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Background and Objective: Despite the high burden of respiratory disease amongst Indigenous populations, prevalence data on spirometric deficits and its determinants are limited. We estimated the prevalence of abnormal spirometry in young Indigenous adults and determined its relationship with perinatal and early life factors. Methods: We used prospectively collected data from the Australian Aboriginal Birth Cohort, a birth cohort of 686 Indigenous Australian singletons. We calculated the proportion with abnormal spirometry (z‐score <−1.64) and FEV1 below the population mean (FEV1% predicted 0 to −2SD) measured in young adulthood. We evaluated the association between perinatal and early life exposures with spirometry indices using linear regression. Results: Fifty‐nine people (39.9%, 95%CI 31.9, 48.2) had abnormal spirometry; 72 (49.3%, 95%CI 40.9, 57.7) had a FEV1 below the population mean. Pre‐school hospitalisations for respiratory infections, younger maternal age, being overweight in early childhood and being born remotely were associated with reduced FEV1 and FVC (absolute, %predicted and z‐score). The association between maternal age and FEV1 and FVC were stronger in women, as was hospitalization for respiratory infections before age 5. Being born remotely had a stronger association with reduced FEV1 and FVC in men. Participants born in a remote community were over 6 times more likely to have a FEV1 below the population mean (odds ratio [OR] 6.30, 95%CI 1.93, 20.59). Conclusion: Young Indigenous adults have a high prevalence of impaired lung function associated with several perinatal and early life factors, some of which are modifiable with feasible interventions. [ABSTRACT FROM AUTHOR]

The treatment of patients with COPD and chronic hypercapnic respiratory failure using noninvasive ventilation (NIV) is well established. A "deventilation syndrome" (DVS) has been described as acute dyspnea after cessation of NIV therapy. A systematic scoping review reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) searching Embase was conducted in September 2021. A final manual search followed in February 2023. Literature synthesis was blinded using Rayyan by three different reviewers. A total of 2,009 studies were screened. Five studies met the eligibility criteria. Four articles presented original data. Three articles examined potential treatment options. Three studies were prospective; none were randomized. A total of 122 patients were included. DVS was defined differently in all studies. Seventy-four patients were identified to suffer from DVS (48 controls). Patients were evaluated by blood gas analysis, transcutaneous TcCO2 measurement, spirometry, whole-body plethysmography, respiratory muscle assessments, diaphragmatic electromyography, ultrasound, 6-min walk test, polysomnography, and questionnaires. Treatment approaches studied were minimization of "patient-ventilator asynchrony" (PVA) and use of pursed- lip breathing ventilation. Pathophysiological mechanisms discussed were PVA, high inspiratory positive airway pressure, hyperinflation, respiratory muscle impairment, and increased respiratory rates. Compared with controls, patients with DVS appeared to suffer from more severe airway obstruction, hyperinflation, and PaCO2 retention; worse exercise test scores; and poorer quality of life. The available evidence does not allow for definite conclusions about pathophysiological mechanisms, ethology, or therapeutic options. Future studies should focus on a consistent definition and possible pathomechanisms. [ABSTRACT FROM AUTHOR]

• We studied bacterial respiratory infections and pneumonia in people with HIV (PWH). • The cumulative incidence of pneumonia was highest in PWH with airflow limitation. • PWH with active smoking had a higher risk of bacterial infections and pneumonia. • PWH with previous AIDS had a higher risk of bacterial respiratory infections. We aimed to determine the incidence rate, pathogen composition, and risk factors, particularly airflow limitation, associated with bacterial respiratory infection and pneumonia in a prospective cohort of well-treated people with HIV (PWH) between 2015-2021. We included 1007 PWH from the Copenhagen Comorbidity in HIV infection (COCOMO) study. Spirometry was performed at inclusion. Microbiology samples were collected prospectively. Cumulative incidence was determined by the Aalen-Johansen estimator. Cox proportional hazard models were used to calculate risk factors, adjusted for traditional and HIV-specific variables. The incidence rates of first bacterial respiratory infection and pneumonia were 12.4 (95% CI 9.7-15.5) and 5.5 (95% CI: 3.8-7.7) per 1000 person-years, respectively. The cumulative incidence of pneumonia was four times higher in PWH with airflow limitation (11.8% vs 3.2%, P <0.001). Risk factors for bacterial respiratory infection were airflow limitation (hazard ratio [HR] 2.9, [95% CI: 1.7-5.1], P <0.001), smoking (HR 2.3, [95% CI: 1.4-3.8], P <0.001), and previous AIDS-defining event (HR 2.0, [95% CI: 1.2-3.3], P = 0.009). For pneumonia, airflow limitation (HR 2.7, [95% CI: 1.2-6.3], P = 0.016), smoking (HR 2.5, [95% CI: 1.2-5.4], P = 0.016), and older age (HR 1.5, [95% CI: 1.1-2.1], P = 0.015) were identified as risk factors. Increased emphasis on airflow limitation prevention, including smoking cessation, may reduce the burden of bacterial respiratory infection and pneumonia in PWH. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: The global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD) defines COPD as a typical preventable and treatable disease. Described by a diligent wind current limit is typically progressive and associated with an improved chronic provocative reaction, in the airways and the lung, to harmful particles or gases. Materials and Methods: It was a prospective observational study carried out at a tertiary care centre to evaluate the prevalence of anemia in patients with COPD and its impact on quality of life. The duration of study was one year. Anemia was defined according to WHO criteria, hemoglobin level <13g/dl in men and <12g/dl in women. 114 patients of COPD (confirmed on spirometry as per the GOLD 2017 guidelines) were enrolled after an explicit, written consent. Patient's detailed history was taken, including smoking status, pack year and biomass fuel exposure. Physical examination was conducted to include anthropometric details, routine blood investigations, chest radiograph (postero-anterior view) and a 6 minute walk test. Results: Out of 114 patients enrolled in the study, 30 (26.32%) were found to be anemic and were classified as group I while rest 84(73.68%) were non - anemic and were classified as group II. The mean hemoglobin levels in group I (anemic group) was 11.42 g/dl whereas the mean hemoglobin level in group II was 14.54 g/dl. However there was no significant difference between those with and without anemia in their average age, gender distribution, dietary habits and pack years smoked. Conclusion: The various factors significantly associated with anemia in our study were number of exacerbations of COPD leading to hospitalization, mMRC grade and quality of life. In conclusion, anemia occurs frequently in patients of COPD and is associated with poor quality of life and increased morbidity in the form of number of exacerbations and hospital admissions. Correcting anemia in these patients may improve their clinical outcome. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: Jet nebulizers are commonly used for bronchodilator therapy in COPD. High-flow nasal cannula with vibrating mesh nebulizer (HFNC-VMN) is a recently developed system; however, few studies have compared the efficacy of bronchodilator administration via HFNC-VMN to jet nebulizer in stable COPD. This study aimed to compare the effect of salbutamol administered via HFNC-VMN versus jet nebulizer on airway and lung function in subjects with stable COPD. METHODS: This randomized non-inferiority crossover physiologic study enrolled subjects with stable COPD. Salbutamol was nebulized via HFNC-VMN or jet nebulizer in random order with a 4-h washout period between crossover sequences. Spirometry, lung volume, and impulse oscillometry were performed at baseline and after each intervention. The primary outcome was change in FEV1 from baseline. Secondary outcomes included changes in other respiratory-related parameters and nebulization time compared between the 2 devices. RESULTS: Seventeen subjects were enrolled. HFNC-VMN and jet nebulizer both significantly improved FEV1 from baseline (P = .005 and P = .002, respectively). The difference between respiratory resistance at 5 Hz and 20 Hz significantly decreased after HFNC-VMN compared to baseline (P = .02), while no significant change was observed after jet nebulizer (P = .056). Area of reactance and resonant frequency of reactance were both significantly decreased (P = .035 and P = .03, respectively), and respiratory reactance at 5 Hz significantly increased (P = .02) in the HFNC-VMN group compared to baseline indicating improved lung mechanics, with no significant changes with the jet nebulizer. HFNC-VMN had a shorter nebulization time (6 [5-9] min vs 20 [16-22] min, respectively, P < .001). CONCLUSIONS: Bronchodilator therapy via HFNC-VMN was not inferior to jet nebulizer for subjects with stable COPD and can significantly improve airway oscillometry mechanics and decrease nebulization time compared to jet nebulizer. [ABSTRACT FROM AUTHOR]

Respiratory function declines following surgery due to atelectasis. After thoracic surgery, there is an even greater decline due to resection and lung handling. Patients undergoing thoracic surgery often have concomitant respiratory disease, and testing pulmonary function preoperatively allows: diagnosis and optimization of lung disease; counselling of patients accurately to obtain truly informed consent; and guides the multidisciplinary team to the best operation. Tests of pulmonary function can be divided into tests of mechanical function, tests of parenchymal function, tests of cardiorespiratory reserve and function, and anatomical tests. When these tests are combined with knowledge of the lobes resected, they allow predicted postoperative values to be calculated. Evidence-based guidelines show which investigations should be performed preoperatively and risk stratify patients for postoperative dyspnoea, morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function. Objectives The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty. Methods Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods. Results Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group. Conclusions The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Data on exercise tolerance of children born non-extremely preterm are sparse. We aimed to explore the cardiopulmonary exercise testing (CPET) characteristics in this population. We studied 63 children (age 7–12 years) born at 290/7–366/7 weeks of gestation (34 were late preterm, 29 were preterm) and 63 age-matched, term-born controls. All performed spirometry and CPET (cycle ergometry). There were no differences in activity levels and spirometric parameters between the group of preterm-born children and controls. A peak oxygen uptake (VO2peak) of <80% was noted in 25.4% of the term-born and 49.2% of preterm-born children (p = 0.001). Term-born participants presented similar VO2peak to late-preterm children but higher than those born at <340/7 weeks of gestation (p = 0.002). Ventilatory limitation was noted in 4.8% of term and 7.9% of preterm participants, while only one preterm child presented cardiovascular limitation. Children born before 34 weeks of gestation had higher respiratory rates and smaller tidal volumes at maximum exercise, as well as lower oxygen uptake for the level of generated work. We conclude that school-age children born at 29–34 weeks of gestation may present decreased exercise performance attributed to an altered ventilatory response to exercise and impaired O2 utilization by their skeletal muscles rather than other cardiopulmonary limiting factors. [ABSTRACT FROM AUTHOR]

In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the 'Respiratory Diseases of Pediatric Interest Unit' at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania 'Luigi Vanvitelli', were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem. The present study aims to provide a global and regional estimate of the prevalence of COPD based on spirometry according to the two most widely used diagnostic criteria of COPD: fixed ratio (FR) and lower limit of normal (LLN). Methods: We conducted a systematic review of the literature according to PRISMA guidelines. MEDLINE, Web of Sciences, and Scopus databases were searched to identify studies on the spirometry-based prevalence of COPD in individuals aged 40 years and older. The meta-analysis was performed using MedCalc 19 software. Results: In total, 42 of the 3393 studies reviewed were eligible for inclusion. The overall prevalence of COPD in people aged 40 years and older was 12.64% (95% CI 10.75%-14.65%) and 7.38% (95% CI 5.47% − 9.55%) based on FR and LLN criteria, respectively. By gender, men had a higher prevalence of COPD compared to women (15.47%; 95% CI 12.22%-19.02% for men versus 8.79%; 95% CI 6.94%-10.82% for women). Using the LLN criteria, the prevalence of COPD in both sexes was almost identical (8.67%; 95% CI 8.44%- 8.90% for men and 8.00%; 95% CI 6.42% − 9.73% for women). We reported a high prevalence of COPD among smokers and the elderly by both definitions of airway obstruction. Regional prevalence estimates using the FR definition indicate that the highest COPD prevalence was recorded in the Americas and the lowest was recorded in the Eastern Mediterranean region. Using the LLN definition, the highest prevalence was recorded in the Southeast Asian region and the lowest prevalence was recorded in the American region. The most common COPD stage was stage II, with a prevalence of 50.46%. The results indicate a huge lack of prevalence data in the African and Eastern Mediterranean region. The results were given using a random-effect model due to the high heterogeneity between studies. Conclusion: Results show that the prevalence of COPD differs according to the diagnostic criteria used. In addition, management and prevention strategies targeting risk factors for COPD are certainly needed to reduce the global burden of this chronic respiratory disease. [ABSTRACT FROM AUTHOR]

Dragonfly nymphs breathe water using tidal ventilation, a highly unusual strategy in water-breathing animals owing to the high viscosity, density and low oxygen (O2) concentration of water. This study examines how well these insects extract O2 from the surrounding water during progressive hypoxia. Nymphs were attached to a custom-designed respiro-spirometer to simultaneously measure tidal volume, ventilation frequency and metabolic rate. Oxygen extraction efficiencies (OEE) were calculated across four partial pressure of oxygen (pO2) treatments, from normoxia to severe hypoxia. While there was no significant change in tidal volume, ventilation frequency increased significantly from 9.4 ± 1.2 breaths per minute (BPM) at 21.3 kPa to 35.6 ± 2.9 BPM at 5.3 kPa. Metabolic rate increased significantly from 1.4 ± 0.3 µl O2 min−1 at 21.3 kPa to 2.1 ± 0.4 µl O2 min−1 at 16.0 kPa, but then returned to normoxic levels as O2 levels declined further. OEE of nymphs was 40.1 ± 6.1% at 21.3 kPa, and did not change significantly during hypoxia. Comparison to literature shows that nymphs maintain their OEE during hypoxia unlike other aquatic tidal-breathers and some unidirectional breathers. This result, and numerical models simulating experimental conditions, indicate that nymphs maintain these extraction efficiencies by increasing gill conductance and/or lowering internal pO2 to maintain a sufficient diffusion gradient across their respiratory surface. [ABSTRACT FROM AUTHOR]

Background: A positive bronchodilator response has been defined as a 12% increase in the forced expiratory volume in one second (FEV1) or forced vital capacity (FVC) from their respective pre-bronchodilator values, combined with at least a 0.2 L absolute change. Recent recommendations suggested the use of the percent change in FEV1 and FVC relative to their predicted normal values without having applied them in patients with airflow obstruction. The aim of the current study was to compare the two approaches over a wide range of pre-bronchodilator FEV1 and FVC values. Methods: A retrospective review of consecutive patients undergoing spirometry and bronchodilator testing was completed. The change in FEV1 and FVC with a bronchodilator was expressed relative to the pre-bronchodilator and predicted normal FEV1 and FVC. Results: In 1,040 patients with a non-paradoxical change in FEV1, 19.0% had a ≥ 12% change in FEV1 using their pre-bronchodilator value compared to 5.7% using their predicted normal value. For FVC, the respective values were 12.7% vs. 5.8%. The difference was retained in patients with a ≥ 0.2 L change in FEV1 or FVC. In unobstructed patients, the upper threshold (two standard deviations above the mean) of the bronchodilator response was 14% for FEV1 and 10% for FVC using predicted normal values. Conclusions: Expressing the percent change in FEV1 and FVC relative to predicted normal values reduces the over-estimation of the bronchodilator response, especially in patients with a very low pre-bronchodilator FEV1, including in those with a ≥ 0.2 L change in FEV1. Irrespective of pre-bronchodilator values, a ≥ 14% change in FEV1 and ≥ 10% change in FVC relative to the predicted normal values could be considered a positive bronchodilator response. [ABSTRACT FROM AUTHOR]

Background: Multiple Breath washout (MBW) represents an important tool to detect early a possible pulmonary exacerbation especially in Cystic Fibrosis (CF) disease. Lung clearance index (LCI) is the most commonly reported multiple breath washout (MBW) index and in the last years was used as management measure for evaluation. Our aim was to analyze clinical utility of LCI index variability in pulmonary exacerbation in CF after intravenous (IV) antibiotic therapy. Methods: A single-center study was conducted at CF Unit of Bambino Gesù Children's Hospital among hospitalized > 3 years patients for pulmonary exacerbations and treated with antibiotic IV treatment for 14 days. MBW and spirometry were evaluated within 72 h of admission to hospital and at the end of hospitalization. Descriptive analysis was conducted and correlations between quantitative variables were investigated. Results: Fifty-seven patients (M22/F35) with an average age 18.56 (± 8.54) years were enrolled. LCI2.5 was significantly reduced at the end of antibiotic treatment in both pediatric and adult populations with an average reduction of -6,99%; 37/57 patients denoted an improvement, 20/57 are stable or worsened in LCI2.5 values and 4/57 (7.02%) had a significant deterioration (> 15%) at end of treatment. On the contrary a significative elevation of FEV1 and FVC were found, respectively of + 7,30% and of + 5,46%. A positive good correlection among LCI 2.5 and Scond (rho = + 0,615, p = 0.000) and LCI 2.5 and Sacin (rho = + 0,649, p = 0.000) and a negative strong correlation between FEV1 and LCI 2.5 were found in post treatment period. A similar modification of LCI 2.5 and FEV1 was noticed in both adult and pediatric population. Conclusions: LCI may have a role in the routine clinical care of both adult and pediatric CF patients as a good tool to assess response to IV antibiotic end-therapy in the same way as FEV1. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has constrained access to spirometry, and the inherent risk of infectious transmission during aerosol-generating procedures has necessitated the rapid development of Remotely Supervised Spirometry (RSS). This innovative approach enables patients to perform spirometry tests at home, using a mobile connected spirometer, all under the real-time supervision of a technician through an online audio or video call. Methods: In this retrospective study, we examined the quality of RSS in comparison to conventional Laboratory-based Spirometry (LS), using the same device and technician. Our sample included 242 patients, with 129 undergoing RSS and 113 participating in LS. The RSS group comprised 51 females (39.5%) with a median age of 37 years (range: 13–76 years). The LS group included 63 females (55.8%) with a median age of 36 years (range: 12–80 years). Results: When comparing the RSS group to the LS group, the percentage of accurate Forced Expiratory Volume in one second (FEV1) measurements was 78% (n = 101) vs. 86% (n = 97), p = 0.177; for Forced Vital Capacity (FVC) it was 77% (n = 99) vs. 82% (n = 93), p = 0.365; and for both FEV1 and FVC, it was 75% (n = 97) vs. 81% (n = 92), p = 0.312, respectively. Conclusions: Our findings demonstrate no significant difference in the quality of spirometry testing between RSS and LS, a result that held true across all age groups, including patients aged over 65 years. The principal advantages of remote spirometry include improved access to pulmonary function tests, reduced infectious risk to curtail disease spread, and enhanced convenience for patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer is still the leading cause of cancer-related death worldwide. The only recommended screening test for lung cancer is low-dose computed tomography (also called a low-dose CT scan). Early intervention is key as it improves the chances that treatments will lead to better prognoses. Various screening programs targeting high-risk individuals showed effectiveness in reducing the disease burden. Yet, in Italy, systematic ongoing prevention and control strategies are lacking, with no government at a national level. The SMAC Trial is an optimized multi-diseases screening program, with imaging, biological indicators, economic validation, general practitioner engagement, and awareness-to-patients elements. Thirty-two subjects were diagnosed with cancer, of which 30 were lung cancers (detection rate 2.7%); fourteen were cured (stage I on final pathology). We want our trial to stimulate further discussion among policy-makers to implement our efforts. In fact, lung cancer screening extends far beyond an imaging: a well-organized and comprehensive program is vital to ensuring high-quality and timely care through screening, diagnosis, and treatment. Thus, financial incentives for lung cancer screening sites are needed, too. As new technologies continue to emerge aiming to change lung cancer patients' diagnostic and treatment journey, even more so early-detection via screening requires a continued support nationally. Background: Lung cancer screening with low-dose helical computed tomography (LDCT) reduces mortality in high-risk subjects. Cigarette smoking is linked to up to 90% of lung cancer deaths. Even more so, it is a key risk factor for many other cancers and cardiovascular and pulmonary diseases. The Smokers health Multiple ACtions (SMAC-1) trial aimed to demonstrate the feasibility and effectiveness of an integrated program based on the early detection of smoking-related thoraco-cardiovascular diseases in high-risk subjects, combined with primary prevention. A new multi-component screening design was utilized to strengthen the framework on conventional lung cancer screening programs. We report here the study design and the results from our baseline round, focusing on oncological findings. Methods: High-risk subjects were defined as being >55 years of age and active smokers or formers who had quit within 15 years (>30 pack/y). A PLCOm2012 threshold >2% was chosen. Subject outreach was streamlined through media campaign and general practitioners' engagement. Eligible subjects, upon written informed consent, underwent a psychology consultation, blood sample collection, self-evaluation questionnaire, spirometry, and LDCT scan. Blood samples were analyzed for pentraxin-3 protein levels, interleukins, microRNA, and circulating tumor cells. Cardiovascular risk assessment and coronary artery calcium (CAC) scoring were performed. Direct and indirect costs were analyzed focusing on the incremental cost-effectiveness ratio per quality-adjusted life years gained in different scenarios. Personalized screening time-intervals were determined using the "Maisonneuve risk re-calculation model", and a threshold <0.6% was chosen for the biennial round. Results: In total, 3228 subjects were willing to be enrolled. Out of 1654 eligible subjects, 1112 participated. The mean age was 64 years (M/F 62/38%), with a mean PLCOm2012 of 5.6%. Former and active smokers represented 23% and 77% of the subjects, respectively. At least one nodule was identified in 348 subjects. LDCTs showed no clinically significant findings in 762 subjects (69%); thus, they were referred for annual/biennial LDCTs based on the Maisonneuve risk (mean value = 0.44%). Lung nodule active surveillance was indicated for 122 subjects (11%). Forty-four subjects with baseline suspicious nodules underwent a PET-FDG and twenty-seven a CT-guided lung biopsy. Finally, a total of 32 cancers were diagnosed, of which 30 were lung cancers (2.7%) and 2 were extrapulmonary cancers (malignant pleural mesothelioma and thymoma). Finally, 25 subjects underwent lung surgery (2.25%). Importantly, there were zero false positives and two false negatives with CT-guided biopsy, of which the patients were operated on with no stage shift. The final pathology included lung adenocarcinomas (69%), squamous cell carcinomas (10%), and others (21%). Pathological staging showed 14 stage I (47%) and 16 stage II-IV (53%) cancers. Conclusions: LDCTs continue to confirm their efficacy in safely detecting early-stage lung cancer in high-risk subjects, with a negligible risk of false-positive results. Re-calculating the risk of developing lung cancer after baseline LDCTs with the Maisonneuve model allows us to optimize time intervals to subsequent screening. The Smokers health Multiple ACtions (SMAC-1) trial offers solid support for policy assessments by policymakers. We trust that this will help in developing guidelines for the large-scale implementation of lung cancer screening, paving the way for better outcomes for lung cancer patients. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have highlighted the association between impaired lung function and ischemic heart disease, suggesting a potential link mediated by systemic inflammation. However, the extent of pulmonary functional abnormalities in elderly patients with ischemic heart disease remains inadequately explored, especially in the Indian context. Methodology: This prospective study aimed to evaluate pulmonary function among elderly patients with ischemic heart disease visiting SLN Medical College and Hospital, Koraput, Odisha, between January 2020 and March 2021. Spirometry and Doppler echocardiography were performed on 56 subjects aged 60 years and above with confirmed coronary heart disease. Data analysis employed descriptive statistics, ANOVA, t-tests, and Pearson correlation analysis. Results: The majority of participants (58.9%) were aged 60-69 years, with a mean age of 69.29 ± 5.66 years. Notable proportions of subjects exhibited impaired lung function, with restrictive-type defects predominant, particularly among older age groups. Associations were observed between impaired lung function, elevated inflammatory markers, and ischemic heart disease. Peak expiratory flow rates were below predicted values, suggesting potential mortality predictors. Discussion: The observed decline in lung function with age aligns with previous research, indicating a complex interplay between pulmonary and cardiac physiology. Systemic inflammation may contribute to impaired lung function and the development of coronary artery disease, emphasizing the need for multidisciplinary management approaches. Conclusion: Our study underscores the intricate relationship between impaired lung function, ischemic heart disease, and systemic inflammation in the elderly. Further research is warranted to elucidate underlying mechanisms and optimize management strategies, emphasizing the importance of early identification and intervention in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Epidemic thunderstorm asthma is an observed increase in cases of acute bronchospasm following thunderstorms. This study aimed to compare the frequency of obstructive airway disease or bronchial hyperresponsiveness in subjects with thunderstorm-associated respiratory symptoms with subjects with similar symptoms presented at other times. Methods: A cross-sectional study from June to November of 2013 was conducted on subjects with thunderstorm-associated respiratory symptoms living in Ahvaz City, Iran. Thunderstorm-associated subjects were presented with asthmatic symptoms in thunderstorms, and other patients presented with similar symptoms at other times. Baseline spirometry was performed on patients to examine the presence of obstructive airway disease. In all patients with normal spirometry, a provocation test was applied. A comparison of qualitative and quantitative variables was made using the Chi-square and independent t test, respectively. All analyses were carried out using SPSS Statistics Version 22. A P value less than 0.05 was considered statistically significant. Results: Out of 584 subjects, 300 and 284 participants were in thunderstorm-associated and non-thunderstorm-associated groups, respectively. After the final analysis, 87 (30.6%) and 89 (33.3%) of the thunderstorm-associated subjects and non-thunderstorm-associated group, respectively, had pieces of evidence of airflow limitation (P=0.27). Among the patients with normal spirometry, 161 (81.72%) of the thunderstorm-associated patients and 100 (56.17%) patients of the non-thunderstorm-associated symptoms group had a positive methacholine challenge test result (P<0.001). Conclusion: Most of the patients with thunderstorm-associated respiratory symptoms had no obvious evidence of airflow limitation in spirometry. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data on effects of long-term meditation on respiration. This systematic review summarized selected respiratory function parameters in healthy long-term meditators (LTMs) at rest, during meditation and their associations with meditation practice variables. Methods: A systematic search of PubMed, EMBASE (Ovid), Scopus, Proquest Dissertation and Thesis Global databases, CENTRAL, and Google Scholar was performed from year 1950 to August 15th, 2023. Keywords "meditation," "long-term meditation," and respiratory/pulmonary/lung function and spirometry were used. Controlled-trials and observational studies exploring respiratory parameters in healthy LTMs published in English were included. Two independent reviewers selected studies, extracted data, and assessed the quality of the evidence. The Joanna-Briggs Institute Critical Appraisal Tools and the Single-Case Reporting Guideline In BEhavioural Interventions Statement were used to assess the methodological quality of the included studies. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Effect estimates of some outcomes were synthesized using alternative methods and data for other outcomes synthesized narratively as a meta-analysis was not possible. Results: Nine studies comprising 3 case–control, 3 cross-sectional, and 3 single-subject study designs, involving 433 participants that met the eligibility criteria, were included. Two studies reported slower resting RR among LTMs compared to controls [SMD = − 2.98, 95% CI (− 4.48 to − 1.47), overall-effect (z-score) = 3.88 (p < 0.001), I2 = 69%] with similar trend reported in the third study (MD = − 1.6, p = 0.053). Three studies reported slower RR in LTMs during meditation compared to baseline. Slower resting RR and mean RR change during meditation compared to baseline significantly negatively associated with meditation experience. PEFR was significantly higher in LTMs than controls [MD = 1.67, 95% CI (0.19–3.15), z-score = 2.21 (p = 0.03)]. No significant difference was observed in tidal volume [SDM = 0.93, 95% CI (− 1.13 to 2.99), z-score = 0.89 (p = 0.37), I2 = 96%] and vital capacity [SDM = 1.25, 95% CI (− 0.45 to 2.95), z-score = 1.44 (p = 0.15), I2 = 94%] of LTMs compared to controls. Conclusions: Long-term meditation appears to be associated with slower baseline RR, and immediate reduction in RR during meditation, where greater practice amplifies the effects. Evidence on spirometry parameters in LTMs with ≥ 3 years of practice was limited. [ABSTRACT FROM AUTHOR]

Background: The quality of the spirometry is estimated with criteria of acceptability and repeatability. The repeatability criteria accepted by consensus is < 0.150 L. Objective: To know the repeatability in quality A spirometry. Material and methods: Analytical cross-sectional design. The demographic variables and the 3 best spirometry curves with normal, suggestive of restriction and bronchial obstruction profiles were obtained from consecutive subjects of both genders from 18 to 80 years of age. The repeatability was analyzed with the mean difference (bias) and the intraclass correlation coefficient. Results: 630 curves from 210 subjects were accepted. Group age 60 ± 15 years. Female predominance 113 (53.8%), occupation: domestic services 61 (29%), and diagnosed with chronic obstructive pulmonary disease: 70 (33.4%). The differences in the curves were < 0.150 L. The mean difference (bias) and the intraclass correlation coefficient (95% confidence interval, 95% CI) of the forced expiratory volume in the first second were 1 vs. 2 maneuver: -0.01 (0.13, -0.14), 0.997 (95% CI 0.996, 0.998); 2 vs. 3 maneuver: 0.00 (0.13, -0.13), 0.997 (95% CI 0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.16, -0.17), 0.995 (95% CI 0.994, 0.996). Forced vital capacity: 1 vs. 2 maneuver: -0.01 (0.17, -0.18), 0.996 (95% CI 0.995, 0.997); 2 vs. 3 maneuver: 0.01 (0.17, -0.16), 0.997 (95% CI 0.0.996, 0.998), and maneuver 1 vs. 3: -0.00 (0.18, -0.19), 0.996 (95% CI 0.995, 0.997). Conclusion: The repeatability obtained in spirometry with quality A validates the use of the repeatability criterion of 0.150 L. [ABSTRACT FROM AUTHOR]

One of the most commonly observed complications after COVID-19 is persistent pulmonary impairment. The aim of this study was to evaluate the impact of individual factors during the acute phase of COVID-19 on subsequent pulmonary function test results. The study involved 46 patients who were admitted to hospital due to respiratory failure caused by SARS-CoV-2 and who were assessed during follow-up visits at 3 and 9 months after discharge. Patients were divided into two subgroups according to the severity of respiratory failure. The severe group included patients requiring mechanical ventilation or HFNOT. The results of the study showed that a severe course of the disease was associated with a lower FVC and a higher FEV1/FVC ratio 3 months after discharge (both p < 0.05). In addition, it has been revealed that the length of hospitalization is a factor that negatively impacts the FEV1, FVC and TLC values measured at follow-up after 3 months. Furthermore, the obtained results identify the presence of cough in the acute phase of the disease as a factor having a positive impact on several PFT parameters (especially the FEV1/FVC ratio) as well as the 6MWT outcome after 3 months. The FVC improved significantly (p < 0.05) between the follow-up visits. The findings may indicate that COVID-19-induced respiratory dysfunction is usually temporary and spontaneously resolves during recovery. Recovery is slower in those who required more intensive oxygenation. The results of this study may be useful in identifying patients who require more intensive and longer rehabilitation after COVID-19. [ABSTRACT FROM AUTHOR]

Background: India experiences a growing aging population and prioritizing the comprehension of respiratory health concerns among the elderly becomes crucial. Those in the elderly demographic residing in urban slums confront notable socioeconomic obstacles and encounter restricted healthcare accessibility, heightening their vulnerability to respiratory illnesses. Therefore, examining respiratory health in this specific urban context provides insights into how living conditions impact the health of vulnerable populations. Objectives: The present study aims to evaluate the occurrence of respiratory abnormalities among slum-dwelling elderly women and also to determine the concomitant factors responsible for respiratory abnormalities among them. Material and Methods: The study includes a total of 261 elderly women aged 60 years and above living in slum areas of Kolkata. The standard protocols were followed to collect spirometry and anthropometric data. Descriptive and inferential statistical analyses were performed to satisfy the study objectives. Results: The majority of the participants show forced vital capacity (FVC) and forced expiratory volume in one second (FEV0.1) below the predicted level, indicating the presence of mild-to-moderate respiratory abnormality. Chronic obstructive respiratory disease (COPD) was observed in 15.2% of elderly women, significantly higher than the national average. The study identified significant correlations between age and respiratory abnormalities. Factors such as overcrowded living conditions, the absence of a separate kitchen, and the use of certain cooking fuels increased the likelihood of COPD. Body fat percentage was found to be inversely related to FVC, FEV0.1, and COPD. Conclusion: The poor living conditions and a few other associated factors are indicative of developing respiratory problems among elderly individuals. As the global population ages, this study contributes valuable insights for public health strategies, emphasizing the need for tailored approaches to address the specific challenges faced by elderly women in urban slums in the megacity of Kolkata. [ABSTRACT FROM AUTHOR]

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

Objective: To evaluate lung function using spirometry and 6MWT in patients recovered from severe and critical illness due to coronavirus disease (COVID-19). Methods: Observational, cross-sectional, and descriptive study, which included patients between 2 and 6 months after suffering from severe and critical illness due to COVID-19. With prior consent, spirometry and 6MWT were performed, and the post-COVID-19 Functional Scale (PCFS) was applied. Descriptive and inferential statistics were used to analyze the data with the SPSS version 24 program. Results: 40 patients were registered; 40% women, aged 53 ± 14 years; 82.5% showed some degree of overweight or obesity, and 72.5% suffered from some comorbidity. Using the PCFS, 77.5% of patients had some degree of limitation. In the 6MWT, the distance traveled was 426.3 ± 123.9 m vs. 530.57 ± 93.7 m expected, with a decrease in oxygen saturation, dyspnea and fatigue (p < 0.05). The forced vital capacity and the forced vital capacity/forced expiratory volume value index in the first second (FEV1/FVC) were lower than expected. Conclusions: Spirometry and 6MWT are available tests that can be implemented in the evaluation of patients recovered from severe and critical illness due to COVID-19. According to the study, patients walk shorter distances than expected, with a decrease in oxygen saturation, dyspnea and fatigue. [ABSTRACT FROM AUTHOR]

BACKGROUND: Systemic corticosteroids have been shown to improve outcomes in severe coronavirus disease 2019 (COVID-19) pneumonia; however, their role in post-COVID-19 persistent lung abnormalities is not well defined. Here, we describe our experience with corticosteroids in patients with persistent lung infiltrates following COVID-19 infection. RESEARCH QUESTION: What is the efficacy of systemic corticosteroids in improving lung function and radiological abnormalities in patients following COVID-19 pneumonia? STUDY DESIGN AND METHODS: This is a single-center retrospective study evaluating patients with persistent respiratory symptoms and abnormal chest computed tomography findings. Patients were divided into two groups based on treatment with corticosteroids: "steroid group" and "nonsteroid group." Clinical data were collected from the electronic medical records. RESULTS: Between March 2020 and December 2021, 227 patients were seen in the post-COVID-19 pulmonary clinic, of which 75 were included in this study. The mean age was 56 years, 63% were female, and 75% were white. The main physiologic deficit was reduced Diffusing capacity of the Lungs for Carbon Monoxide (DLCO) at 72% (±22). On chest imaging, the most common findings were ground-glass opacities (91%) and consolidation (29%). Thirty patients received corticosteroid (steroid group) and 45 did not (nonsteroid group). Patients treated with corticosteroids had lower DLCO (DLCO [%]: steroid group 63 ± 17, nonsteroid group 78 ± 23; P = 0.005) and all had ground-glass opacities on imaging compared to 84% in the nonsteroid group (P = 0.04). At follow-up, patients in the steroid group (n = 16) had a significant improvement in spirometry and DLCO. In addition, there was a significant improvement with resolution of ground-glass opacities in both the groups (P < 0.05). CONCLUSION: The use of systemic corticosteroids in patients with persistent respiratory symptoms and radiological abnormalities post-COVID-19 was associated with significant improvement in pulmonary function testing and imaging. Prospective studies are needed to confirm whether these findings are the effect of corticosteroid therapy or disease evolution over time. [ABSTRACT FROM AUTHOR]

Silicosis is a progressive pneumoconiosis caused by inhalation of crystalline silica dust commonly seen in workers of construction sites, flour mills, and mining. Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus antigens commonly encountered in patients with asthma and cystic fibrosis. We report a case of 60-year-old flour mill worker presented with clinico-radiological features of silicosis; further evaluation was found to have an overlap of ABPA in view of severe atopic symptoms. We describe a rare duet of silicosis with ABPA overlap. [ABSTRACT FROM AUTHOR]

Introduction: Serial follow-up with pulmonary function testing (PFT) and chest computed tomography (CT) after severe COVID-19 are recommended. As a result, many longitudinal studies have been published on COVID-19 of different grade of severity up to 1-year follow-up. Therefore, we aimed at a long-term observational study throughout 2 years after severe COVID-19. Methods: Severe COVID-19 patients were consecutively recruited after hospital discharge between March and June 2020 and prospectively followed up for 24 months, with mMRC dyspnea scale and PFT at 6, 12, and 24 months. Chest CT was performed when clinically indicated. Results: One hundred one patients enrolled completed the observational study. At 24 months, those with reduced total lung capacity (TLC) were 16%, associated with fibrotic ground glass opacity (GGO) and mMRC score >1, respectively, in 75% and 69% of them. At 24 months, those with a reduced diffusing capacity of the lung for CO were 41%, associated with fibrotic GGO and mMRC score >1, respectively, in 53% and 22% of them. Conclusion: Two years after hospitalization for severe COVID-19, a non-negligible number of patients still suffer from "long COVID" due to respiratory damage. [ABSTRACT FROM AUTHOR]

Background: The current morphological condition of an individual is described by a somatotype, which is a three-number scale. The endomorph, mesomorph and ectomorph components are presented in the same sequence, and each number corresponds to one of the three basic components of body composition. Methods: We recruited 50 healthy male subjects with a mean age of 24.10 ± 4.55 yrs. Somatotype was determined by the Heath and Carter method. Impulse oscillometry was performed followed by spirometry according to the European Respiratory Society (ERS) or American Thoracic Society (ATS) guidelines. Resistance at 5 Hz (R5) %pred, R20%pred, R5–R20, X5%pred, X20, area of reactance (Ax) and resonant frequency (Fres) were obtained by doing impulse oscillometry. Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio and maximum mid-expiratory flow (MMEF) were assessed by doing spirometry. Results: Endomorphs (0.05 (0.00–0.09) vs 0.01 (0.00–0.04); P < 0.0001) and mesomorphs (0.04 (0.000.09) vs 0.01 (0.00–0.04); P = 0.002) had significantly higher R5–R20 than ectomorphs. Similarly, endomorphs (0.32 (0.07–0.82) vs 0.15 (0.08–0.35); P = 0.001) and mesomorphs (0.28 (0.17–0.64) vs 0.15 (0.08–0.35); P = 0.015) also showed significantly higher Ax than ectomorphs, Fres of endomorphs (15.37 (8.43–21.85) vs 10.08 (8.94–14.30); P < 0.0001) and mesomorphs (14.32 (10.24–20.86) vs 10.08 (8.94-14.30); P < 0.0001) were significantly high than ectomorphs. Moreover, spirometric measures reveal significant variation in which mesomorphs had significantly higher values of % predicted of FVC than ectomorphs (92.49 ± 7.211 vs 83.86 ± 7.861; P = 0.042) and the ratio of FEV1 to FVC was significantly higher in ectomorphs than in endomorphs (89.00 ± 5.80 vs 85.04 ± 5.73; P = 0.03). Conclusion: Peripheral airway dysfunction was observed in endomorphs and mesomorphs as compared to ectomorphs. Mesomorphs had a relatively higher FVC that may be due to their greater muscular strength. [ABSTRACT FROM AUTHOR]

Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the interpretation of spirometry results; however, as yet none are validated. We evaluated the interpretation accuracy of the Espiro app using pulmonologist interpretations as the gold standard. This is an observational descriptive study in which 118 spirometry results were interpreted by the Espiro app, two pulmonologists, two primary care physicians, and two residents of a primary care training program. We determined the interpretation accuracy of the Espiro app and the concordance of the pattern and severity interpretation between the Espiro app and each of the observers using Cohen's kappa coefficient (k). We obtained a sensitivity and specificity for the Espiro app of 97.5% (95% confidence interval (CI): 86.8–99.9%) and 94.9% (95%CI: 87.4–98.6%) with pulmonologist 1 and 100% (95%CI: 91.6–100%) and 98.7% (95%CI: 92.9–99.9%) with pulmonologist 2. The concordance for the pattern interpretation was greater than k 0.907, representing almost perfect agreement. The concordance of the severity interpretation was greater than k 0.807, representing substantial to almost perfect agreement. We concluded that the Espiro app is a valid tool for spirometry interpretation. [ABSTRACT FROM AUTHOR]

Introduction: It is important to increase awareness and identify the predictors of Deep Vein Thrombosis (DVT) in Chronic Obstructive Pulmonary Disease (COPD) patients presenting with worsening dyspnoea, as they are at a high-risk for Venous Thromboembolism (VTE) due to immobility, inflammation, and comorbidities. Aim: To determine the prevalence of DVT in hospitalised patients with acute exacerbation of COPD, as well as to identify associated risk factors for DVT in this group. Materials and Methods: A cross-sectional study was conducted from March 2021 to June 2022 in the Department of Respiratory Medicine at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. The sample population consisted of hospitalised patients with acute exacerbation of COPD who were aged over 40 years. All patients underwent routine blood investigations, Electrocardiograph (ECG), echocardiogram, arterial blood gas analysis, D-dimer test, chest radiograph, and lower-limb venous Doppler. Risk assessment was performed using the Modified Well's criteria for DVT, and pretest probability was determined for all patients. The Chi-square test was used as a test of significance, with a p-value <0.05 considered statistically significant in all analyses. Results: The mean age of the study population was found to be 60.80±10.21 years. Among the 74 patients included in the study, it was found that 3 (4.05%) patients had DVT. There was no statistically significant difference between the DVT and non DVT groups regarding age, sex, obesity, modified Medical Research Council (mMRC) grade of breathlessness, smoking status, severity of airflow obstruction in spirometry, COPD class, type of respiratory failure, and presence of comorbidities. However, there was a statistically significant difference between the DVT and non DVT groups in terms of elevated D-dimer (>500 ng/mL), history of immobilisation for more than three days, and Modified Wells' score (>2). Conclusion: Patients with acute exacerbation of COPD, associated with a significant history of immobilisation and high D-dimer values, along with a high-risk pretest probability using clinical predictors such as the Modified Wells' score for DVT, should be considered for evaluation of VTE and early initiation of prophylactic anticoagulation therapy to prevent Pulmonary Thromboembolism. [ABSTRACT FROM AUTHOR]

Background: The spirometry test is a valuable test to evaluate the performance of the respiratory system. The interpretation of the results is highly dependent on the quality of its performance, while the inappropriate quality results in unwanted consequences for individuals and the healthcare system. This study investigated the quality of spirometry tests performed in occupational health. Methods: In this cross-sectional study, the quality of 776 spirometry tests in different occupational centers by the specialists in Rasht, Iran, in 2020, based on the guidelines of the American Thoracic Society (ATS), was investigated. The quality and success rate of the test and the demographical characteristics of the operators and the participants were collected. All data was analyzed using SPSS software version 20. Results: Out of 776 spirometry tests, about 69.7% were unacceptable. Among the unacceptable tests, a pause error between inhalation and exhalation was identified in 7.4% of tests. Additionally, 4.6% of the unacceptable tests exhibited a cough error within the first second, while an exhalation error of less than six was observed in 85%. Repeatability errors were found in 60.9% of the tests. Furthermore, among some errors, the communication error between the characteristics of the technicians and the test performance errors were evident. Conclusion: According to the results, most of the performed tests were unacceptable with no repeatability, which indicated that the validity and quality of spirometry tests and their interpretation were inappropriate in the field of occupational health in Rasht, Iran. [ABSTRACT FROM AUTHOR]

The article focuses on bronchiectasis, a respiratory condition characterized by irreversible dilatation of the bronchi due to inflammation and infection, resulting in impaired drainage of secretions and progressive lung damage if not managed appropriately. It mentions common causes include respiratory infections, muco-ciliary disorders, airway obstruction, cystic fibrosis, and existing respiratory conditions, with idiopathic cases comprising 44 present of all instances.

This article discusses a study that aimed to analyze the interactions between respiration and cardiac function under normal conditions. The researchers used real-time MRI and MR-compatible spirometry to measure changes in the heart and lungs during deep breathing. They found that certain parameters, such as the left ventricular end-diastolic eccentricity index and the mid-ventricular areas of the right and left cavity, varied with respiratory volume and timing. The study concludes that this combination of imaging techniques is valuable for understanding the respiratory dependence of ventricular parameters and may be useful for studying pathological conditions in the future. [Extracted from the article]

ΟBJECTIVE The determination of socio-economic, demographic and environmental factors as well as the lifestyle of the Greek family, which possibly shape the degree of passive and active smoking among teenagers-students of vocational high schools. METHOD The sample consisted of 265 students from technical vocational high schools in the prefecture of Achaia, who were spirometrically (max % expiratory flow [PEF, pred79%], forced vital capacity [FVC] and forced expiratory volume in 1 sec [FEV1.pred80%]) tested and answered a questionnaire which was based on the tools of the Global Youth Tobacco Survey. RESULTS 61.2% of the sample were men, most aged 14-18 years and with a percentage of smokers reaching 81.1%. Age, smoking initiation, active or passive smoking, poor place of residence, and number of cigarettes (%pred) were assessed as independent predictors of PEF. Smokers and those in late adolescence also had lower FEV1 (%pred). It seems interesting that despite the impaired respiratory function, the generally not good physical condition and the overall low quality of life, the popularity and sociability of these students remains high. %max expiratory flow, forced vital capacity and forced expiratory volume in 1 sec were the respiratory function parameters that differed statistically significantly between smokers and non-smokers (p<0.001). CONCLUSIONS It appears that young smokers-students of vocational high schools have their respiratory function reduced quite early in life, therefore immediate preventive interventions in secondary education are necessary. Thus, through participation in interactive programs, students will acquire supplement or revise their knowledge and perceptions, developing and strengthening anti-smoking attitudes, and cultivating health positive values and attitudes. [ABSTRACT FROM AUTHOR]

Background: Chronic respiratory disease is a collection of conditions that affect the lungs and airways primarily. It is linked to considerable morbidity and mortality. Because India has the biggest TB burden of any country on the planet, it is quite likely that it also has a significant burden of COPD that is related with TB. Present study was aimed to study prevalence of tuberculosis in diagnosed cases of chronic obstructive pulmonary disease. Material and Methods: Present study was singlecenter, prospective, observational study, conducted in adults more than 18 years age, who had a definite history of pulmonary or extra pulmonary tuberculosis, had received complete anti-tuberculous therapy course & with a history of COPD diagnosis and presenting with chronic dyspnoea. Results: Among 119 patients, majority were males (73.1%). Mean age of the study population was 58.59 ± 12.89 years. Majority of the study Population had GOLD stage 2 of COPD (53.8%), while 21% had Stage 3 and 10.1% had stage 4 COPD. Prevalence of TB in COPD patients in the present study was found to be 28.6%. Amongst those with a history of TB, Patients with history of extra pulmonary TB had less severe stage of COPD. Majority of those with history of Pulmonary TB, presented with Stage 3 (12.6%) and Stage 4 (7.6%) of COPD. Spirometry observations of FEV1, FVC and FEF25-75 were significantly lower in Patients of COPD with previous history of Tuberculosis. There is a statistically significant association between history of TB and Severity of COPD. Conclusion: Prevalence of Tuberculosis in patients of COPD was 28.6%. Spirometry observations of FEV1, FVC and FEF25-75 were significantly lower in Patients of COPD with previous history of Tuberculosis. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 diabetes mellitus is a chronic metabolic disease marked by poor glucose metabolism and insulin resistance. Although diabetes-related cardiovascular and renal complications have historically received the majority of attention in research and clinical care, the effects of diabetes on pulmonary functions are becoming more widely acknowledged. There appears to be a reciprocal relationship between type 2 diabetes (T2DM) and pulmonary function, whereby respiratory health is influenced by diabetes and vice versa. Aims and Objective: To assess of pulmonary functions in subjects with type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched healthy controls. Methodology: A pre-made questionnaire, anthropometric measurements, systemic and general examinations, and computerized spirometer pulmonary function tests were all part of the methodology. Results: Significant reductions in a number of pulmonary function test parameters were found statistically in T2DM patients, suggesting a restrictive pattern of pulmonary function in this population. Conclusion: The results emphasized the need to comprehend how diabetes affects lung health by highlighting the relationship between T2DM and pulmonary function. These findings add to the body of knowledge being researched to help T2DM patients with their respiratory health. [ABSTRACT FROM AUTHOR]

Background: The assessment of lung function, particularly lung volumes and gas transfer, recorded initially upon patient presentation and subsequent follow-up evaluations, along with high-resolution computed tomography (HRCT) of the chest, can facilitate the evaluation of the natural history of the disease or provide insights to guide therapy in interstitial lung disease (ILD). The utilization of available data related to connective tissue-related ILD (CTD-ILD), gastroesophageal reflux disease (GERD), smoke exposure, as well as any potential correlation of treatment with changes in lung functions, can offer valuable insights. Objectives: The main aim of this study was to study the changes in lung functions of ILD patients over one year apart, and whatever observations could be noticed based on case record form. Methodology: The study was conducted in a Tertiary Care Centre to evaluate changes in lung functions in patients with Interstitial Lung Disease (ILD) over one-year period, specifically assessing increases or decreases in lung function values. The data was collected on ILD patients over 18 years of age who had undergone two Pulmonary Function Tests (PFTs) one year apart, between 2013 and 2015, from the PFT register available in the Centre's PFT lab. Results: This study revealed that 81.25% of patients fell within the age range of 40-70 years. Furthermore, it was found that 77.5% of the patients experienced lung function restrictions. In fact, 95% of the patients exhibited HRCT chest images consistent with Nonspecific Interstitial Pnuemonia (NSIP), while 5% displayed Usual Interstitial Pnuemonia (UIP) patterns. Additionally, within the study group, 47.75% were diagnosed with connective tissue related ILDs. Notably, patients with a history of GERD experienced a median fall in FVC of 130ml/year, compared to 170ml/year in 15 patients without GERD. Conclusion: Thus the findings of the study hold the potential to improve the clinical care and outcomes of interstitial lung disease patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of bronchodilator on the respiratory mechanics and pulmonary function of children and adolescents with cystic fibrosis. Methods: Cross-sectional study on clinically stable children and adolescents with cystic fibrosis aged from six to 15 years. Participants underwent impulse oscillometry and spirometry evaluations before and 15 minutes after bronchodilator inhalation. The Kolmogorov-Smirnov test was applied to verify the sample distribution, and the Student’s t-test and Wilcoxon test were used to compare the data before and after bronchodilator inhalation. Results: The study included 54 individuals with a mean age of 9.7±2.8 years. The analysis showed a statistically significant improvement in impulse oscillometry and spirometry parameters after bronchodilator inhalation. However, according to the American Thoracic Society (ATS) and European Respiratory Society (ERS) recommendations (2020 and 2021), this improvement was not sufficient to classify it as a bronchodilator response. Conclusions: The use of bronchodilator medication improved respiratory mechanics and pulmonary function parameters of children and adolescents with cystic fibrosis; however, most patients did not show bronchodilator response according to ATS/ERS recommendations. [ABSTRACT FROM AUTHOR]

Objective: To compare and analyze pulmonary function and respiratory mechanics parameters between healthy children and children with cystic fibrosis. Methods: This cross-sectional analytical study included healthy children (HSG) and children with cystic fibrosis (CFG), aged 6–13 years, from teaching institutions and a reference center for cystic fibrosis in Florianópolis/SC, Brazil. The patients were paired by age and sex. Initially, an anthropometric evaluation was undertaken to pair the sample characteristics in both groups; the medical records of CFG were consulted for bacterial colonization, genotype, and disease severity (Schwachman-Doershuk Score — SDS) data. Spirometry and impulse oscillometry were used to assess pulmonary function. Results: In total, 110 children were included, 55 in each group. In the CFG group, 58.2% were classified as excellent by SDS, 49.1% showed the ΔF508 heterozygotic genotype, and 67.3% were colonized by some pathogens. Statistical analysis revealed significant differences between both groups (p<0.05) in most pulmonary function parameters and respiratory mechanics. Conclusions: Children with cystic fibrosis showed obstructive ventilatory disorders and compromised peripheral airways compared with healthy children. These findings reinforce the early changes in pulmonary function and mechanics associated with this disease. [ABSTRACT FROM AUTHOR]

We assessed whether personal exposure to household air pollution [PM2.5 and black carbon (BC)] is associated with lung functions (FEV1, FVC, and their ratio) in non-smoking adults in rural Bangladesh. We measured personal exposure to PM2.5 using gravimetric analysis of PM2.5 mass and BC by reflectance measurement between April 2016 and June 2019. The average 24-hour PM2.5 and BC concentration was 141.0μgm−3 and 13.8μgm−3 for females, and 91.7 μgm−3 and 10.1 μgm−3 for males, respectively. A 1 μgm−3 increase in PM2.5 resulted in a 0.02 ml reduction in FEV1, 0.43 ml reduction in FVC, and 0.004% reduction in FEV1/FVC. We also found a similar inverse relationship between BC and lung functions (9.6 ml decrease in FEV1 and 18.5 ml decrease in FVC per 1μgm−3 increase in BC). A higher proportion of non-smoking biomass fuel users (50.1% of the females and 46.7% of the males) had restrictive patterns of lung function abnormalities, which need further exploration. [ABSTRACT FROM AUTHOR]

The study aimed to determine the respiratory effects of solvents among workers in the Mauritius paint industry. A total of 388 participants were selected using simple random sampling, and were subjected to a questionnaire for data collection. Lung function test was performed using a spirometer. Multiple regression was used to analyze the relationship between hours of exposure to solvents, while adjusting for socio-demographic factors. Independent t-test was also used to identify any difference between the means of lung function tests and the two exposed groups. Male participants were found less likely exposed to solvents compared to females (AOR, 3.39, CI 1.97-5.81). Those with secondary and lower secondary education, and worked for ≤12 hours per week, had an increased likelihood of being exposed to solvents (AOR 2.95, CI 1.20-7.28) (AOR 2.48, CI 1.19-5.16). Participants who were aware of occupational hazards (AOR 0.15, CI (0.05-0.46), and have used PPE (AOR 0.14, CI 0.08-0.25) were less likely to be less exposed to solvents. This study highlights the adverse effects of workplace exposures on respiratory health among paint factory workers. [ABSTRACT FROM AUTHOR]

Glycated haemoglobin (HbA1c) has been related to impaired lung function in the diabetic population. Few studies have analysed the association between lung function and HbA1c in the non-diabetic population. We investigated whether HbA1c below the diagnostic threshold is associated with lung function parameters. Forty non-diabetic adults took part in this study. Fasting blood samples were drawn to determine the HbA1c level. Lung function was assessed by spirometry using the Spiropalm 6MWT (Cosmed, Italy) Spirometer. One-way ANOVA was performed to detect significant differences between the groups according to their HbA1c level (%). Pearson and Spearman's correlations were used to determine the associations between variables. Participants were divided into 3 groups according to HbA1c level as follows: Group 1 (n = 18), = 5.0 to = 5.5%; Group II (n = 10), >5.5 and = 5.7%; and Group III (n = 12), >5.7 and = 6.2%.Group I had the higher FVC (108.33 ± 13.81% pred.), FEV1 (108.11 ± 14.92% pred.), PFE (7.63 ± 2.25 L/s) and the lowest FEV1/FVC ratio (80.03 ± 5.52%) compared to other groups; however, there were no significant differences between groups. Bivariate correlation analysis showed that HbA1c was negatively related to FVC (L) (r = - 0.465, p = .002 [low]), FVC% prev. (r = -0.377, p = .016 [low]), and FEV1 (L) (r = -0.375, p = .017 [low]) but not to PFE and FEV1/FVC (p > .05). Our results suggest that HbA1c (%) level is associated with lower FVC and FEV1 in middle-aged adults, which may be a potential predictor of poor lung function. [ABSTRACT FROM AUTHOR]

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Background: A condition known as coronary artery disease occurs when the myocardium does not receive enough blood or oxygen. It is caused by blockage of the coronary arteries and is characterized by an imbalance in the supply and demand of oxygen. Usually, it involves blood flow obstruction caused by plaques that form in the coronary artery lumen. It is the leading global cause of death. Objectives: this study aims to measure the impact of slow deep breathing exercises using incentive spirometry on functional capacity of patients with coronary artery disease. Methodology: Participants in this quasi-experimental research design included patients with coronary artery diseases. Patients with severe respiratory conditions, a history of coughing, difficulty breathing deeply, non-pulmonary status at first examination, and inability to complete the study were among the exclusion criteria. the participants in the study were 50 samples (25 research groups and 25 control groups), the research groups were given an incentive spirometer in addition to hands-on instruction on how to use it and collect accurate measurements. Patients were told to lie down or sit in order to breathe in and out through the tube 10 times. Patients were instructed to do this exercise three times every eight hours for a duration of three weeks. Results: Three weeks following the intervention, a re-assessment of the functional capacity, revealed an improvement in factional capacity solely in the study groups relative to the pre-test. Conclusion: Using an innovative spirometer, the study demonstrated the impact of various deep breaths on the functional capacity of patients with CAD. Nearly all patients demonstrated a significant short-term improvement in their functional capacity, and no significant side effects were found. Consequently, this methodology can be applied in subsequent research to examine long-term impacts for weeks or months. Because it is simple to use and the measurement is non-intrusive, this method is perfect for self-monitoring at home. [ABSTRACT FROM AUTHOR]

Purpose: It is still unclear whether considering abnormal spirometry as a marker for disease control can help physicians adjust asthma controllers in children because of the scarcity of pediatric studies. We aimed to investigate the prevalence of abnormal spirometry in a selected pediatric asthmatic population and its effect on longitudinal outcomes.Patients and Methods: This retrospective cohort study was conducted at the Songklanagarind Hospital, Thailand. Children with asthma aged < 18 years were recruited for review if they attended the clinic and underwent acceptable spirometry with bronchodilator responsiveness (BDR) tests after receiving asthma treatment for at least 3 months between January 2011 and June 2022. Differences in baseline characteristics, atopic factors, asthma treatment, and outcomes were analyzed between the normal and abnormal spirometry groups over a 12-month post-spirometry period.Results: The mean age of the 203 enrolled patients was 10.9 ± 2.6 years. Abnormal spirometry, defined as airflow limitation or the presence of BDR, was observed in 58.1% of patients. No significant differences were observed in baseline characteristics, atopic factors, asthma treatment, or outcomes between the normal and abnormal spirometry groups. Further analysis of 107 patients with abnormal spirometry with symptom control revealed that physicians adjusted the asthma controller based on spirometry and symptoms in 84 and 23 patients, respectively. There was no significant difference in the loss of disease control over the 12-month post-spirometry period between the two groups.Conclusion: Abnormal spirometry was found in 58.1% of treated school-aged patients with asthma. Abnormal spirometry results were not associated with poor asthma outcomes during the 12-month follow-up. Both symptom-based and spirometry-based adjustments of asthma controllers resulted in comparable symptom control over a 12-month follow-up period in the selected population. [ABSTRACT FROM AUTHOR]

Background: Bronchodilator responsiveness (BDR) in asthma involves both the central and peripheral airways but is primarily relieved with beta-2-agonists and evaluated by spirometry. To date, antimuscarinics can be added as a reliever medication in more severe asthma. We hypothesize that combining both short-acting beta-2 agonist (SABA) and short-acting muscarinic antagonist (SAMA) could also improve the responsiveness in mild-moderate asthma. Therefore, we aimed to compare the direct effects of inhaling SABA alone, SAMA alone or combining both SABA and SAMA on the central and peripheral airways in asthma.Methods: Twenty-three patients with mild-moderate BDR in asthma performed dynamic spirometry and impulse oscillometry before (baseline) and multiple timepoints within an hour after inhalation of SABA (salbutamol), SAMA (ipratropium bromide), or both SABA and SAMA at three different visits.Results: The use of SAMA alone did not show any improvement compared to the use of SABA alone. Inhalation of SABA+SAMA, however, averaged either similar or better BDR than SABA alone in FEV1, MMEF, FVC, R5, R20 and R5-R20. Inhaling SABA+SAMA reached a stable BDR in more patients within 0– 10 minutes and also reached the FEV1 (Δ%)> 12% faster (3.5 minutes) than inhaling SABA alone (5.1 minutes). Inhaling SABA+SAMA was significantly better than SAMA alone in FEV1 (p = 0.015), MMEF (p = 0.0059) and R20 (p = 0.0049). Using these three variables highlighted a subgroup (30%, including more males) of patients that were more responsive to inhaling SABA+SAMA than SABA alone.Conclusion: Overall, combining SAMA with SABA was faster and more consistent at increasing the lung function than SABA alone or SAMA alone, and the additive effect was best captured by incorporating peripheral-related variables. Therefore, SAMA should be considered as an add-on reliever for mild-moderate patients with BDR in asthma. [ABSTRACT FROM AUTHOR]

Background: Asthma is the most common chronic respiratory condition of childhood worldwide, with around 14% of children and young people are affected. Characteristic asthma features include wheeze, shortness of breath and cough, which are typically triggered by several possible stimuli. About 5-10% of patients with asthma suffer from poorly-controlled disease despite corticosteroid (CS) therapy. There is increased effort to identify biomarkers to define different phenotypes of asthma. IL-6 is known as an inflammatory cytokines and serum levels of IL-6 have been implicated as a biomarker for asthma especially in children. Aim of the study: To investigate the role of IL-6 as a potential biomarker for asthma severity in children. Methods: This study is a cross sectional study that carried out on 100 children (70 pediatric patients with bronchial asthma and 30 age- and sex-matched healthy control subjects) of the attendants to pediatric pulmonology clinic of Sayed Galal university hospital during the period from September 2022 to May 2023. Detailed history taking, thorough clinical examinations, Complete blood count (CBC), blood film and stool analysis, Serum interlukin-6 level using ELISA Technique was done to all patients and control groups. PRAM score and Pulmonary function tests were performed for all patients using Spirometry. Spirometry indices included FEV1, FVC, and FEV1/FVC. Results: IL-6 was significantly higher among patients compared with controls, respectively. A positive correlation was found between serum IL6 an asthma severity. IL-6 was normal in all control subjects and elevated in 8.5%, 28.5%, 31.5% and 100% of patients with intermittent, mild persistent, moderate persistent and severe persistent asthma respectively. Conclusion: IL-6 appears to be valuable for assessment of asthma severity in children. [ABSTRACT FROM AUTHOR]

Introduction and aim of the study: The diagnosis and treatment of interstitial lung diseases (ILD), a class of diffuse parenchymal lung disorders that are associated with significant morbidity and death, provide challenges to the clinician. Multidisciplinary discussions (MDD) between a clinician, radiologist, and pathologist are used to diagnose ILD. There is a lack of information on the use of composite prediction models such as the ILD Gap Index and the Composite Physiologic Index. The main objective of the study was to evaluate factors affecting adverse outcomes in interstitial lung diseases with idiopathic pulmonary fibrosis (IPF) and other non-IPF interstitial lung diseases at 6 months in a tertiary care centre. Material and methods: This was a retrospective cohort research carried out at a tertiary care centre at Howrah, a district of state West Bengal in India. The main inclusion criteria were to include all patients who had complete medical records after being diagnosed with ILD. Any patients who suffered from pulmonary TB or lung cancer were excluded. The study comprised 164 consecutive individuals with a multidisciplinary diagnosis of interstitial lung disease. At 6 months, clinical evaluation, spirometry and DLCO were performed on the patients. FVC reduction of less than 10% at 6 months and mortality were evaluated as outcome variables. Results: Idiopathic pulmonary fibrosis (IPF) affected 27.2% of the 164 patients who were evaluated, while non-IPF affected 72.8% of the patients. At a 6-month follow-up, 15.2% of patients died, with 72% having IPF. At 6 months, the FVC of 51.2% had decreased by 10%. Age more than 60, male gender, BMI 18,5, smoking, the presence of pulmonary hypertension, mean saturation more than 90%, percentage predicted FVC more than 50%, percentage predicted DLCO more than 40 per cent, 6-minute walk distance more than 250 m at diagnosis, UIP pattern in HRCT, CPI score more than 50, and ILD-GAP index more than 4 are factors associated with mortality in interstitial lung diseases. Age more than 60 years old and IPF group were variables linked with death in multivariate analysis using logistic regression in bivariate analysis, the same factors were linked to a reduction in FVC of more than 10% at 6 months, whereas in multivariate analysis, smoking history and an initial projected DLCO of less than 40% were significant. In interstitial lung disorders, the ILD Gap index is a better predictor of death than a composite physiologic index. (AURO 0.912 vs., CPI 0.856). Conclusions: Interstitial lung disease mortality indicators include age more than 60, idiopathic pulmonary fibrosis type, and FVC decline = 10% at 6 months and less than 50% at baseline. Prediction methods like composite physiologic index (CPI) and ILD Gap index aid prognosis and clinical decision-making. The ILD Gap index predicted mortality better than the composite physiologic index. The main objective of the study was to evaluate factors affecting adverse outcomes in interstitial lung diseases with idiopathic pulmonary fibrosis (IPF) and other non-IPF interstitial lung diseases at 6 months in a tertiary care centre. [ABSTRACT FROM AUTHOR]

We measured resting metabolic rate (RMR), tidal volume (VT), breathing frequency (fR), respiratory flow, and end‐expired gases in rough‐toothed dolphins (Steno bredanensis) housed in managed care after an overnight fast and 1–2 hr following a meal. The measured average (± standard deviation) VT (4.0 ± 1.3 L) and fR (1.9 ± 1.0 breaths/min) were higher and lower, respectively, as compared with estimated values from both terrestrial and aquatic mammals, and the average VT was 43% of the estimated total lung capacity. The end‐expired gas levels suggested that this species keep alveolar O2 (10.6% or 80 mmHg) and CO2 (7.6% or 57 mmHg), and likely arterial gas tensions, low and high, respectively, to maximize efficiency of gas exchange. We show that following an overnight fast, the RMR (566 ± 158 ml O2/min) was 1.8 times the estimated value predicted by Kleiber for terrestrial mammals of the same size. We also show that between 1 and 2 hr after ingestion of a meal, the metabolic rate increases an average of 29% (709 ± 126 ml O2/min). Both body mass (Mb) and fR significantly altered the measured RMR and we propose that both these variables should be measured when estimating energy use in cetaceans. [ABSTRACT FROM AUTHOR]