0.328). The obtained FEFR showed a strong association with the blood group (P = 0.031), as did the percent FEFR (P = 0.043). Finally, no association was found between MVV and blood groups (P = 0.656). These findings contribute to our understanding of the complex relationship between blood groups and pulmonary function. Conclusion: Our study suggests that individuals with the B-positive blood group tend to have higher pulmonary function values, particularly FEV1/FVC and FEFR. However, further research is needed due to the lower sample size and fewer cases in Rh-negative blood groups. [ABSTRACT FROM AUTHOR]

Background: Acute exacerbations of chronic obstructive pulmonary diseases (AECOPD) are a frequent cause of hospitalization, morbidity, and mortality and require serious medical attention. Much research has demonstrated the beneficial effects of intravenous and nebulized magnesium sulfate (MgSO4) as a bronchodilator, in the management of acute severe asthma. Nevertheless, the extent of the benefits of intravenous MgSO4 as an adjuvant to bronchodilators in AECOPD remains uncertain. Therefore, the current study aims to address this gap in knowledge. Aims and Objectives: The study aimed to compare the effectiveness of intravenous magnesium sulfate (MgSO4) versus placebo when used as an adjuvant to nebulized salbutamol in managing AECOPD. Materials and Methods: In this comparative prospective interventional, parallel-group, placebo-controlled study, a total of 60 subjects were assigned to two groups consisting of 30 individuals each. The allocation was non-randomized and open-label, with one group receiving intravenous MgSO4 as an adjuvant to nebulized salbutamol, while the other group received a placebo in the same manner. The evaluation of MgSO4 efficacy involved measuring the peak expiratory flow rate (PEFR), which served as the primary outcome parameter. PEFR measurements were taken at 0, 15, 30, and 45 min to assess the effectiveness of MgSO4. Safety and tolerability of MgSO4 were assessed based on changes in heart rate, blood pressure, deep tendon reflexes, and respiratory rate. Results: At 45 min, the mean change in PEFR was significantly higher (P = 0.061) in the MgSO4 group (178.33 ± 49.18) compared to the placebo group (155.43 ± 41.86). Moreover, the mean difference in PEFR between the two groups was consistently higher in the MgSO4 group at every observation. MgSO4 showed considerable safety and tolerability in subjects based on the postmedication monitoring of hypermagnesemia symptoms. Conclusion: Administering intravenous magnesium sulfate (MgSO4) as an adjuvant to bronchodilators in AECOPD led to the improvement of both clinical condition and PEFR. In AECOPD, MgSO4 exhibits enhanced early bronchodilator response when combined with other drugs, demonstrating significant efficacy, good safety, and tolerability at the prescribed dosage. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study on bronchial remodeling in preschool children with severe preschool wheezing (SPW). The study identified two distinct classes of SPWs, BR1 and BR2, based on bronchial remodeling characteristics. These classes had different disease trajectories, clinical manifestations, and treatment responses. The study suggests that quantifying and targeting multiple bronchial remodeling features can help identify and monitor these two endotypes of SPWs. The article also emphasizes the need for biomarkers and genetic characteristics to easily identify these endotypes. [Extracted from the article]

Background: Several studies have documented the detrimental impacts of secondhand smoke (SHS) exposure to a range of pediatric respiratory conditions, including asthma, bronchitis, and reduced lung function. The aim of the study was to investigate the influence of SHS exposure on lung function, physical fitness, and body mass index (BMI) in children aged 10 to 14 years. Methods: This cross-sectional study included children aged 10 to 14 years at the Elementary School "Trilj" in Trilj, Croatia. Data on SHS exposure were collected using a questionnaire. Antropometric and spirometry measurements were performed. Physical fitness was assessed using the shuttle run (BEEP) test. Results: This study included 157 children, 89 (56.69%) boys and 68 (43.31%) girls. Children exposed to every day SHS in households had significantly lower values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF) (p < 0.001) and higher z-score BMI levels (p = 0.018) in comparison to unexposed children. Logistic regression showed that children unexposed to SHS had higher odds for better results in the BEEP test (OR 62.45, 95% CI 21.26–179.24, p < 0.001). Children with poorer physical fitness, expressed by lower BEEP score levels, had significantly lower FVC, FEV1, FEV1/FVC, and PEF (p < 0.001). Conclusions: Every day SHS exposure in children was associated with poorer lung function, higher BMI, and poorer physical fitness. [ABSTRACT FROM AUTHOR]

This article is a systematic review that evaluates the effects of high-intensity interval training (HIIT) on exercise capacity and asthma-related outcomes in children with asthma. The review includes seven studies involving 432 pediatric asthma patients. The findings suggest that HIIT can improve exercise capacity, asthma control, and quality of life in children with asthma. However, the review acknowledges limitations such as small sample sizes and variability in HIIT protocols. Further research is needed to standardize HIIT protocols and assess its long-term effects on lung function and inflammation in pediatric asthma management. [Extracted from the article]

Introduction. Despite all the improvements in surgical and anesthetic techniques, this procedure is still associated with pulmonary and cardiovascular complications in the postoperative period, and early rehabilitation, done through the use of cycloergometer, can minimize such complications, besides reducing the length of hospital stay. Objective. Therefore, the aim of the study was to assess the impact of cardiovascular exercise on lung function, respiratory muscle strength, and functional capacity in elderly patients after heart bypass surgery. Methods. To this purpose, a randomized and controlled clinical trial was conducted. Research participants were randomized to the cycle ergometer group (CEG) or to the control group (CG). The CG was managed based on the institution's protocol. The CEG also carried out all the activities of the control group, but there was the inclusion of cycle ergometry through a device built by the researchers. Pulmonary function (vital capacity (VC) and peak expiratory flow (PEF)), ventilatory muscle strength (maximum inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), and functional capacity (six‐minute walk test) were evaluated before surgery, at ICU, and hospital discharge. Results. During the research period, 122 patients were evaluated, 61 in each group. The MIP of the cycle ergometry group was higher at discharge from the ICU 95% CI 8 (5.46 to 10.54) and at hospital discharge 95% CI 14 (16.89 to 11.11). MEP was higher in the cycle ergometry group at discharge from the ICU with 95% CI 6 (8.18 to 3.82) and at hospital discharge with 95% CI 9 (11.69 a 6.31). Vital capacity at ICU discharge with 95% CI 6 (7.98 to 4.02) and at hospital discharge with 95% CI 7 (8.98 to 5.02), as well as peak flow at ICU discharge with 95% CI 43 (75.27 to 10.73), showed relevance, being higher in the group that used the cycle ergometer. The CEG showed improvement in functional capacity at the time of hospital discharge with a 95% CI 56 (30.37 to 81.63). Conclusion. We conclude that application of cycloergometry after CABG decreases the loss of pulmonary function, muscle strength, and functional capacity. This trial is registered with RBR-39yrht6. [ABSTRACT FROM AUTHOR]

Introduction: Volcanism is an important natural producer of pollution that impacts health and the quality of the environment. Lung changes caused by exposure to volcanoes have been previously studied. However, limited information exists regarding the effects of prolonged exposure to volcanic compounds. So, this study aimed to analyze the pulmonary effects and stress tolerance in older adults for chronic exposure to the volcanic ashes of the Galeras volcano. Methods: A descriptive cross-sectional study of association included rural inhabitants aged over 60 years from Genoy, a village located in a high volcanic hazard zone of Galeras volcano, 2603 meters above sea level. Those in this group, called exposed, were contrasted with a sample of El Encano inhabitants with similar socioeconomic and cultural characteristics. Both villages belong to the rural area of San Juan de Pasto in Colombia. Results: It was found that of 31 exposed participants, 18 had obstructive alteration, and in the control group, it was found that of 31 subjects, 6 presented this alteration. The difference between the two groups was significant (p<0.001). A similar situation occurred with distal airway obstruction assessed with the forced expiratory flow of 25–75%. No significant differences were found in restrictive alteration between the exposed and unexposed groups. Conclusion: Chronic exposure to volcanic compounds has generated obstructive changes in the population, and these changes were greater in number and severity than those in the control group of unexposed people. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of inspiratory muscle training under low intensity [20% maximum inspiratory pres- sure (MIP)] and medium intensity (40% MIP) threshold load on diaphragm function, lung function and quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods: 120 COPD patients who were admitted to Heze Hospital of Shandong Provin- cial Hospital from April 2020 to May 2023 were divided into control group, low intensity group and medium intensity group according to the random number table method, with 40 cases in each group. Control group was given routine treatment; On the basis of control group, the low intensity group used 20% MIP as the initial load of inspiratory muscle training; Medium intensity group used 40% MIP as the ini- tial load of inspiratory muscle training. The lung function [forced vital capacity (FVC), MIP, forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), maximum ventilation volume per minute (MVV)], diaphragm function [diaphragmatic displacement (DE), deep inspiratory diaphragm thickness (DTei) and quiet end-expiratory diaphragm thickness (DTee), diaphragmatic thickness frac- tion (DTF)] and quality of life [COPD quality of life scale (COPD-QOL), St George's respiratory disease questionnaire (SGRQ)] were compared among three groups. Results: After treatment, MIP, FVC, FEV₁, MVV and PEF in control group, low intensity group and medi- um intensity group increased in turn (P<0.05). After treatment, DE, DTei and DTF in control group, low intensity group and medium intensity group increased in turn (P<0.05). After treatment, DTee in control group, low intensity group and medium intensity group decreased in turn (P<0.05). After treatment, the scores of COPD-QOL and SGRQ in control group, low intensity group and medium intensity group decreased in turn (P<0.05). Conclusion: Inspiratory muscle training can effectively improve lung function, diaphragm function and quality of life in COPD patients, and the effect of moderate intensity threshold load is the best. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between serum programmed cell death molecule 5 (PDCD5), CXC chemokine ligand 8 (CXCL8), human cartilage glycoprotein 39 (YKL-40) and disease condition and clinical outcome in influenza A virus pneumonia. Methods: 165 patients with influenza A virus pneumonia who were admitted to Jilin Fifth People's Hospital from March 2021 to May 2023 were selected as observation group, and 50 healthy subjects who underwent physical examination during the same period were selected as control group. The PDCD5, CXCL8 and YKL-40 of patients and subjects were detected, and the differences of each index level between groups were compared, and the levels of each index of patients with influenza A virus pneumonia in different conditions were compared. The clinical outcomes of patients were statistically analyzed, and patients were divided into death group and survival group, the levels of PDCD5, CXCL8 and YKL-40 were compared between two groups, the risk factors and protective factors of death in patients with influenza A virus pneumonia were analyzed by univariate and multivariate Logistic analysis. Results: The levels of PDCD5, CXCL8 and YKL-40 in observation group were higher than those in control group (P<0.05). The levels of PDCD5, CXCL8 and YKL-40 in severe group were higher than those in mild group (P<0.05). After follow-up observation, 39 patients died, and the levels of PDCD5, CXCL8 and YKL-40 in death group were higher than those in survival group (P<0.05). Univariate analysis showed that, there was no significant difference in gender, body mass index (BMI), smoking history, drinking history, hypertension history, diabetes history, hyperlipidemia history and course of disease between two groups (P>0.05). The age, PDCD5, CXCL8 and YKL-40 in death group were higher than those in survival group, and the forced vital capacity(FVC), peak expiratory flow (PEF) and maximum middle expiratory flow rate (MMEF) were lower than those in survival group (P<0.05). Logistic multivariate analysis showed that, age, PDCD5, CXCL8 and YKL-40 were independent risk factors for the prognosis of patients with influenza A virus pneumonia, and FVC, PEF and MMEF were protective factors for the prognosis of patients. Conclusion: Serum PDCD5, CXCL8 and YKL-40 are involve in the occurrence and progression of influenza A virus pneumonia, and are closely relate to the clinical outcome of patients, together with age, they constitute a risk factor for the prognosis of patients, while FVC, PEF and MMEF are protective factors for the prognosis of patients [ABSTRACT FROM AUTHOR]

Objective: To investigate the correlation between serum Rac1 enzyme (Rac1) level with asthma control, airway inflammatory response and lung function in asthmatic children. Methods: A retrospective analysis was performed on 79 children with asthma who were diagnosed and treated in our hospital from June 2020 to January 2023. According to the severity of the disease, the children were divided into mild group (25 cases), moderate group (30 cases) and severe group (24 cases). 36 healthy children who underwent physical examination at the same period in our hospital were selected as the control group. The state of an illness, control level, serum mRNA Rac1, inflammatory factors, and lung function of the children in two groups were compared between the control group and the observation group. Results: The Rac1 mRNA levels, forced vital capacity (FVC), forced expiratory volume in one second/FVC (FEV1/FVC), peak expiratory flow (PEF), and maximum mid-expiratory flow (MMEF) in the observation group were significantly lower than these in the control group (P < 0.05). The tumor necrosis factor-alpha (TNF-α), interleukin-5 (IL-5), IL-6, and IL-33 in the observation group were markedly higher than these in the control group (P < 0.05). As the state of an illness worsened, the Rac1 mRNA levels, FVC, FEV1/FVC, PEF, and MMEF gradually reduced (P < 0.05), while the levels of TNF-α, IL-5, IL-6, and IL-33 increased (P < 0.05). As the degree of disease control improved, the Rac1 mRNA levels, FVC, FEV1/FVC, PEF, and MMEF gradually elevated (P < 0.05), and the levels of TNF- α, IL-5, IL-6, and IL-33 showed the opposite trend (P < 0.05). Rac1 was negatively related to the levels of TNF-α, IL-5, IL-6 and IL-33 (P < 0.05), and positively to the levels of FVC, FEV1/FVC, PEF and MMEF (P < 0.001). Rac1 mRNA levels, FVC, FEV1/FVC, PEF and MMEF were protective factors, while TNF-α, IL-5, IL-6 and IL-33 were risk factors for the prognosis of children with asthma (P < 0.05). Conclusion: Children with asthma have obviously lower serum Rac1 mRNA levels, higher inflammatory factor levels and lower lung function. Serum Rac1 mRNA level may be associated with better asthma control, lower airway inflammatory response, better lung function and lower disease severity. It has important reference value for the evaluation of the state of an illness, efficacy and prognosis of children with bronchial asthma. [ABSTRACT FROM AUTHOR]

Background: Asthma is a chronic inflammatory condition, and choline may alleviate airway inflammation and oxidative stress but studies on the association between dietary choline and asthma remain limited. The purpose of this study is to investigate the associations between dietary choline intake and asthma, as well as pulmonary inflammation and lung function in children and adults. Methods: In our research, we employed the data of the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2018, including 7,104 children and 16,580 adults. We used fractional exhaled nitric oxide (FENO) to assess pulmonary inflammation and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, peak expiratory flow rate (PEF), predicted FEV1% and predicted FVC% to assess lung function. Binary logistic regression, linear regression, and the restricted cubic splines were used to analyze the associations between dietary choline intake and asthma and pulmonary inflammation and lung function. Results: In children, we observed the positive associations between the natural logarithmic transformation of choline (ln-choline) and ln-FEV1 [ β:0.011; 95%CI: (0.004,0.018)] and ln-FVC [ β:0.009; 95%CI: (0.002,0.016)]. In adult males, the ln-choline was positively associated with ln-FEV1[ β:0.018; 95%CI: (0.011,0.024)], ln-FVC [ β:0.020; 95%CI: (0.014,0.026)], ln-PEF [ β:0.014; 95%CI: (0.007,0.022)], ln-predicted FEV1% [ β: 0.007; 95%CI: (0.001, 0.013)] and ln-predicted FVC%[ β: 0.010; 95%CI: (0.005, 0.015)] and negatively associated with FENO [ β: -0.029; 95%CI: (-0.049, -0.009)]. In unadjusted and partially adjusted models, adult females with ln-choline in the highest quartile had 25.2% (95%CI:9.4-38.3%) and 23.8% (95%CI:7.6-37.1%) decreased odds of asthma compared to those with the lowest quartile group. In the dose-response relationships of dietary choline and pulmonary inflammation and lung function indicators in adults, there existed threshold and saturation effects. Conclusion: The associations between dietary choline and lung function indicators such as FEV1 and FVC are positive in children and adults. The association between dietary choline and pulmonary inflammation is negative only in adults. [ABSTRACT FROM AUTHOR]

Respiratory Distress Syndrome (RDS) remains a significant challenge in neonatal intensive care, particularly in preterm infants who suffer from surfactant deficiency, leading to alveolar collapse, decreased lung compliance, and impaired gas exchange. While conventional mechanical ventilation (CMV) is the current standard of care, it often involves cyclic alveolar recruitment and derecruitment, which can contribute to ventilator-induced lung injury (VILI). Airway Pressure Release Ventilation (APRV) is a mode of ventilation that maintains continuous alveolar recruitment through prolonged high-pressure phases while allowing spontaneous breathing, potentially reducing VILI. This protocol outlines the rationale, initial settings, adjustments, monitoring, and weaning strategies for using APRV to manage RDS in preterm infants. The paper also emphasizes the importance of adjusting Tlow (time at low pressure) to maintain the T-PEFR (peak expiratory flow rate termination point) at 75% with changes in lung compliance to prevent overinflation and underinflation, highlighting the need for further studies to validate APRV's safety, efficacy, and optimal use in this population. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy and safety of lentinan combined with docetaxel and nedaplatin (DN) in the treatment of pulmonary tuberculosis complicated by non-small cell lung cancer (NSCLC). Methods: A total of 100 patients diagnosed with pulmonary tuberculosis combined with NSCLC in Ankang People's Hospital, Ankang, China were randomized equally into study and control groups. Control group received standard anti-tuberculosis therapy and intravenous chemotherapy regimen based on docetaxel (75 mg/m² on day 1) and nedaplatin (80 - 100 mg/m²), while the study group received, in addition, lentinan (given intravenously every two days). The patients received a total of 2 courses of treatment. Tumor response, survival, adverse reactions, quality of life score, and pulmonary function indices were compared before and after treatment. Results: The study group showed significantly higher total response rate than the control group (p < 0.05). Median overall survival and progression-free survival in the study group was significantly higher than in the control group (p < 0.05). Also, the study group showed significantly lower incidence of adverse reactions compared to control group (p < 0.05). Quality of life score, maximum voluntary ventilation (MVV) and peak expiratory flow (PEF) levels in the study group was significantly higher compared to control group (p < 0.05). Conclusion: Lentinan combination with DN chemotherapy regimen improves response rate, prolongs survival, reduces incidence of adverse reactions, improves quality of life and pulmonary function in patients with pulmonary tuberculosis complicated by NSCLC. These findings provide a new perspective for future studies on the application of lentinan in the treatment of pulmonary tuberculosis complicated by NSCLC. [ABSTRACT FROM AUTHOR]