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BACKGROUND: Chronic exposure to microorganisms inside homes can impact respiratory health. Few studies have used advanced sequencing methods to examine adult respiratory outcomes, especially continuous measures. We aimed to identify metagenomic profiles in house dust related to the quantitative traits of pulmonary function and airway inflammation in adults. Microbial communities, 1264 species (389 genera), in vacuumed bedroom dust from 779 homes in a US cohort were characterized by whole metagenome shotgun sequencing. We examined two overall microbial diversity measures: richness (the number of individual microbial species) and Shannon index (reflecting both richness and relative abundance). To identify specific differentially abundant genera, we applied the Lasso estimator with high-dimensional inference methods, a novel framework for analyzing microbiome data in relation to continuous traits after accounting for all taxa examined together. RESULTS: Pulmonary function measures (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio) were not associated with overall dust microbial diversity. However, many individual microbial genera were differentially abundant (p-value < 0.05 controlling for all other microbial taxa examined) in relation to FEV1, FVC, or FEV1/FVC. Similarly, fractional exhaled nitric oxide (FeNO), a marker of airway inflammation, was unrelated to overall microbial diversity but associated with differential abundance for many individual genera. Several genera, including Limosilactobacillus, were associated with a pulmonary function measure and FeNO, while others, including Moraxella to FEV1/FVC and Stenotrophomonas to FeNO, were associated with a single trait. CONCLUSIONS: Using state-of-the-art metagenomic sequencing, we identified specific microorganisms in indoor dust related to pulmonary function and airway inflammation. Some were previously associated with respiratory conditions; others were novel, suggesting specific environmental microbial components contribute to various respiratory outcomes. The methods used are applicable to studying microbiome in relation to other continuous outcomes. Video Abstract.

BACKGROUND: In tobacco-exposed persons with preserved spirometry (active smoking or secondhand smoke [SHS] exposure), air trapping can identify a subset with worse symptoms and exercise capacity. The physiologic nature of air trapping in the absence of spirometric airflow obstruction remains unclear. The aim of this study was to examine the underlying pathophysiology of air trapping in the context of preserved spirometry and to determine the utility of bronchodilators in SHS tobacco-exposed persons with preserved spirometry and air trapping. METHODS: We performed a double-blinded placebo-controlled crossover randomized clinical trial in nonsmoking individuals at risk for COPD due to exposure to occupational SHS who had preserved spirometry and air trapping defined as either a residual volume-to-total lung capacity ratio (RV/TLC) > 0.35 or presence of expiratory flow limitation (EFL, overlap of tidal breathing on maximum expiratory flow-volume loop) on spirometry at rest or during cardiopulmonary exercise testing (CPET). Those with asthma or obesity were excluded. Participants underwent CPET at baseline and after 4-week trials of twice daily inhalation of 180 mcg of albuterol or placebo separated by a 2-week washout period. The primary outcome was peak oxygen consumption (VO2) on CPET. Data was analyzed by both intention-to-treat and per-protocol based on adherence to treatment prescribed. RESULTS: Overall, 42 participants completed the entire study (66 ± 8 years old, 91% female; forced expiratory volume in 1 s [FEV1] = 103 ± 16% predicted; FEV1 to forced vital capacity [FVC] ratio = 0.75 ± 0.05; RV/TLC = 0.39 ± 0.07; 85.7% with EFL). Adherence was high with 87% and 93% of prescribed doses taken in the treatment and placebo arms of the study, respectively (P = 0.349 for comparison between the two arms). There was no significant improvement in the primary or secondary outcomes by intention-to-treat or per-protocol analysis. In per-protocol subgroup analysis of those with RV/TLC > 0.35 and ≥ 90% adherence (n = 27), albuterol caused an improvement in peak VO2 (parameter estimate [95% confidence interval] = 0.108 [0.014, 0.202]; P = 0.037), tidal volume, minute ventilation, dynamic hyperinflation, and oxygen-pulse (all P

INTRODUCTION: Although a major goal of preoperative evaluation is to identify risk factors and improve postoperative outcomes, current clinical guidelines in Mexico indicate that preoperative spirometry should only be performed on patients with pulmonary disease. The aim of this study was to compare the incidence of postoperative complications (POC), mortality, and risk factors among adults who did or did not undergo preoperative spirometry, based on their Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk level. MATERIAL AND METHODS: An observational, retrospective and comparative study design was used to identify 2059 patients from the General Hospital of Mexico who had an ARISCAT assessment during 2013-2017. Patients were classified in two groups: ARISCAT with spirometry (n = 1306) and ARISCAT without spirometry (n = 753). Chi-square, Fishers exact test and the Students t-tests were used to compare groups. Logistic regression was used to identify factors associated with an increased risk of POC and mortality. RESULTS: In the ARISCAT with spirometry group, 11% of patients had POC, compared with 48% of patients in the ARISCAT without spirometry group. High-risk ARISCAT patients who did not receive spirometry had higher mortality (18%), than those who underwent spirometry (0.4%). Logistic regression results indicate that not performing preoperative spirometry increases the probability of POC and mortality. CONCLUSIONS: Our findings suggest that the combined use of preoperative spirometry and ARISCAT is associated with reduced POC and mortality. Future clinical guidelines should recommend the use of preoperative spirometry for patients with a moderate or high ARISCAT level in Mexico.

Background: Small airway dysfunction (SAD) is increasingly recognized as an important feature of pediatric asthma yet typically relies on spirometry-derived FEF25–75 to detect its presence. Multiple breath washout (MBW) and oscillometry potentially offer improved sensitivity for SAD detection, but their utility in comparison to FEF25–75, and correlations with clinical outcomes remains unclear for school-age asthma. We investigated SAD occurrence using these techniques, between-test correlation and links to clinical outcomes in 57 asthmatic children aged 8–18 years. Methods: MBW and spirometry abnormality were defined as z-scores above/below ± 1.96, generating MBW reference equations from contemporaneous controls (n = 69). Abnormal oscillometry was defined as > 97.5th percentile, also from contemporaneous controls (n = 146). Individuals with abnormal FEF25–75, MBW, or oscillometry were considered to have SAD. Results: Using these limits of normal, SAD was present on oscillometry in 63% (resistance at 5–20 Hz; R5-R20; >97.5th percentile), on MBW in 54% (Scond; z-scores> +1.96) and in spirometry FEF25–75 in 44% of participants (z-scores< −1.96). SAD, defined by oscillometry and/or MBW abnormality, occurred in 77%. Among those with abnormal R5-R20, Scond was abnormal in 71%. Correlations indicated both R5-R20 and Scond were linked to asthma medication burden, baseline FEV1 and reversibility. Additionally, Scond correlated with FENO and magnitude of bronchial hyper-responsiveness. SAD, detected by oscillometry and/or MBW, occurred in almost 80% of school-aged asthmatic children, surpassing FEF25–75 detection rates. Conclusions: Discordant oscillometry and MBW abnormality suggests they reflect different aspects of SAD, serving as complementary tools. Key asthma clinical features, like reversibility, had stronger correlation with MBW-derived Scond than oscillometry-derived R5-R20. [ABSTRACT FROM AUTHOR]

Introduction: People with HIV (PWH) have nearly twice the risk of emphysema than people without HIV. This risk, which has been associated with HIV-mediated changes in the lung immune environment and more extensive radiographic emphysema, may result in different patterns of airflow limitation on pulmonary function testing (PFT) than those traditionally used in people without HIV. Methods: In this prospective cohort of PWH in Atlanta, Georgia, we analyzed PFT and chest computed tomography data from July 2013 through June 2018. After comparing the prevalence of PFT measures of airflow limitation for those with and without radiographic emphysema, we used binary recursive partitioning to identify PFT measures that differentiated between PWH with and without radiographic emphysema. Results: Among 167 PWH who had both PFT and computed tomography data during the study period, 89 (53%) had radiographic emphysema. Those with radiographic emphysema were more likely to have airflow limitations on PFTs. Recursive partitioning identified partitions at a forced expiratory volume in 1 second to forced vital capacity ratio (FEV1/FVC) of 0.78 and a residual volume of 116% predicted. These partitions enabled the identification of 84 (94%) PWH with radiographic emphysema, in contrast to the traditional diagnostic criteria of an FEV1/FVC ratio of 0.7, which only identified 49 (55%) of those with radiographic emphysema. Conclusions: Emphysema in PWH may have different patterns of airflow limitation on PFTs that are not adequately captured by traditional diagnostic criteria. Future studies can seek to validate these findings and determine optimal thresholds for diagnosing HIV-associated emphysema. [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: Pulmonary function tests (PFTs) have historically used race-specific prediction equations. The recent American Thoracic Society guidelines recommend the use of a race-neutral approach in prediction equations. There are limited studies centering the opinions of practicing pulmonologists on the use of race in spirometry. Provider opinion will impact adoption of the new guideline. The aim of this study was to ascertain the beliefs of academic pulmonary and critical care providers regarding the use of race as a variable in spirometry prediction equations. METHODS: We report data from 151 open-ended responses from a voluntary, nationwide survey (distributed by the Association of Pulmonary Critical Care Medicine Program Directors) of academic pulmonary and critical care providers regarding the use of race in PFT prediction equations. Responses were coded using inductive and deductive methods, and a thematic content analysis was conducted. RESULTS: There was a balanced distribution of opinions among respondents supporting, opposing, or being unsure about the incorporation of race in spirometry prediction equations. Responses demonstrated a wide array of understanding related to the concept and definition of race and its relationship to physiology. CONCLUSIONS: There was no consensus among providers regarding the use of race in spirometry prediction equations. Concepts of race having biologic implications persist among pulmonary providers and will likely affect the uptake of the Global Lung Function Initiative per the American Thoracic Society guidelines. [ABSTRACT FROM AUTHOR]

Rationale: Knowledge regarding the prevalence and shared and unique characteristics of the restrictive spirometric pattern (RSP) and preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs. Objectives: To investigate shared and unique features for RSP and PRISm. Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50–64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score. Odds ratios with 95% confidence intervals (CIs) were calculated using adjusted logistic regression. RSP was defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ≥0.70 and FVC <80%. PRISm was defined as FEV1/FVC ≥0.70 and FEV1 <80%. A local reference equation was applied. Results: The prevalence of RSP and PRISm were 5.1% (95% CI, 4.9–5.4) and 5.1% (95% CI, 4.8–5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease, bronchial wall thickening, interstitial lung abnormalities, and bronchiectasis. Emphysema was uniquely linked to PRISm (odds ratio, 1.69; 95% CI, 1.36–2.10) versus 1.10 (95% CI, 0.84–1.43) for RSP. Coronary artery calcification score ≥300 was related to PRISm, but not among never-smokers. Conclusions: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not. [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]

The long‐term effects of COVID‐19 on lung function are not understood, especially for periods extending beyond 1 year after infection. This observational, longitudinal study investigated lung function in Mexican Hispanics who experienced severe COVID‐19, focusing on how the length of recovery affects lung function improvements. At a specialized COVID‐19 follow‐up clinic in Yucatan, Mexico, lung function and symptoms were assessed in patients who had recovered from severe COVID‐19. We used z‐scores, and Wilcoxon's signed rank test to analyse changes in lung function over time. Lung function was measured twice in 82 patients: the first and second measurements were taken a median of 94 and 362 days after COVID‐19 diagnosis, respectively. Initially, 61% of patients exhibited at least one of several pulmonary function abnormalities (lower limit of normal = –1.645), which decreased to 22% of patients by 390 days post‐recovery. Considering day‐to‐day variability in lung function, 68% of patients showed improvement by the final visit, while 30% had unchanged lung function from the initial assessment. Computed tomography (CT) scans revealed ground‐glass opacities in 33% of patients. One year after infection, diffusing capacity of the lungs for carbon monoxide z‐scores accounted for 30% of the variation in CT fibrosis scores. There was no significant correlation between the length of recovery and improvement in lung function based on z‐scores. In conclusion, 22% of patients who recovered from severe COVID‐19 continued to show at least one lung function abnormality 1 year after recovery, indicating a prolonged impact of COVID‐19 on lung health. [ABSTRACT FROM AUTHOR]

Background: Evidence on how decisions regarding escalation to triple therapy and de- or re-escalation are taken and the rationale on which these decisions are based is currently limited in Germany. Objectives: The TETRIS study aims to elucidate influences on treatment decisions surrounding triple therapy in a real-world practice setting in Germany. Design: TETRIS is an ongoing, multicenter, prospective, observational cohort study recruiting patients with chronic obstructive pulmonary disease (COPD) with or without asthma who have already been treated with triple therapy for 2–48 weeks. Methods: For better representation of the treatment reality in Germany, patients are recruited from general practitioners and pulmonologists. Data are collected in two parts. Part 1 involves cross-sectional phenotyping of patients at enrollment. Part 2 involves a 2-year longitudinal follow-up period to monitor/document all visits by the patients during the 24-month observation period per routine clinical practice. Here, we report the demographic and baseline characteristics of 1213 eligible patients recruited to part 1 of the study. Results: The mean patient age was 66.4 years overall, and 29.3% (356/1213) of patients had no comorbidities. The mean CAT score was 19.4; the number of exacerbations and hospitalizations due to exacerbations in the past 3 years before starting triple therapy was 0.6 and 0.1, respectively. Dual bronchodilation with a long-acting muscarinic antagonist (LAMA) plus a long-acting β-2 agonist (LABA) was the most common therapy for COPD before initiation of triple therapy in 58.3% of patients. Conclusion: In this real-world setting in Germany, patients with COPD have a relatively low reported exacerbation rate but high symptom burden, and over 70% are multimorbid. Triple therapy is initiated in patients who are primarily highly symptomatic despite being on LAMA + LABA. Future prospective studies in patients with multimorbidity are warranted to better understand the treatment landscape across the disease spectrum. Trial registration: https://clinicaltrials.gov/study/NCT04657211 [ABSTRACT FROM AUTHOR]

Prematurity-associated lung disease (PLD) is a long-term consequence of preterm-birth. Since the underlying mechanisms of PLD remain poorly characterised, we compared the urinary metabolome between recently described spirometry phenotypes of PLD. Preterm- and term-born children aged 7–12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) cohort, underwent spirometry and urine collection. The urinary metabolome was analysed by gas chromatography time-of-flight mass spectrometry. Preterm-born children were classified into phenotypes of prematurity-associated obstructive lung disease (POLD, Forced expiratory volume in 1 s (FEV1) < lower limit of normal (LLN), FEV1/Forced Vital Capacity (FVC) < LLN), prematurity-associated preserved ratio impaired spirometry (pPRISm, FEV1 < LLN, FEV1/FVC ≥ LLN) and Preterm/Term controls (FEV1 ≥ LLN). Metabolite set enrichment analysis was used to link significantly altered metabolites between the groups with metabolic pathways. Univariable and multivariable linear regression models examined associations between early and current life factors and significantly altered metabolites of interest. Urine from 197 preterm- and 94 term-born children was analysed. 23 and 25 were classified into POLD and pPRISm groups respectively. Of 242 identified metabolites, 49 metabolites were significantly altered in the POLD group compared with Preterm controls. Decreased capric acid (log2 fold change − 0.23; p = 0.003), caprylic acid (− 0.18; 0.003) and ceratinic acid (− 0.64; 0.014) in the POLD group, when compared to preterm controls, were linked with reduced β-oxidation of very long chain fatty acids (p = 0.004). Reduced alanine (log2 fold change − 0.21; p = 0.046), glutamic acid (− 0.24; 0.023), and pyroglutamic acid (− 0.17; 0.035) were linked with decreased glutathione metabolism (p = 0.008). These metabolites remained significantly associated with POLD in multivariable models adjusting for early/current life factors. The pPRISm urinary metabolome was minimally changed when compared with preterm-born controls. When compared to term-born subjects, alterations in tryptophan metabolism were implicated (p = 0.01). The urinary metabolome in POLD showed significantly altered β-oxidation of fatty acids and glutathione metabolism, implying alterations in cellular metabolism and oxidative stress. Similar findings have been noted in adults with chronic obstructive pulmonary disease. Given the similarity of findings between the POLD group and those reported for COPD, the POLD group should be considered at future risk of developing COPD. [ABSTRACT FROM AUTHOR]

Background: Despite receiving adequate treatment, many tuberculosis (TB) survivors are left with post-tuberculosis complications, possibly due to lung tissue damage incurred during the active period of the disease. Current TB programs worldwide deliver quality care throughout the course of active TB treatment, yet often fail to provide organized follow-up once treatment ends. Post-tuberculosis lung disease (PTLD) is a prominent, yet underrecognized cause of chronic lung disease, managed similarly to chronic respiratory diseases with pharmacotherapy and/or personalized pulmonary rehabilitation interventions. Basic pulmonary rehabilitation packages for people finishing TB treatment are still lacking in low- and middle-income countries (LMICs). We offer a study protocol to evaluate the implementation of spirometry and symptom screening for PTLD among people who have completed TB treatment in a rural district in Mozambique. Methods: The overall objective of this study is to evaluate the introduction of a new screening program that utilizes symptom screening and spirometry for diagnosing PTLD among adolescents and adults that have completed TB treatment. This research protocol consists of three complementary components: 1) assessing the prevalence of PTLD among patients enrolled in the National TB Control Program (NTCP) at Carmelo Hospital (CHC) in Chókwè District, Mozambique; 2) evaluating anticipated implementation outcomes through the identification of the site-, provider-, and individual-level determinants that either facilitate or hinder the successful adoption, implementation, and maintenance of the spirometry screening program, and 3) evaluating the real-time implementation outcomes/processes in order to provide practical evidence-based key indicators of successful implementation of the spirometry screening program. Discussion: Providing well-organized, evidence-based care for individuals with a history of TB who are experiencing symptoms of PTLD can relieve chronic respiratory issues, enhance quality of life, and potentially lower the risk of further pulmonary infections, including recurrent TB. However, there is a significant gap in the literature regarding the implementation of best practices of HIV and TB health services delivery. Addressing this gap could assist Mozambique in improving diagnosis, treatment, and continuity of care for people formerly living with TB. The insights from this study will help decision-makers improve spirometry screening coverage, enhance intervention effectiveness, and translate our findings to evidence-based programming. Trial registration: ISRCTN92021748 retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Pulmonary rehabilitation (PR) is widely recommended for short-term benefits in chronic respiratory diseases, yet long-term outcomes remain uncertain. This retrospective cohort study addresses this gap, comparing 20-year mortality rates between PR participants and matched controls, and hypothesizing that the short-term benefits of PR contribute to improved long-term survival. Methods: The 20-year mortality of stable chronic respiratory patients who participated in an outpatient PR program was compared with a matched control group based on the type of lung disease. Demographic and clinical variables, and the dates of deaths, were extracted and compared between two groups with two sample t-test and chi-square tests. Kaplan-Meier plots and Cox regression analyses were employed to evaluate survival differences. Results: Between 2000 and 2002, 238 individuals enrolled in a pulmonary rehabilitation (PR) program (58% male, mean age ± SD: 69 ± 8 years, mean FEV1% predicted ± SD: 46 ± 21%). An equal number of people with comparable lung disease were selected as controls (88% COPD, 5% ILD). Controls had lower FEV1% predicted values (mean ± SD: 39 ± 17%, P < 0.001), smoked more (mean ± SD: 48 ± 35 pack-years, P = 0.032), and no differences in age, BMI, sex, and Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Median (IQR) follow-up time was 68 months (34–123), with 371 (78%) deaths. Univariable (HR = 1.71, p < 0.001) and multivariable (HR = 1.64, p < 0.001) Cox regression found higher mortality risk in controls. Subgroup analysis for COPD replicated these findings (HR = 1.70, P < 0.001). Discussion: Despite some methodological limitations, our study suggests that clinically stable patients with chronic respiratory disease who undertake PR may have lower mortality than matched controls. Trial registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Despite the frequent inclusion of fluid therapy in the treatment of many conditions, there are limited studies available to provide an evidence-based specific recommendation for fluid therapy in acute drug toxicity. Salicylate toxicity is considered one of the common clinical problems. It is commonly associated with fatal complications and even can lead to death. The study was designed to investigate the effects of various IV fluid types as isotonic saline (NaCl 0.9%), Ringer lactate (RL), and albumin and their impact on acetyl salicylic acid (ASA) toxicity outcome in a rat model of acute salicylate toxicity. Sixty male Albino rats were divided into 10 groups of 6 rats each. The first four groups were the control, saline, RL, and albumin groups. The fifth group received two doses of ASA solution orally, and the next five groups were treated with IV fluids as follows: saline-ASA, RL-ASA, albumin-ASA, RL + albumin-ASA, and saline + albumin-ASA. Upon completion of the study, spirometry, arterial blood gas analysis (ABG), and serum liver and kidney function tests were done on all groups. Furthermore, quantitative real-time polymerase chain reaction (PCR) was used to assess interleukin-6 (IL6), nuclear factor kappa beta (NF-kβ), and beta-actin mRNA gene expression of histopathology and immunohistochemistry assessments were also performed on liver and kidney tissues. Results: The results revealed the ASA group showed marked deterioration across all the investigated parameters. The groups that received saline and RL showed improvements in the following: respiratory rates, ABG, liver and kidney function, and histopathological findings. The RL + albumin group did not show any improvements. The albumin group and the saline + albumin group showed variable responses, ranging from mild improvement to no improvement. Conclusions: The saline and RL groups showed positive results; however, the RL + albumin group showed the worst outcomes. The inclusion of albumin did not appear to provide any extra benefits and produced varying results. [ABSTRACT FROM AUTHOR]

Background: Subway systems are becoming increasingly common worldwide transporting large populations in major cities. PM2.5 concentrations have been demonstrated to be exceptionally high when underground, however. Studies on the impact of subway PM exposure on cardiopulmonary health in the United States are limited. Methods: Healthy volunteers in New York City were exposed to a 2-h visit on the 9th Street Station platform on the Port Authority Trans-Hudson train system. Blood pressure, heart rate variability (HRV), spirometry, and forced impulse oscillometry were measured, and urine, blood spot, and nasal swab biosamples were collected for cytokine analysis at the end of the 2-h exposure period. These endpoints were compared against individual control measurements collected after 2-h in a "clean" control space. In addition to paired comparisons, mixed effects models with subject as a random effect were employed to investigate the effect of the PM2.5 concentrations and visit type (i.e., subway vs. control). Results: Mean PM2.5 concentrations on the platform and during the control visit were 293.6 ± 65.7 (SD) and 4.6 ± 1.9 µg/m3, respectively. There was no change in any of the health metrics, but there was a non-significant trend for SDNN to be lower after subway exposure compared to control exposure. Total symptomatic scores did increase post-subway exposure compared to reported values prior to exposure or after the control visit. No significant changes in cytokine concentrations in any specimen type were observed. Mixed-effects models mostly corroborated these paired comparisons. Conclusions: Acute exposures to PM on a subway platform do not cause measurable cardiopulmonary effects apart from reductions in HRV and increases in symptoms in healthy volunteers. These findings match other studies that found little to no changes in lung function and blood pressure after exposure in underground subway stations. Future work should still target potentially more vulnerable populations, such as individuals with asthma or those who spend increased time underground on the subway such as transit workers. [ABSTRACT FROM AUTHOR]

Introduction: Impulse oscillometry (IOS) is an effortless test compared to spirometry. Numerous studies explored the role of IOS in spirometry-based chronic obstructive pulmonary disease (COPD), but most of them had limited sample sizes with poor statistical power. This systematic review and meta-analysis aimed to pool the individual data and quantitatively analyze the clinical value of IOS in COPD. Methods: PubMed, Web of Science, Ovid, Cochrane Library, China National Knowledge Internet, and Wanfang were searched for studies with comparisons of IOS indicators between COPD patients and healthy controls, including respiratory resistance at 5 Hz (R5) and 20 Hz (R20), difference between R5 and R20 (R5−R20), respiratory reactance at 5 Hz (X5), resonant frequency (Fres), and area of reactance (Ax). Meta-analyses were conducted to calculate the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Results: 39 eligible studies were enrolled, involving 6,144 COPD patients and 4,611 healthy controls. Relative to healthy controls, COPD patients had significantly higher R5 (WMD: 0.17, 95% CI: 0.14, 0.20), R5−R20 (WMD: 0.13, 95% CI: 0.11, 0.15), Fres (WMD: 9.04, 95% CI: 7.66, 10.42), Ax (WMD: 1.24, 95% CI: 0.86, 1.61), and lower X5 (WMD: −0.15, 95% CI: −0.18, −0.11), and such differences became even greater as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage escalated. Pooled correlation coefficients presented that R5, R5−R20, Fres, and X5 were significantly related to post-bronchodilator forced expiratory volume in the first second (FEV1)/forced vital capacity ratio (meta r = −0.37, −0.45, −0.53, and 0.42, respectively) and FEV1 as a percentage of predicted value (meta r = −0.43, −0.54, −0.59, and 0.56, respectively). Conclusion: IOS may be a supplement to spirometry in diagnosing and assessing COPD, especially when spirometry is inappropriate. More well-designed, large sample-sized, prospective studies are warranted to establish an IOS-based criterion for COPD management. [ABSTRACT FROM AUTHOR]

Introduction: Anti‐thymocyte globulin (ATG) is a polyclonal antibody formulation which has been used as a second‐line therapy for chronic lung allograft dysfunction (CLAD). Limited data exist evaluating its efficacy; however, several single‐center retrospective studies have variably demonstrated either improvement or stabilization of spirometry parameters after administration of ATG. ATG has been in use at UT Southwestern for treatment of CLAD since at least 2010; here, we seek to evaluate the effectiveness of this intervention at our center. Methods: A retrospective chart review was conducted of a total of 136 patients who underwent lung transplantation at UT Southwestern Medical Center between 2010 and 2022. Of these, 72 patients had received ATG specifically for treatment of CLAD, and the remaining 64 had never received ATG. Two separate analyses were performed: in the first, among those who received ATG for CLAD, spirometry data from the 6 months preceding and following ATG administration were reviewed and rates of change in FEV1 were calculated for each time period. Descriptive statistics were performed to summarize the baseline clinical characteristics and outcomes after ATG, with patients classified as having either a full response (positive rate of change in FEV1) or partial response (>20% attenuation in rate of FEV1 decline) to ATG. In the second analysis, survival was described among those who received ATG for CLAD and comparison was provided between propensity‐score matched cohorts from the ATG and non‐ATG groups. Results: Of the 63 patients who received ATG for treatment of CLAD (and had adequate spirometry measurements available to trend FEV1), 49 (77.8%) had at least a partial response to therapy; 8 (12.7%) experienced an overall improvement in FEV1. Response to ATG was found to be associated with a more rapid rate of pre‐ATG decline in FEV1; no other baseline parameters were found to be predictive of a response to ATG. Median post‐CLAD graft survival was 31.7 months among those who received ATG, and only baseline absolute neutrophil count was found to be associated with worse post‐CLAD graft survival among this group. Conclusion: Anti‐thymocyte globulin therapy, when given for CLAD, was associated with at least a modest attenuation in rate of FEV1 decline in most patients but only rarely preceded an absolute improvement in FEV1. Further study is warranted to better define the role for ATG in treatment of CLAD, a challenging disease state with limited therapeutics available. [ABSTRACT FROM AUTHOR]

In future the battle against this plague of mankind tuberculosis will not just be concerned with an uncertain something, but with a tangible parasite about whose characteristics a great deal is known, and can be explored. The mortality rate was high in HIV seropositive as compared to seronegative patients. Hence this study is undertaken, considering the seriousness of public health, importance of these two grave diseases, to understand their gravity at local level and its comparison with studies in the other parts of country and world and to observe beneficial effect of chest physiotherapy on these TB patients. For this study slandered study protocol was designed. Then results were observed on demographic and statistical data and after performing spirometry results were commented upon. HIV no untoward effects of chemotherapy was noted in HIV seropositive as well as in HIV seronegative patients. Though all types of respiratory infections are common in HIV Early screening of symptomatic for tuberculosis could be a seropositive. effective approach to early detection and management of tuberculosis among not HIV seropositive but also in HIV seronegative individual. Patients of extrapulmonary tuberculosis or disseminated TB should be screened for high-risk behaviour as well as HIV testing. Also, a longer follow up of these patients is recommended to enable us to study relapses and acquired drug resistance as these patients are already registered at main centre. Also, from the present study this can be concluded that physiotherapy helps in improving the pulmonary function tests in sever TB patients at least after a 30 days of training session. [ABSTRACT FROM AUTHOR]

Chronic cough in children is a common and multifaceted symptom, often requiring a comprehensive approach for accurate diagnosis and effective management. This review explores the use of spirometry, radiology (chest X-rays and computed tomography (CT) scans), and flexible bronchoscopy in the assessment of chronic cough in children through current guidelines and studies. The strengths, clinical indications, and limitations of each modality are examined. Spirometry, radiology, and in some cases flexible bronchoscopy are integral to the assessment of chronic cough in children; however, a tailored approach, leveraging the strengths of each modality and guided by clinical indications, enhances diagnostic accuracy and therapeutic outcomes of pediatric chronic cough. [ABSTRACT FROM AUTHOR]

This study comprehensively validated the bleomycin (BLEO) induced mouse model of IPF for utility in preclinical drug discovery. To this end, the model was rigorously evaluated for reproducible phenotype and TGFβ‐directed treatment outcomes. Lung disease was profiled longitudinally in male C57BL6/JRJ mice receiving a single intratracheal instillation of BLEO (n = 10–12 per group). A TGFβR1/ALK5 inhibitor (ALK5i) was profiled in six independent studies in BLEO‐IPF mice, randomized/stratified to treatment according to baseline body weight and non‐invasive whole‐body plethysmography. ALK5i (60 mg/kg/day) or vehicle (n = 10–16 per study) was administered orally for 21 days, starting 7 days after intratracheal BLEO installation. BLEO‐IPF mice recapitulated functional, histological and biochemical hallmarks of IPF, including declining expiratory/inspiratory capacity and inflammatory and fibrotic lung injury accompanied by markedly elevated TGFβ levels in bronchoalveolar lavage fluid and lung tissue. Pulmonary transcriptome signatures of inflammation and fibrosis in BLEO‐IPF mice were comparable to reported data in IPF patients. ALK5i promoted reproducible and robust therapeutic outcomes on lung functional, biochemical and histological endpoints in BLEO‐IPF mice. The robust lung fibrotic disease phenotype, along with the consistent and reproducible lung protective effects of ALK5i treatment, makes the spirometry‐confirmed BLEO‐IPF mouse model highly applicable for profiling novel drug candidates for IPF. [ABSTRACT FROM AUTHOR]

Background: Long term respiratory complications of Corona Virus Disease-2019 (COVID-19) are of great concern. Many studies have reported altered respiratory patterns in COVID-19 recovered individuals and most of them were from severe to critically ill patients. The association of viral load at the time of infection with symptoms of long COVID-19 specifically on pulmonary functions after months of recovery is still not known. This study was aimed to assess the impact of SARS-CoV-2 viral load during mild-moderate COVID-19 disease on pulmonary functions in middle-aged population after 6–8 months of acute infection. Methods: This study included 300 (102 healthy controls and 198 COVID-19 recovered) individuals between age 30–60 of either gender. Mild-moderate COVID-19 recovered individuals were recruited between a period of 6–8 months post-acute infection. Spirometry was performed with MIR-Spirolab-III. The association of spirometry pattern was compared with SARS-CoV-2 viral loads during acute infection. Results: We observed up to 70% of the participants presented with either shortness of breath (11.5%), body aches (23.5%), recurrent cough (4.4%), recurrent respiratory infections (9.5%) and/or fatigue (33.3%) at follow up. In our study, 35.5% of COVID-19 recovered individuals had abnormal respiratory patterns (33.5% had restrictive and 2% had obstructive patterns). Viral load ≤ 20 CT value was associated with restrictive respiratory patterns (p = 0.004). No association was found between viral load and disease severity (p = 0.23). Conclusion: In this study, we found one third of mild-moderate COVID-19 recovered individuals have restrictive respiratory patterns after 6–8 months of recovery. These findings had a strong association with SARS-CoV-2 viral loads during acute infection which has been reported for the first time in our study. Studying the relationship between viral load and pulmonary functions can contribute to identifying potential risk factors for long COVID and developing preventive measures to mitigate the long-term impact on lung health. Clinical trial number: Not applicable. [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]

Purpose: Over 550 loci have been associated with human pulmonary function in genome-wide association studies (GWAS); however, the causal role of most remains uncertain. Single nucleotide polymorphisms in a disintegrin and metalloprotease domain 19 (ADAM19) are consistently related to pulmonary function in GWAS. Thus, we used a mouse model to investigate the causal link between Adam19 and pulmonary function. Methods: We created an Adam19 knockout (KO) mouse model and validated the gene targeting using RNA-Seq and RT-qPCR. Mouse body composition was assessed using dual-energy X-ray absorptiometry. Mouse lung function was measured using flexiVent. Results: Contrary to prior publications, the KO was not neonatal lethal. KO mice had lower body weight and shorter tibial length than wild-type (WT) mice. Their body composition revealed lower soft weight, fat weight, and bone mineral content. Adam19 KO had decreased baseline respiratory system elastance, minute work of breathing, tissue damping, tissue elastance, and forced expiratory flow at 50% forced vital capacity but higher FEV0.1 and FVC. Adam19 KO had attenuated tissue damping and tissue elastance in response to methacholine following LPS exposure. Adam19 KO also exhibited attenuated neutrophil extravasation into the airway after LPS administration compared to WT. RNA-Seq analysis of KO and WT lungs identified several differentially expressed genes (Cd300lg, Kpna2, and Pttg1) implicated in lung biology and pathogenesis. Gene set enrichment analysis identified negative enrichment for TNF pathways. Conclusion: Our murine findings support a causal role of ADAM19, implicated in human GWAS, in regulating pulmonary function. [ABSTRACT FROM AUTHOR]

Small airways obstruction (SAO) is common in general populations. It has been associated with respiratory symptoms, cardiometabolic diseases, and progression to COPD over time. Whether SAO predicts mortality is largely unknown. Is spirometry-defined SAO associated with increased mortality? Data were analyzed from 252,877 adult participants, aged 40 to 69 years at baseline, in the UK Biobank who had provided good-quality spirometry measurements. SAO was defined as the ratio of the forced expiratory volume in 3 s to the forced expiratory volume in 6 s less than the lower limit of normal. SAO was considered to be isolated if present when the FEV 1 /forced expiratory volume in 6 s ratio was normal (ie, greater than the lower limit of normal). A multivariable Cox regression model was used to assess the association of SAO, and isolated SAO, with all-cause and disease-specific mortality. Sex differences were investigated in these associations, and the primary analysis was repeated, excluding those who ever smoked. All models were adjusted for potential confounders such as sex, BMI, smoking status, smoking pack-years, assessment center, Townsend deprivation index, and ethnicity. A total of 59,744 participants with SAO were identified, of whom 24,004 had isolated SAO. A total of 5,009 deaths were reported over a median of 12.8 years of follow-up. Participants with SAO had increased all-cause (hazard ratio [HR], 1.31; 95% CI, 1.26-1.36), cardiovascular (HR, 1.39; 95% CI, 1.29-1.51), respiratory (HR, 2.20; 95% CI, 1.92-2.51), and neoplasm (HR, 1.23; 95% CI, 1.17-1.29) mortality risk. These associations were not modified by sex. However, in those who never smoked, only respiratory and cardiovascular mortality risk was associated with SAO. Isolated SAO was also associated with an increased mortality risk (HR, 1.14; 95% CI, 1.07-1.20). Individuals with SAO have an increased risk of all-cause and disease-specific mortality. Further studies are needed to determine whether SAO causes mortality or is a marker of underlying disease. [Display omitted] [ABSTRACT FROM AUTHOR]

This systematic review explores the release and health outcomes of exposure to chalk particles in classrooms. A literature search was conducted on Scopus, Google Scholar, and the Web of Science. Chalk particles contribute significantly to poor indoor air quality in classrooms. Higher concentrations of PM2.5 chalk particles were found in the front row (14.25 µg/m3) and near the chalkboard (19.07 µg/m3). Inhalation and dermal are significant exposure routes; hence, teachers and learners are at risk of developing respiratory and skin disorders. Inhalation of chalk particles correlates with reduced lung function in teachers and learners. The release and size of chalk particles depend on the activities, type of chalk sticks, and texture of the chalkboards. Wiping the chalkboard releases more chalk particles of smaller size (3.85–9.3 µm) than writing (10.57–92.91 µm). A shift from chalk sticks and chalkboards in classrooms is necessary to mitigate the associated health risks. [ABSTRACT FROM AUTHOR]

Noninvasive mechanical ventilation (NIV) may reduce postoperative complications of obesity--associated restrictive pulmonary syndrome. We evaluated the effects of NIV use after extubation in patients undergoing bariatric surgery on acute changes in lung function. A randomized clinical trial was performed with patients in the immediate postoperative period of bariatric surgery. The intervention group used NIV for 1 hour after arrival at the post-anesthesia recovery room, the control group received standard care. Pulmonary function assessment was performed preoperatively, immediately after surgery and 1 hour after arrival in the recovery room. Statistical analysis was performed using the Generalized Estimation Equations test and Bonferroni's post-hoc test. The significance level adopted was 0.05. A total of 46 individuals were evaluated, of which 31 were able to perform spirometry in the pre and immediate postoperative period. The sample consisted of 25 women, mean age of 42.55 ± 10.39 years and mean Body Mass Index of 50.82 ± 10.20. Preoperative spirometry showed that most patients had mild restrictive disorders (46.7% versus 43.8%) or no respiratory disorder (40% versus 31.3%). In the post-extubation evaluation, most patients had severe restrictive disorder (66.7% versus 53.8%), after one hour in the recovery room, 64.3% versus 60% of patients had severe restriction and 21.4% versus 20% severe obstruction. It was concluded that the use of prophylactic NIV did not improve pulmonary function in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 2021, the European Respiratory Society (ERS)/American Thoracic Society (ATS) guidelines issued a new definition of bronchodilator responsiveness, which is now defined as an increase in FEV1 or FVC by ≥ 10% of the predicted FEV1 or FVC. The impact of this revised definition on bronchodilator responsiveness prevalence has been relatively understudied. METHODS: We retrospectively analyzed data from 2,696 subjects who performed pulmonary function testing at the University of Iowa from 1997 to 2018. We compared the prevalence of bronchodilator responsiveness by using the 2005 (FEV1 or FVC increase ≥ 12% baseline value and ≥ 200 mL) and 2021 (FEV1 or FVC increase ≥ 200 mL and ≥ 12% of baseline value) ERS/ATS definitions, across several different respiratory diagnosis categories. We compared the prevalence of bronchodilator responsiveness using the 2 definitions by applying the McNemar test and assessed concordance of bronchodilator responsiveness by calculating kappa coefficients for the whole study population and within each diagnosis category. RESULTS: The prevalence of bronchodilator responsiveness increased from 9% when using the 2005 ERS/ATS definition to 16% when using the 2021 definition within the entire cohort and also within each respiratory diagnosis category. In the subjects with normal pre-bronchodilator spirometry, there was a low prevalence of bronchodilator responsiveness (3%) when using the 2005 definition, and the prevalence increased (8%) when using the 2021 definition. In the subjects with normal pre-bronchodilator spirometry and FEV1 Z score ≥ 0, 2% had bronchodilator responsivness according to the 2005 guidelines, whereas 7% had bronchodilator responsiveness according to the 2021 guidelines. CONCLUSIONS: The prevalence of bronchodilator responsiveness increased when using the new 2021 ERS/ATS definition compared with the 2005 definition. In the subjects with normal pre-bronchodilator spirometry, the prevalence of bronchodilator responsiveness increased when using the 2021 definition, in particular, among those with an FEV1 Z score ≥ 0, which raises concerns for overdiagnosis. Future investigations should examine the correlation of bronchodilator responsiveness with clinical outcomes in this group of subjects. [ABSTRACT FROM AUTHOR]

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]

Self-reported occupational exposure was previously associated with COPD in the Spanish population. This study aimed to analyse the relationship between occupational exposure to various chemical and biological agents, COPD, emphysema, and the bronchial wall area, which was determined by lung computed tomography (CT) in 226 individuals with COPD and 300 individuals without COPD. Lifetime occupational exposures were assessed using the ALOHA(+) job exposure matrix, and CT and spirometry were also performed. COPD was associated with high exposure to vapours, gases, dust and fumes (VGDF) (OR 2.25 95% CI 1.19–4.22), biological dust (OR 3.01 95% CI 1.22–7.45), gases/fumes (OR 2.49 95% CI 1.20–5.17) and with exposure to various types of solvents. High exposure to gases/fumes, chlorinated solvents and metals (coefficient 8.65 95% CI 1.21–16.09, 11.91 95%CI 0.46- 23.36, 14.45 95% CI 4.42–24.49, respectively) and low exposure to aromatic solvents (coefficient 8.43 95% CI 1.16–15.70) were associated with a low 15th percentile of lung density indicating emphysema. We conclude that occupational exposure to several specific agents is associated with COPD and emphysema in the Spanish population. [ABSTRACT FROM AUTHOR]

Background and Aims: Although Spinal Anesthesia (SA) remains the technique of choice for many surgeries below the umbilicus, it is associated with multiple intraoperative complications. Sympathetic blockade and Bezold‐Jarisch reflex do not fully explain SA‐related cardiopulmonary complications. Reduction in FEV1 has been reported as a predictor of sudden cardiac death. This study aimed to determine the association between reduction in FEV1 following SA and adverse intraoperative cardiopulmonary complications. Materials and Methods: A prospective study of 48 patients of ASA status I and II with no history of primary cardiopulmonary disease scheduled for elective surgery under SA. Spirometry was performed based on ATS/ERS guidelines before induction and 30 min after induction of SA. FEV1% predicted was determined using GLI 2012 equations. Participants were grouped into two (∆FEV1% < 10% and ∆FEV1% ≥ 10%) based on reductions (∆) in FEV1% predicted following SA. Logistic regression analyses were used to examine associations between ∆FEV1% and intraoperative hypoxia, hypotension, bradycardia, and nausea/vomiting, with adjustments for age, gender, and BMI. Results: The mean FEV1% predicted following SA was lower than the mean FEV1% predicted before SA (83.42 vs. 95.31, p = 0.001). In a fully adjusted model, ∆FEV1% ≥ 10% was associated with an increased risk of hypoxia [AOR 13.55; 95% CI, 1.07–171.24, p = 0.044]. The positive associations between ∆FEV1% ≥ 10% and hypotension [2.02 (0.33–12.46), 0.449], bradycardia [1.10 (0.28–4.25), 0.895] and nausea/vomiting [9.74 (0.52–183.94), 0.129] were not statistically significant. Conclusion: Reduction in FEV1% predicted following SA was associated with adverse intraoperative outcomes. FEV1 may play an important role in the association between SA and cardiopulmonary complications. [ABSTRACT FROM AUTHOR]

Background and Purpose: Kinesiology tape (KT) has been used clinically to improve posture, mobility, and muscle strength. Limited research has investigated the effect of KT on respiratory function. The purpose of this study was to explore the effects of KT on posture and breathing in healthy individuals. Methods: Ninety-two adult participants were randomly assigned to a KT, sham tape (ST), or control group. Data collection occurred over 2 sessions. Baseline measurements included chest wall expansion (CWE) at the sternal angle (SA) and xiphoid process (Xi), maximal inspiratory pressure (MIP), and tragus (TWD) and acromion (AWD) to wall distances. Next, KT or ST was applied to the upper back and neck, or no tape was applied based on group assignment. Measurements were then repeated. Participants returned for a final round of measurements 48 hours later. Mixed-measures ANOVAs were used to determine the influence of tape at baseline (T0), immediately post-taping (T1), and 48 hours post-taping (T2). Post hoc analyses used the Tukey method. Results: Analysis showed significant differences between T0 and T1 (P = .004) and between T1 and T2 (P 5 .004) for AWD on the left. CWE-Xi data showed within group differences T0-T2 (P = .004) and T1-T2 (P = .004). MIP data showed within group differences between T0 and T1 (P = .001), T0 and T2 (P < .001), and T1 and T2 (P < .001). Discussion: KT had a limited and inconsistent impact on posture where there was a decrease inAWDon the left from T0 to T1 and then an increase from T1 to T2. No other changes in posture were found. Taping did not affect CWE at the SA. There was an evident training effect for CWE-Xi and MIP, where all groups saw increases over time. Conclusion: This method of KT application is not supported as an intervention for influencing posture and enhancing inspiratory breathing mechanics in healthy adults. Further investigation of KT in other populations is needed. [ABSTRACT FROM AUTHOR]

Rationale: Declines in percent predicted forced expiratory volume in 1 second (ppFEV1) are an important marker of clinical progression of cystic fibrosis (CF). Objectives: We examined ppFEV1 variability in relation to a combined outcome of lung transplant or death. Methods: We estimated the association between ppFEV1 variability and the combined outcome of lung transplant or death. We included children aged 8 years and older with CF and two prior years of ppFEV1 data before baseline between 2005 and 2021. We defined ppFEV1 increased variability as any relative increase or decrease of at least 10% in ppFEV1 from a 2-year averaged baseline. A marginal structural Cox proportional hazards model was used. We examined a cumulative measure of ppFEV1 variability, defined as the cumulative proportion of visits with ppFEV1 variability at each visit. Kaplan-Meier survival curves were generated on the basis of quartiles of the cumulative distribution of ppFEV1 variability. Results: We included 9,706 patients with CF in our cohort. The median age at cohort entry was 8.3 (interquartile range, 8.2–8.4) years; 50% of patients were female; 94% were White; and the median baseline ppFEV1 was 94.4 (interquartile range, 81.6–106.1). The unadjusted hazard ratio for increased ppFEV1 variability on lung transplant/mortality was 4.13 (95% confidence interval, 3.48–4.90), and the weighted hazard ratio was 1.49 (95% confidence interval, 1.19–1.86). Survival curves stratified by quartile of cumulative variability demonstrated an increased hazard of lung transplant/mortality as the proportion of cumulative ppFEV1 variability increased. Conclusions: We found a strong association between ppFEV1 variability and lung transplant or mortality in a cohort of people with CF in the United States. [ABSTRACT FROM AUTHOR]

Rationale: Spirometry reference equations that are derived from a large, nationally representative general population are warranted in China, and the impact of using prebronchodilator (pre-BD) and post-BD spirometry reference values has yet to be assessed in Chinese populations. Objectives: To present the pre-BD and post-BD spirometry reference values for Chinese adults using the China Pulmonary Health (CPH) Study. Methods: A reference population of 17,969 healthy, nonsmoking participants in the CPH Study was used to calculate the pre- and post-BD reference values for FEV1, FVC, and FEV1/FVC ratio. Pre- and post-BD reference values were applied to the entire CPH population (N = 50,991) to illustrate the divergence between the use of different references in determining disease prevalence and severity grading. Measurements and Main Results: The prevalences of airflow limitation were 5.36% using the pre-BD reference and 8.02% using the post-BD reference. Individuals who had a post-BD FEV1/FVC ratio lower than the post-BD reference value but higher than the pre-BD reference value were found to have significantly higher rates of self-reported respiratory symptoms and significantly lower values on spirometry indicators than those whose post-BD FEV1/FVC ratio was greater than the post-BD reference value. An additional 3.51% of participants were identified as having grade II–IV chronic obstructive pulmonary disease using the post-BD FEV1 predicted values. Conclusions: This study generated and applied pre- and post-BD spirometry reference values in a nationally representative Chinese adult population. Post-BD reference values may serve as an additional criterion in identifying individuals at risk for obstructive pulmonary diseases, and their diagnostic and prognostic values should be further investigated. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusionsThere is limited information on the discrepancy between the spirometric values calculated with diverse spirometric prediction equations in normal children.To determine the differences in percentage predicted (PP) values calculated through thirteen prediction equations (PEs) in healthy Chilean children.We compared the PP values for FVC, FEV1, FEF25–75% and FEV1/FVC obtained by applying thirteen PEs, using GLI-2012 as a gold standard reference equation and including race neutral GLI-2022 in the analysis; PP values are from a group of 208 healthy Chilean children aged 7 to 17 years.In boys, the range of differences for FVC between PEs compared to the reference group went from −5.47% to 20.82% and from −6.4% to 19.74% in girls. For FEV1, in girls, the range of differences went from −5.96% to 18.01% and from −5,04% to 20.67% in boys. Significant differences between GLI-2012 PPs and the other PEs were observed more frequently in girls than in boys (p < 0.001).There is a wide difference between the spirometric PPs values by different PEs, including race neutral GLI-2022. Our findings, especially given the potential interpretative and clinical implications, might suggest the need for conducting standardized, multicenter studies in Latin America to determine which PEs would better fit pediatric populations in this region. [ABSTRACT FROM AUTHOR]

Spirometry is one of the important non-invasive, sensitive, easy-to-perform, reproducible, and objective biomedical screening and diagnostic procedures in healthcare for the assessment of lung function. To date, there is no unified system, equation, or framework for the prediction of spirometry parameters for the Indian population. In this research article, a machine-learning-based system has been proposed and evaluated, and a web application developed for the prediction of Spirometry Parameters of the Adult Indian Population. The four most commonly used supervised machine-learning algorithms (Linear Regression, Gradient Boosting Regression, Deep Neural Multi-Layer Perceptron (MLP) Regression, and Support Vector Regression) for regression tasks have been evaluated for this purpose. Based on Mean absolute error, root mean squared error and adjusted R2 value, it has emerged that Gradient Boosting and Deep Neural MLP are the best-fit models to predict Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1) respectively for the Indian population. A web application has been designed using the Flask web framework to predict the FVC, FEV1, and corresponding Lower Limit Normality. This research work paves the foundation for ML-assisted spirometry for lung function assessment of the Indian population to extend the benefits of state-of-the-art technology in healthcare. [ABSTRACT FROM AUTHOR]

Summary Obstructive airway disease is associated with sleep disturbances. We aimed to assess the relationship between lung function and sleep disorder symptoms using cross‐sectionally collected data between March 2017 and August 2021 from the Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study, a prospective community‐based multi‐site case‐finding study. Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population study participants with respiratory symptoms but without diagnosed lung disease who completed spirometry and the Global Sleep Assessment Questionnaire were included. We conducted multivariate linear regression models for forced expiratory volume in 1 s, forced vital capacity and forced expiratory volume in 1 s/forced vital capacity by Global Sleep Assessment Questionnaire responses adjusted for confounders. The same models were employed to examine respiratory symptoms, as reported on the St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test, by Global Sleep Assessment Questionnaire responses. Logistic regression models were used to assess the association of undiagnosed obstructive airway disease with sleep symptoms. Amongst 2093 adults included in the study, 48.3% were female and the median age was 63 years (interquartile range 53–72). Two‐hundred and five (9.79%) subjects met spirometry criteria for undiagnosed chronic obstructive pulmonary disease, and 191 (9.13%) for undiagnosed asthma. There were no significant associations between spirometry measures and sleep symptoms (p > 0.5), controlling for age, sex, body mass index, smoking and comorbidities. Those with undiagnosed asthma were more likely to report insomnia “at least sometimes” versus “never” (odds ratio 2.58, 95% confidence interval: 1.27–6.19, p = 0.02). Respiratory symptoms were associated with sleep symptoms, with significant (p < 0.05) increases in St George's Respiratory Questionnaire and Chronic Obstructive Pulmonary Disease Assessment Test scores in those reporting most sleep symptoms. Overall, we found an association between undiagnosed asthma and insomnia, and between respiratory and sleep disorder symptoms. [ABSTRACT FROM AUTHOR]

Background: It has been proposed that prolonged use of anti-inflammatory and anti-fibrotic drugs diminish the probability of development of lung fibrosis. Prolonged low-dose corticosteroid may prevent remodeling of the lung in survivors. Pirfenidone and colchicine may exhibit anti-fibrotic and anti-inflammatory properties as well. Methods: This retrospective observational study was conducted at post COVID-19 clinic, Mansoura University Hospitals, during the period between October 2020 and March 2022. This study included 104 patients who had COVID-19 pneumonia confirmed either by RT-PCR or radiologically by CT scan and divided into 3 groups; group A (corticosteroids only) included 33 (31.7%) patients, group B (corticosteroids and colchicine) included 56 (53.8%) patients, and group C (corticosteroids, colchicine, and pirfenidone) included 15 (14.4%) patients. All patients were assessed during follow-up visits in post COVID-19 clinic 1 and 3 months after discharge by evaluation of resting SpO2, spirometry, and radiological assessment. Patients' data during hospitalization was collected from hospital electronic systems. Results: There was non-statistically significant improvement in FEV1 in group A while there was statistically significant improvement in FEV1 in groups B and C (P value = 0.002 and 0.041, respectively) 1 month and 3 months after discharge. Group B exhibited more statistically significant improvement in FVC as well compared to group C (P value = 0.003 and 0.025, respectively) while group A showed non-statistically significant improvement in FVC. There was a statistically significant decrease in CT severity score in all the groups during follow-up with P value < 0.001 in groups A and B and to less extent less statistically significant decrease in group C comparing the 3 groups to each other. Conclusion: The use of colchicine added to corticosteroids after acute phase of COVID-19 pneumonia resulted in statistically significant improvement regarding functional and radiological changes during follow-up when compared to corticosteroids alone. The addition of pirfenidone (which is a relatively expensive drug) to corticosteroids and colchicine did not add more statistically significant improvement in functional or radiological changes. [ABSTRACT FROM AUTHOR]

Introduction Asthma is the most common diagnosis in military personnel who endorse chronic dyspnea. Service members have unique occupational risk factors, and there is concern that airborne exposures in the deployed environment as well as other occupational exposures may contribute to the development of asthma or exacerbate pre-existing disease. Asthma phenotyping with clinical biomarkers such as serum immunoglobulin E (IgE) levels and eosinophil (EOS) counts is useful in defining treatment strategies for the management of asthma. This study sought to characterize the phenotype of medically separated military personnel with career-limiting asthma to define potential management strategies and guide future research evaluating the unexplained prevalence of asthma in this population. Materials and Methods A retrospective chart review of active duty service members (ADSM) who underwent fitness for duty evaluation via medical evaluation board between 2005 and 2016 and were separated with a minimum 30% conditional disability rating for asthma was performed. Only ADSM who were diagnosed with asthma by a pulmonologist and had spirometry data available were included in the analysis. Demographics, spirometry data, and laboratory data to include IgE levels, radioallergosorbent panels, and EOS counts were analyzed from the DoD electronic medical record. Results A total of 141 service members were evaluated with a mean age of 42 ± 6.8 years, mean serum EOS count of 300 ± 358 cells/μL, and mean IgE level of 305 ± 363 IU/mL. The patients were further categorized into 4 subgroups based on serum EOS count and IgE level: group A with IgE < 100 IU/mL and EOS < 300 cells/μL (n  = 45; 33%), group B with IgE > 100 IU/mL and EOS < 300 cells/μL (n  = 44; 32%), group C with IgE < 100 IU/mL and EOS > 300 cells/μL (n  = 6; 1%), and group D with IgE > 100 IU/mL, EOS > 300 cells/μL (n  = 46; 34%). Among the cohorts, there were no statistically significant differences in demographics, body mass index, spirometry, smoking history, or disability rating. Conclusion The majority of ADSM with a defined asthma history do not have concordant elevations in serum IgE and blood EOS suggestive of a Th2-high phenotype. Asthma in this population is heterogeneous, and phenotyping using clinical biomarkers may be useful to define optimal treatment strategies. [ABSTRACT FROM AUTHOR]

Background: Patients with severe coronavirus-19 disease (COVID-19) have more spirometric alterations, especially a restrictive pattern characterized by low forced vital capacity (FVC). Some variables associated with this alteration in lung function have been described, such as hypoxemia, vaccination and hand strength, which in turn are related to the magnitude of lung damage. Objective: To analyze different clinical variables and their association with alterations in spirometry in survivors of severe COVID-19. Material and methods: Retrospective and observational study of survivors of severe COVID-19 sent for their first spirometry, hand dynamometry, and 6-minute walk (6MW) in a secondary care unit during 2021. Results: 2 doses of SARS-CoV-2 vaccine were protective factor (odds ratio [OR]: 0.36, 95% CI [95% CI]: 0.1-0.8, p = 0.02) and hospitalization (> 15 days) was a risk factor for spirometric alterations (FVC < 80% of predicted) (OR: 3.0; 95% CI 1.3-6.8, p = 0.00); hand weakness, SpO2 desaturation > 4% in 6MW, and days of hospitalization were associated with low FVC. Conclusions: A hospitalization > 15 days and having 2 doses of vaccination are risk and protective factors, respectively, of having a low FVC. Days of hospitalization, vaccination status, and FVC allowed to identify clusters of severe COVID-19 survivors with greater deterioration. [ABSTRACT FROM AUTHOR]

The aim of this research was to examine the existence of broncho-obstruction of the airways in patients suffering from chronic obstructive pulmonary disease, as well as changes in resistance values in this part of the bronchial tree after inhalation of salbutamol. This study was designed as a prospective, interventional clinical trial that included a sample of 147 patients suffering from COPD. Patients were stratified into four groups of thirty patients each based on the severity of airflow limitation (based on the post-bronchodilator FEV1 value), according to the GOLD grade. The test was conducted at the University Clinical Center Sarajevo, Clinic for Lung Diseases and Tuberculosis "Podhrastovi" The results of our research showed that the average values of FEV1 compared to the predicted values of this parameter in subjects in the GOLD 4 group before the administration of salbutamol were statistically significantly lower than the average values of FEV1 in other subjects of the GOLD group. After the administration of salbutamol, a statistically significant increase in the value of FEV1 was registered in all tested groups. When the response to salbutamol was compared among the GOLD groups, it was assessed that the difference in the percentage increase in predicted FEV1 values after the administration of salbutamol among the tested groups was not statistically significant. Bronchodilation with salbutamol and additional ipratropium had a significant effect on both mentioned parameters, especially in the COPD group, which speak in favor of the presence of increased peripheral resistance in all groups of patients. A statistically significant bronchodilator response was obtained in GOLD 1 and GOLD 2 groups, i.e. in groups of patients with milder forms of the disease. [ABSTRACT FROM AUTHOR]

Asthma is one of the most common chronic inflammatory diseases of childhood with a heterogeneous impact on health and quality of life. Mepolizumab is an antagonist of interleukin-5, indicated as an adjunct therapy for severe refractory eosinophilic asthma in adolescents and children aged >6 years old. We present the case of a 9 year-old boy with severe asthma who experienced several asthmatic exacerbations following a SARS-CoV-2 infection, necessitating therapy with short-acting bronchodilators, oral corticosteroids, and hospitalization. We follow the patient using validated questionnaires for the evaluation of asthma control: Children Asthma Control Test, Asthma Control Questionnaire, respiratory function tests, and evaluation of exhaled nitric oxide fraction. After 12 weeks from the start of therapy with mepolizumab, we found significant improvements in lung function, a reduction in the degree of bronchial inflammation, and improvements in quality of life. No asthmatic exacerbations have been reported since the initiation of treatment with mepolizumab. Respiratory infections, such as those related to SARS-CoV-2, represent a significant risk factor for exacerbations in patients with moderate to severe forms of asthma. In our experience, following new episodes of exacerbation, the initiation of treatment with mepolizumab has allowed us to improve asthma control and enhance the quality of life of patients from the first doses. Although mepolizumab showed promise in this child with severe asthma during SARS-CoV-2 infection, the results from this single case cannot be generalized. Further studies are needed to confirm its safety and effectiveness. [ABSTRACT FROM AUTHOR]

Background: As the pulmonary system and cardiovascular system are intimately linked, patients with chronic obstructive pulmonary disease (COPD) and asthma have high risk for developing cardiovascular diseases (CVDs) and altered central hemodynamic. Objective: We aim to assess the central aortic blood pressure (CABP) indices, pulse wave velocity (PWV) and other indicators of arterial stiffness in Indian patients with COPD and bronchial asthma. Methods: This is a single‐center, cross‐sectional study conducted in outpatients diagnosed with either chronic stable phase of COPD or bronchial asthma. CABP indices, vascular age, arterial stiffness and central hemodynamics were measured in patients. Results: Of 193 patients with obstructive airway disease who were enrolled, (n = 81 had COPD and n = 112 had partially‐controlled bronchial asthma) the proportion of male patients was higher in both groups. The PWV, augmentation index (AI) and vascular age (VA) were significantly higher in patients with COPD compared to those with bronchial asthma (all, p < 0.05). Conclusion: The study showed that PWV, AI and VA were higher in patients with stable COPD without any cardiac comorbidities compared to bronchial asthma. [ABSTRACT FROM AUTHOR]

Objective: Adverse respiratory outcomes in post-9/11 veterans with elevated urinary metal measures and enrolled in the VA's Toxic Embedded Fragment registrywere compared to thosewithout elevated urinary metals. Methods: Veterans completed questionnaires, underwent pulmonary physiology tests (pulmonary function and oscillometry), and provided urine samples for analysis of 13 metals. Respiratory symptoms, diagnoses, and physiology measures were compared in veterans with ≥1 urine metal elevation to those without metal elevations, adjusted for covariates, including smoking. Results: Among 402 study participants, 24% had elevated urinemetals, often just exceeding upper limits of reference values. Compared to veterans without elevated metals, those with elevated metals had had higher FEV1 values but similar frequencies of respiratory symptoms and diagnoses and abnormalities on pulmonary physiology tests. Conclusions: Mild systemic metal elevations in post-9/11 veterans are not associated with adverse respiratory health outcomes. [ABSTRACT FROM AUTHOR]

The high cost and limited availability of home spirometers pose a significant barrier to effective respiratory disease management and monitoring. To address this challenge, this paper introduces a novel Venturi-based spirometer designed for home use, leveraging the Bernoulli principle. The device features a 3D-printed Venturi tube that narrows to create a pressure differential, which is measured by a differential pressure sensor and converted into airflow rate. The airflow is then integrated over time to calculate parameters such as the Forced Vital Capacity (FVC) and Forced Expiratory Volume in one second (FEV1). The system also includes a bacterial filter for hygienic use and a circuit board for data acquisition and streaming. Evaluation with eight healthy individuals demonstrated excellent test-retest reliability, with intraclass correlation coefficients (ICCs) of 0.955 for FVC and 0.853 for FEV1. Furthermore, when compared to standard Pulmonary Function Test (PFT) equipment, the spirometer exhibited strong correlation, with Pearson correlation coefficients of 0.992 for FVC and 0.968 for FEV1, and high reliability, with ICCs of 0.987 for FVC and 0.907 for FEV1. These findings suggest that the Venturi-based spirometer could significantly enhance access to spirometry at home. However, further large-scale validation and reliability studies are necessary to confirm its efficacy and reliability for widespread use. [ABSTRACT FROM AUTHOR]

Background: Within-breath analysis of oscillometry parameters is a growing research area since it increases sensitivity and specificity to respiratory pathologies and conditions. However, reference equations for these parameters in White adults are lacking and devices using multiple sinusoids or pseudorandom forcing stimuli have been underrepresented in previous studies deriving reference equations. The current study aimed to establish reference ranges for oscillometry parameters, including also the within-breath ones in White adults using multi-sinusoidal oscillations. Methods: White adults with normal spirometry, BMI ≤30 kg/m2, without a smoking history, respiratory symptoms, pulmonary or cardiac disease, neurological or neuromuscular disorders, and respiratory tract infections in the previous 4 weeks were eligible for the study. Study subjects underwent oscillometry (multifrequency waveform at 5–11–19 Hz, Resmon PRO FULL, RESTECH Srl, Italy) in 5 centers in Europe and the USA according to international standards. The within-breath and total resistance (R) and reactance (X), the resonance frequency, the area under the X curve, the frequency dependence of R (R5–19), and within-breath changes of X (ΔX) were submitted to lambda-mu-sigma models for deriving reference equations. For each output parameter, an AIC-based stepwise input variable selection procedure was applied. Results: A total of 144 subjects (age 20.8–86.3 years; height 146–193 cm; BMI 17.42–29.98 kg/m2; 56% females) were included. We derived reference equations for 29 oscillatory parameters. Predicted values for inspiratory and expiratory parameters were similar, while differences were observed for their limits of normality. Conclusions: We derived reference equations with narrow confidence intervals for within-breath and whole-breath oscillatory parameters for White adults. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 30%of people infected with COVID-19 require hospitalization, and 20% of them are admitted to an intensive care unit (ICU). Most of these patients experience symptoms of fatigue weeks post-ICU, so understanding the factors associated with fatigue in this population is crucial. Methods: Fifty-nine patients (38-78 yr) hospitalized in ICU for COVID-19 infection for 32 (6-80) d, including 23 (3-57) d of mechanical ventilation, visited the laboratory on two separate occasions. The first visit occurred 52 ± 15 d after discharge and was dedicated to questionnaires, blood sampling, and cardiopulmonary exercise testing, whereas measurements of the knee extensors neuromuscular function and performance fatigability were performed in the second visit 7 ± 2 d later. Results: Using the FACIT-F questionnaire, 56% of patients were classified as fatigued. Fatigued patients had worse lung function score than non-fatigued (i.e., 2.9 ± 0.8 L vs 3.6 ± 0.8 L; 2.4 ± 0.7 L vs 3.0 ± 0.7 L for forced vital capacity and forced expiratory volume in 1 s, respectively), and forced vital capacity was identified as a predictor of being fatigued. Maximal voluntary activation was lower in fatigued patients than non-fatigued patients (82% ± 14% vs 91% ± 3%) and was the only neuromuscular variable that discriminated between fatigued and non-fatigued patients. Patient-reported outcomes also showed differences between fatigued and non-fatigued patients for sleep, physical activity, depression, and quality of life (P < 0.05). Conclusions: COVID-19 survivors showed altered respiratory function 4 to 8 wk after discharge, which was further deteriorated in fatigued patients. Fatigue was also associated with lower voluntary activation and patient-reported impairments (i.e., sleep satisfaction, quality of life, or depressive state). The present study reinforces the importance of exercise intervention and rehabilitation to counteract cardiorespiratory and neuromuscular impairments of COVID-19 patients admitted in ICU, especially individuals experiencing fatigue. [ABSTRACT FROM AUTHOR]

Introduction The effects of smoking on lung function among post-9/11 Veterans deployed to environments with high levels of ambient particulate matter are incompletely understood. Materials and Methods We analyzed interim data (04/2018-03/2020) from the Veterans Affairs (VA) Cooperative Studies Program #595, "Service and Health Among Deployed Veterans". Veterans with ≥1 land-based deployments enrolled at 1 of 6 regional Veterans Affairs sites completed questionnaires and spirometry. Multivariable linear regression models assessed associations between cigarette smoking (cumulative, deployment-related and non-deployment-related) with pulmonary function. Results Among 1,836 participants (mean age 40.7 ± 9.6, 88.6% male), 44.8% (n  = 822) were ever-smokers (mean age 39.5 ± 9.5; 91.2% male). Among ever-smokers, 86% (n  = 710) initiated smoking before deployment, while 11% (n  = 90) initiated smoking during deployment(s). Smoking intensity was 50% greater during deployment than other periods (0.75 versus 0.50 packs-per-day; P  < .05), and those with multiple deployments (40.4%) were more likely to smoke during deployment relative to those with single deployments (82% versus 74%). Total cumulative pack-years (median [IQR] = 3.8 [1, 10]) was inversely associated with post-bronchodilator FEV1%-predicted (−0.82; [95% CI] = [−1.25, −0.50] %-predicted per 4 pack-years) and FEV1/FVC%-predicted (−0.54; [95% CI] = [−0.78, −0.43] %-predicted per 4 pack-years). Deployment-related pack-years demonstrated similar point estimates of associations with FEV1%-predicted (−0.61; [95% CI] = [−2.28, 1.09]) and FEV1/FVC%-predicted (−1.09; [95% CI] = [−2.52, 0.50]) as non-deployment-related pack-years (−0.83; [95% CI] = [−1.26, −0.50] for FEV1%-predicted; −0.52; [95% CI] = [−0.73, −0.36] for FEV1/FVC%-predicted). Conclusions Although cumulative pack-years smoking was modest in this cohort, an inverse association with pulmonary function was detectable. Deployment-related pack-years had a similar association with pulmonary function compared to non-deployment-related pack-years. [ABSTRACT FROM AUTHOR]

Background Smoking kills 8 million people a year worldwide. It is the most prevalent cause of death in France by cancer, cardiovascular, or respiratory diseases. Minimal advice consists in asking patients who smoke if they are interested in quitting. It is effective in reducing smoking. The French High Health Authority recommends its systematic use with patients, whatever their reason for seeking treatment. The beneficial effect of spirometry on smoking cessation is controversial. The objective of our study was to measure the consequences of spirometry associated with minimal advice, compared with only minimal advice in soldiers seen during a routine medical examination. Methods Our prospective, longitudinal, open, multicenter, controlled, randomized study was conducted among French military smokers presenting for an occupational medicine visit. Each participant received, depending on their group (intervention or control), either minimal advice associated with an evaluation of lung function by mini-spirometer, or only minimal advice. Follow-up visits were performed at 6 and 12 months. The primary objective was self-reported tobacco use cessation at 6 months. Results A total of 267 participants (126 in the intervention group and 141 for the control arm) were included in 10 centers between June 2019 and June 2020. The response rate was 75.6% at 6 months. The cessation rates were 17% and 18% in the intervention and control groups, respectively, with no significant difference between the two groups (P  = 0.9). The cessation rate in the general population was 13% at 6 months. Conclusions Spirometry does not seem to influence smoke cessation on a military population at 6 months. The overall cessation rate in our study was well in excess of the 3-6% expected from only providing minimal which is underused in general practice and should be encouraged. [ABSTRACT FROM AUTHOR]