Search

ObjectivesThis study aimed to evaluate the screening performance of COPD-PS questionnaire, COPD-SQ questionnaire, peak expiratory flow (PEF), COPD-PS questionnaire combined with PEF, and COPD-SQ questionnaire combined with PEF for chronic obstructive pulmonary disease (COPD).MethodsThis was a cross-sectional study. We distributed self-designed surveys and COPD screening scales (COPD-PS questionnaire and COPD-SQ questionnaire) to residents who underwent physical examination in five community health centers in Haicang District, Xiamen City, from February 2023 to May 2023, and measured their lung function and PEF with a portable device. We used logistic regression to obtain the coefficients of COPD-PS questionnaire, COPD-SQ questionnaire, and PEF, and plotted the receiver operating characteristic curves of each tool for diagnosing COPD and moderate-to-severe COPD. We evaluated and compared the optimal cut-off points and scores of sensitivity, specificity, Youden index, and area under the curve (AUC) values, and assessed the screening efficiency of different methods.ResultsOf the 3,537 residents who completed the COPD-SQ questionnaire, COPD-PS questionnaire, and spirometry, 840 were diagnosed with COPD. We obtained the coefficients of COPD-PS questionnaire combined with peak expiratory flow (PEF), and COPD-SQ questionnaire combined with PEF, by logistic regression as −0.479-0.358 × PEF +0.321 × COPD-PS score and − 1.286-0.315 × PEF +0.125 × COPD-SQ score, respectively. The sensitivity of diagnosing COPD by COPD-SQ questionnaire, COPD-PS questionnaire, PEF, COPD-PS questionnaire combined with PEF, and COPD-SQ questionnaire combined with PEF were 0.439, 0.586, 0.519, 0.586, 0.612 respectively, and the specificity were 0.725, 0.621, 0.688, 0.689, 0.663 respectively, with ROC values of 0.606 (95%CI: 0.586–0.626), 0.640 (0.619–0.661), 0.641 (0.619–0.663), 0.678 (0.657–0.699), 0.685 (0.664–0.706) respectively. The sensitivity of diagnosing GOLD II and above by COPD-SQ questionnaire, COPD-PS questionnaire, PEF, COPD-PS questionnaire combined with PEF, and COPD-SQ questionnaire combined with PEF were 0.489, 0.620, 0.665, 0.630, 0.781 respectively, and the specificity were 0.714, 0.603, 0.700, 0.811, 0.629 respectively, with ROC values of 0.631 (95%CI: 0.606–0.655), 0.653 (0.626–0.679), 0.753 (0.730–0.777), 0.784 (0.762–0.806), 0.766 (0.744–0.789) respectively.ConclusionOur study found that the accuracy of COPD screening by COPD-SQ questionnaire and COPD-PS questionnaire can be improved by combining the results of PEF. The screening performance of COPD-SQ questionnaire combined with PEF is relatively better. In future research, further studies are needed to optimize the performance of screening tools and understand whether their use will affect clinical outcomes.

Introduction: the basic characteristic of chronic obstructive pulmonary disease (COPD) is a persistent reduction of forced expiratory volume in the first second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC). Exacerbation of COPD (ECOPD) is an important event during the course of the disease. There is a question of whether peak expiratory flow (PEF) is useful in a shortterm evaluation of COPD, especially when spirometry is not available on a regular basis. Aim: to determine and compare the PEF values using a peak flow meter and the FEV1 measured with spirometry in a patient suffering from COPD. Materials and methods: the research is designed as a cross-sectional, clinical study. It included 120 patients suffering from COPD who gave informed consent for the participation in the study according to the Helsinki Declaration. The relationship between PEF measured by mini-Wright PEF meter and FEV1 measured by spirometry was tested. Results: PEF values measured by peak flow meter correlate with FEV1 values measured by spirometry in patients suffering from COPD (r = 0.532, p <0.001). Conclusion: based on the research results, the measurement of PEF with a peak flow meter could be applicable even in primary health care, where spirometry is unavailable for monitoring COPD exacerbations. [ABSTRACT FROM AUTHOR]

Abstract Background Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust, such as hydrotreated vegetable oil (HVO), on human health is less known. Nineteen healthy volunteers were exposed to HVO exhaust for 3 h in a chamber with a double-blind, randomized setup. Exposure scenarios comprised of HVO exhaust from two modern non-road vehicles with 1) no aftertreatment system (‘HVOPM+NOx’ PM1: 93 µg m−3, EC: 54 µg m−3, NO: 3.4 ppm, NO2: 0.6 ppm), 2) an aftertreatment system containing a diesel oxidation catalyst and a diesel particulate filter (‘HVONOx’ PM1: ~ 1 µg m−3, NO: 2.0 ppm, NO2: 0.7 ppm) and 3) filtered air (FA) as control. The exposure concentrations were in line with current EU occupational exposure limits (OELs) of NO, NO2, formaldehyde, polycyclic aromatic hydrocarbons (PAHs), and the future OEL (2023) of elemental carbon (EC). The effect on nasal patency, pulmonary function, and self-rated symptoms were assessed. Calculated predicted lung deposition of HVO exhaust particles was compared to data from an earlier diesel exhaust study. Results The average total respiratory tract deposition of PM1 during HVOPM+NOx was 27 µg h−1. The estimated deposition fraction of HVO PM1 was 40–50% higher compared to diesel exhaust PM1 from an older vehicle (earlier study), due to smaller particle sizes of the HVOPM+NOx exhaust. Compared to FA, exposure to HVOPM+NOx and HVONOx caused higher incidence of self-reported symptoms (78%, 63%, respectively, vs. 28% for FA, p

Background: Diesel engine exhaust causes adverse health effects. Meanwhile, the impact of renewable diesel exhaust, such as hydrotreated vegetable oil (HVO), on human health is less known. Nineteen healthy volunteers were exposed to HVO exhaust for 3 h in a chamber with a double-blind, randomized setup. Exposure scenarios comprised of HVO exhaust from two modern non-road vehicles with 1) no aftertreatment system ('HVOPM+NOx' PM1: 93 µg m−3, EC: 54 µg m−3, NO: 3.4 ppm, NO2: 0.6 ppm), 2) an aftertreatment system containing a diesel oxidation catalyst and a diesel particulate filter ('HVONOx' PM1: ~ 1 µg m−3, NO: 2.0 ppm, NO2: 0.7 ppm) and 3) filtered air (FA) as control. The exposure concentrations were in line with current EU occupational exposure limits (OELs) of NO, NO2, formaldehyde, polycyclic aromatic hydrocarbons (PAHs), and the future OEL (2023) of elemental carbon (EC). The effect on nasal patency, pulmonary function, and self-rated symptoms were assessed. Calculated predicted lung deposition of HVO exhaust particles was compared to data from an earlier diesel exhaust study. Results: The average total respiratory tract deposition of PM1 during HVOPM+NOx was 27 µg h−1. The estimated deposition fraction of HVO PM1 was 40–50% higher compared to diesel exhaust PM1 from an older vehicle (earlier study), due to smaller particle sizes of the HVOPM+NOx exhaust. Compared to FA, exposure to HVOPM+NOx and HVONOx caused higher incidence of self-reported symptoms (78%, 63%, respectively, vs. 28% for FA, p < 0.03). Especially, exposure to HVOPM+NOx showed 40–50% higher eye and throat irritation symptoms. Compared to FA, a decrement in nasal patency was found for the HVONOx exposures (− 18.1, 95% CI: − 27.3 to − 8.8 L min−1, p < 0.001), and for the HVOPM+NOx (− 7.4 (− 15.6 to 0.8) L min−1, p = 0.08). Overall, no clinically significant change was indicated in the pulmonary function tests (spirometry, peak expiratory flow, forced oscillation technique). Conclusion: Short-term exposure to HVO exhaust concentrations corresponding to EU OELs for one workday did not cause adverse pulmonary function changes in healthy subjects. However, an increase in self-rated mild irritation symptoms, and mild decrease in nasal patency after both HVO exposures, may indicate irritative effects from exposure to HVO exhaust from modern non-road vehicles, with and without aftertreatment systems. [ABSTRACT FROM AUTHOR]

ObjectivesCough impairment may lead to excessive accumulation of pulmonary secretions and increase the risk of postoperative pulmonary complications (PPCs). Peak expiratory flow (PEF) is a sensitive indicator of cough ability. We aimed to investigate the correlation between PEF and PPCs for lung cancer patients undergoing lobectomy or segmental resection for improved risk assessment.MethodsThis retrospective study assessed 560 patients with non-small cell lung cancer admitted for surgery between January 2014 to June 2016. The measurements of PEF were performed before surgery and the clinical outcomes were recorded, including PPCs, postoperative hospital stay, hospitalization costs, and other variables.ResultsPreoperative PEF was significantly lower in PPCs group compared to non-PPCs group (294.2 ± 95.7 vs. 363.0 ± 105.6 L/min, P < 0.001). Multivariable regression analysis showed that high PEF (OR=0.991, 95%CI: 0.988-0.993, P < 0.001) was an independent protective factor for PPCs. According to the receiver operating characteristic (ROC) curve, a PEF value of 250 L/min was selected as the optimal cutoff value in female patients, and 320 L/min in male patients. Patients with PEF under cutoff value of either sex had higher PPCs rate and unfavorable clinical outcomes.ConclusionsPreoperative PEF was found to be a significant predictor of PPCs for surgical lung cancer patients. It may be beneficial to consider the cutoff value of PEF in perioperative risk assessment.

Objectives: Cough impairment may lead to excessive accumulation of pulmonary secretions and increase the risk of postoperative pulmonary complications (PPCs). Peak expiratory flow (PEF) is a sensitive indicator of cough ability. We aimed to investigate the correlation between PEF and PPCs for lung cancer patients undergoing lobectomy or segmental resection for improved risk assessment. Methods: This retrospective study assessed 560 patients with non-small cell lung cancer admitted for surgery between January 2014 to June 2016. The measurements of PEF were performed before surgery and the clinical outcomes were recorded, including PPCs, postoperative hospital stay, hospitalization costs, and other variables. Results: Preoperative PEF was significantly lower in PPCs group compared to non-PPCs group (294.2 ± 95.7 vs. 363.0 ± 105.6 L/min, P < 0.001). Multivariable regression analysis showed that high PEF (OR=0.991, 95%CI: 0.988-0.993, P < 0.001) was an independent protective factor for PPCs. According to the receiver operating characteristic (ROC) curve, a PEF value of 250 L/min was selected as the optimal cutoff value in female patients, and 320 L/min in male patients. Patients with PEF under cutoff value of either sex had higher PPCs rate and unfavorable clinical outcomes. Conclusions: Preoperative PEF was found to be a significant predictor of PPCs for surgical lung cancer patients. It may be beneficial to consider the cutoff value of PEF in perioperative risk assessment. [ABSTRACT FROM AUTHOR]

Brittle asthma, even though it is thought to be a rare form of Asthma, may form the bulk of our difficult to treat asthma and frequently unresponsive exacerbation. Brittle Asthma. Brittle asthma is a rare form of 1 severe asthma characterized by a wide variation of Peak Expiratory Flow (PEF), 1in spite of high doses of inhaled steroids and bronchodilator therapy. Brittle asthmatic patients have very serious and often, life threatening, attacks. There are two forms of brittle asthma. CASE PRESENTATION We present the cases of a 45yr old Nurse anesthetics who was diagnosed>5yrs ago and a 56yr old unemployed who was diagnosed>15yrs ago. Both have been stable for years on add on maintenance therapy with high doses of inhaled corticosteroid and β2 agonist as oral salbutamol and an inhaler therapy 2 during exacerbation. Recently, both patients noticed worsening of symptoms despite high dose therapy, They have been in and out of hospital recently for uncontrolled asthma. They later had to be admitted in ICU because of respiratory insufficiency. These two lapsed into brittle asthma with recurrent bronchospasm, due to repeated exposure to anesthetic agents and environmental exposure at home respectively.

Nancy K Leidy,1 Fernando J Martinez,2 Karen G Malley,1 David M Mannino,3 MeiLan K Han,4 Elizabeth D Bacci,5 Randall W Brown,6 Julia F Houfek,7 Wassim W Labaki,4 Barry J Make,8 Catherine A Meldrum,4 Wilson Quezada,9 Stephen Rennard,10 Byron Thomashow,9 Barbara P Yawn11 1Evidera, Patient-Centered Research, Bethesda, MD, USA; 2Weill Cornell Medicine, Joan & Sanford Weill Department of Medicine, New York, NY, USA; 3University of Kentucky, Preventive Medicine & Environmental Health, Lexington, KY, USA; 4University of Michigan, Division of Pulmonary & Critical Care Medicine, Ann Arbor, MI, USA; 5Evidera, Patient-Centered Research, Seattle, WA, USA; 6University of Michigan, Department of Health Behavior & Health Education, School of Public Health, Ann Arbor, MI, USA; 7University of Nebraska Medical Center College of Nursing, Omaha, NE, USA; 8National Jewish Health, Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Denver, CO, USA; 9Columbia University Medical Center, Division of Pulmonary, Allergy, & Critical Care, New York, NY, USA; 10AstraZeneca, IMED Biotech Unit, Cambridge, UK & University of Nebraska Medical Center, Department of Medicine, Omaha, NE, USA; 11University of Minnesota, Department of Family & Community Health, Minneapolis, MN & COPD Foundation, Miami, FL, USA Background: COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE™) uses five questions and peak expiratory flow (PEF) thresholds (males ≤350 L/min; females ≤250 L/min) to identify patients with a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) 2: 37% vs 5%, p10: 86% vs 57%, p

Abstract Background The combination of budesonide + formoterol (BFC) offers the advantages of dose adjustment in a single inhaler according to asthma symptoms. We analyzed the relationship between asthma symptoms in terms of peak expiratory flow (PEF) and dose adjustment by the patient. Methods Twenty-eight patients with asthma who used BFC for alleviation of their symptoms (12 men, 16 women; 60 years old) were instructed that the inhaled BFC dose could be increased to a maximum of 8 inhalations per day according to symptom severity. Patients measured and recorded PEF every morning and evening in their asthma diary along with their symptoms and the dose of drugs taken. Results Sixteen of the 28 patients increased their dose for asthma symptoms. The time to recovery from the asthma symptoms was significantly shorter when cough was the only symptom present compared with dyspnea or wheeze (1.4 vs. 5.3 or 6.6 days, p

Introduction: Asthma is a continuous significant health problem. Strategies for treating exacerbations are best adapted and implemented at a local level. Severe exacerbations are potentially life threatening, and their treatment requires close supervision. The severity of the exacerbation determines the treatment administered. Indices of severity, particularly peak expiratory flow (PEF), pulse rate, respiratory rate, and pulse oximetry should be monitored during treatment. Aim of the work: The aim of this work was to assess the effect of the implementation of the Global Initiative for Asthma (GINA) guidelines in the prognosis and the outcome of asthma exacerbation in the emergency department. Subjects and methods: The study was conducted on one hundred asthmatic patients. All patients were informed about the study and gave their consents. Patients were subjected to full history taking and clinical evaluation. Investigations were done in the form of peak flow rate (PFR) measurement, pulse oximetry assessment, ABG analysis (for only 17 patients), chest X-ray (it is not routinely recommended) and complete blood count (if needed). Then patients were classified according to their attacks. All patients were managed according to GINA guidelines. Results: Older patients were significantly suffering from severe to life threatening attacks than younger patients. We found that 12% of patients had occupational related asthma in relation to 88% of patients had non-occupational related asthma. There were no statistical significant differences between classification of severity of current attack and previous emergency department (ED) visits/year. There were no statistical significant differences between the studied groups regarding temperature. Systolic and diastolic blood pressure had statistically significant lower values in patients with severe to life threatening attacks than those with mild to moderate attacks. Severe to life threatening group had respiratory rate higher than mild to moderate group. Mild to moderate group had PEF and SaO2% higher than severe to life threatening group. PEF was statistically higher post treatment than pre treatment. Three patients of 17 had PaCo2 >45 mmHg with hypoxemia and respiratory acidosis and they admitted to the intensive care unit (ICU). All patients in ED were assisted to determine the severity of asthma concomitant with administration of initial treatment (plan A), which is oxygen to achieve O2 saturation ⩾92%, inhaled B2 adrenergic bronchodilator and an oral or intravenous dose of corticosteroids. Five patients met a good response so they enter in (plan C1). Seventy-five patients met with the criteria of moderate episode they go to plan B1, 68 patients of them (about 90%) had a good response within 2 h so go to plan C1 and the rest 7 patients (10%) had an incomplete response go to plan C2. Twenty patients met with criteria of severe episode, 17 of them (85%) with incomplete response move to plan C2, and the rest 3 patients (15%) had a poor response and moved to plan C3, no improvement noticed so they were admitted to the ICU. Hospitalization was done to 11 patients who met a poor response (plan C2), 86 patients were discharged from the ED (73 patients from plan C1 and 13 patients from plan C2). Severe to life threatening group stayed in ED longer than mild to moderate group. Conclusions and recommendations: All patients presenting in the emergency department with asthma exacerbations should be evaluated and triaged immediately and must be treated according to their severity of classification using GINA guidelines. Measurements of airflow obstruction, using peak expiratory flow, can help to guide therapy for acute asthma. Continuous monitoring of oxyhaemoglobin saturation by pulse oximetry should be undertaken for all patients with acute exacerbation of asthma. We must; educate patients in ED about the nature of asthma and its therapy, educate patients how to use inhalers, encourage patients to use spirometer at home and discharge each patient with ED-asthma discharge plan.

Background: To reduce deaths from asthma, further use of inhaled corticosteroids (ICS) in accordance with the guidelines is required. The present study was conducted because specialists are responsible for increasing the use of guidelines, but the current state of asthma care provided by specialists in primary clinical settings has not been clarified. Methods: In collaboration with five primary medical facilities throughout Japan, severity of asthma, contents of asthma therapy, and the implementation rate of pulmonary function testing and peak flow measurements were analyzed for 1007 outpatients ≥40 years old with stable bronchial asthma. In all patients, peak inspiratory flow (PIF) was measured during examination. Results: Either ICS or ICS/long-acting beta 2 agonist (LABA) was used in almost all patients with at least mild persistent asthma. Although treatments adhered to the guidelines, therapeutic steps did not match asthma severity in many patients with mild intermittent asthma. Large gaps existed between facilities that measure pulmonary function and PEF in daily clinical practice and those that do not. While mean PIF value for all subjects was well maintained at 102.0 ± 29.1 L/min, some patients may not have been able to inhale efficiently in terms of PIF (5.1% of Turbuhaler® users and 5.7% of Diskhaler® users). Conclusions: When stepping down asthma therapy, some confusion in policy may exist, leading to guideline mismatches. Differences in the implementation of pulmonary function and PEF measurements, as indicators for long-term management, need to be minimized among specialists. For maintaining effective inhalation, inspiratory flow should be periodically checked.

More than one percent of the labor force in each country consists of welders exposed to various damages caused by welding. The number of studies conducted in this field is low, especially in Iran. In this paper, we tried to discover any temporary and reversible obstructive effect of welding fumes on the respiratory systems of welders. In this cross-sectional study, peak expiratory flow rates and respiratory symptoms of 37 welders during work shift were evaluated. Peak expiratory flow rates of welders were recorded in three working days and one non-working day. Peak expiratory flow rates in working days were compared with non-working Peak expiratory flow rates as a control measure. PEF values were higher in every recorded time in non-working days than that of working days. Besides, PEF of the middle shift decreased an hour after end of the shift had increased. Changes in PEF since the start of shift until an hour after the shift had the same pattern in all four days, but in conflict with daily physiological patterns. Fewer people complained respiratory symptoms such as cough and sputum in non-working days. Therefore, exposure to the welding fumes can result in reversible and temporary effect on PEF and this could lead to bronchial irritation and cause respiratory symptoms. Therefore, it is recommended that welders use sufficient respiratory protection and weld in places with air ventilator specialty when welding with CO2 in order to reduce irritant effects of welding fumes on respiratory systems.

Pulmonary function tests (PFTs) are noninvasive diagnostic tests that evaluate the functionality of the lungs. Spirometry is an established diagnostic tool for the evaluation and management of lung disorders. Pulmonary function testing carried out using a spirometer provides vital information about the functional status of the respiratory system. In this study, a spirometer based on a fiber Bragg grating (FBG) sensor for PFT has been proposed. The proposed fiber Bragg grating spirometer (FBGS) is a novel, noninvasive device that has the ability to convert the rate of air flow into strain variations using an FBG sensor bonded on a cantilever. The FBGS dynamically acquires in real time, the complete breath sequence comprising of inhalation phase, pause phase, and exhalation phase, in terms of the air flow rate along with the time duration of each phase. Fundamental pulmonary parameters such as forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), the FEV1/FVC ratio, and peak expiratory flow are evaluated from the data obtained from the FBGS, which will aid greatly during clinical tests. The results from the FBGS developed are compared with a standard hospital grade pneumotachograph-based spirometer for a sample size of 16 subjects to prove the efficacy of the proposed device. [ABSTRACT FROM PUBLISHER]

More than one percent of the labor force in each country consists of welders exposed to various damages caused by welding. The number of studies conducted in this field is low, especially in Iran. In this paper, we tried to discover any temporary and reversible obstructive effect of welding fumes on the respiratory systems of welders. In this cross-sectional study, peak expiratory flow rates and respiratory symptoms of 37 welders during work shift were evaluated. Peak expiratory flow rates of welders were recorded in three working days and one non-working day. Peak expiratory flow rates in working days were compared with non-working Peak expiratory flow rates as a control measure. PEF values were higher in every recorded time in non-working days than that of working days. Besides, PEF of the middle shift decreased an hour after end of the shift had increased. Changes in PEF since the start of shift until an hour after the shift had the same pattern in all four days, but in conflict with daily physiological patterns. Fewer people complained respiratory symptoms such as cough and sputum in non-working days. Therefore, exposure to the welding fumes can result in reversible and temporary effect on PEF and this could lead to bronchial irritation and cause respiratory symptoms. Therefore, it is recommended that welders use sufficient respiratory protection and weld in places with air ventilator specialty when welding with CO2 in order to reduce irritant effects of welding fumes on respiratory systems. [ABSTRACT FROM AUTHOR]

Asthma affects over 300 million people worldwide. Asthmatics experience difficulty in breathing and airflow obstruction caused by inflammation and constriction of the airways. Home monitoring of lung function is the preferred course of action to give physicians and asthma patients a chance to control the disease jointly. Thus, it is important to develop accurate and efficient asthma monitoring devices that are easy for patients to use. While classic spirometry is currently the best way to capture a complete picture of airflow obstruction and lung function, the machines are bulky and generally require supervision. Portable peak flow meters are available but are inconvenient to use. There also exist no portable inexpensive exhaled breath biomarker devices commercially available to simultaneously measure concentrations of multiple chemical biomarkers. We have created a user-friendly, accurate, and portable external mobile device accessory that collects spirometry, peak expiratory flow, exhaled nitric oxide, carbon monoxide, and oxygen concentration information from patients after two breath maneuvers. We have also developed a software application that records and stores the gathered test information and e-mails the results to a physician. Telemetric capabilities help physicians to track asthma symptoms and lung function over time, which allow physicians the opportunity to make appropriate changes in a patient's medication regimen more quickly. [ABSTRACT FROM AUTHOR]

• It is rational to clarify whether changes in pulmonary function over time are associated with baseline depression levels among older populations without lung diseases. • Depressive symptoms were significantly associated with peak expiratory flow (PEF) among general middle-aged and older adults. • The association between depressive symptoms and PEF was greater for men than for women. Objective Most previous studies focusing on the association between depressive symptoms and lung function were conducted in patients with chronic lung diseases. This study aims to investigate the association of depressive symptoms with lung function among general Chinese middle-aged and older adults. Participants This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Analyses were conducted with data from three waves (2011, 2013, and 2015) and restricted to those respondents aged 45 and older. Finally, 9487 individuals [mean age (SD) = 58.47 (9.19); female, 53.1%] were included in analysis. Methods Depressive symptoms were measured by the Chinese version of 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Lung function was assessed by peak expiratory flow (PEF). Two-level linear mixed growth models were used to evaluate the longitudinal association between depressive symptoms and PEF. Results Depressive symptoms were significantly associated with PEF among general middle-aged and older adults (b = − 1.85, p < 0.001) after adjusting for multiple confounding factors. A significant interaction between depressive symptoms and gender was found (b = 1.29, p < 0.001). The association between depressive symptoms and PEF was greater for men (b = − 2.36, p < 0.001) than for women (b = − 1.46, p < 0.001). Conclusions This longitudinal study found that increased depressive symptoms were associated with reduced PEF in middle-aged and older adults in China. Compared with women, men with a higher level of depressive symptoms experienced a greater decrement in PEF. Our findings suggest that it is possible to reduce the effects of PEF by improving psychological health among general middle-aged and older populations. [ABSTRACT FROM AUTHOR]

Highlights: [•] Stronger particulate effects were found in relation to high temperature levels. [•] Stronger temperature effects were found in relation to high particulate levels. [•] Particulate and temperature may interact synergistically to alter lung function. [Copyright &y& Elsevier]

Summary: Evidence suggests that pro-inflammatory cytokines and cortisol play a crucial role in the etiology of chronic obstructive pulmonary disease (COPD) and depression. Depression occurs commonly among COPD patients and an earlier diagnosis would be beneficial. This study investigated the associations between depression, sputum cytokines and salivary cortisol in COPD patients. The diurnal rhythms of sputum IL-1, IL-6, TNF-α and salivary cortisol were measured in COPD patients with depression compared to those only with depression, or COPD and healthy controls. The area under the diurnal variation curves (AUC) over the 24h time course and relative diurnal variation (VAR) were calculated while correlation and regression analysis were performed. Patients with co-morbid depression and COPD showed an increasing sputum IL-1, sputum TNF-α AUC and a decreasing salivary cortisol VAR (P <0.001). The combination of sputum TNF-α AUC, sputum IL-1 AUC, sputum IL-6 AUC and salivary cortisol VAR performed best as a potential biomarker in the diagnosis of depression in COPD patients, with a sensitivity of 94.74% and a specificity of 96.67%. Positive correlations were found between sputum IL-1 AUC and sputum TNF-α AUC versus depressive symptoms, respectively a negative correlation was found between salivary cortisol VAR and depression. They were independently associated with depression in logistic regression models. Depression in COPD is associated with higher 24-h overall levels of sputum IL-1, TNF-α and flattened diurnal salivary cortisol. These non-invasive sputum and salivary biomarkers may serve as a simple clinical tool for the early diagnosis of depression in COPD patients. [Copyright &y& Elsevier]

Background: Combination therapy with an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA) in a single inhaler is the mainstay of asthma management. We previously showed that switching from salmeterol/fluticasone combination (SFC) 50/250 μg bid to a fixed-dose formoterol/budesonide combination (FBC) 9/320 μg bid improved asthma control and pulmonary functions, but not fractional exhaled nitric oxide (FeNO), in patients with asthma not adequately controlled under the former treatment regimen. Objective: To assess whether switching from SFC to FBC improves peripheral airway/alveolar inflammation in asthma (UMIN000009619). Methods: Subjects included 66 patients with mild to moderate asthma receiving SFC 50/250 μg bid for more than 8 weeks. Patients were randomized into FBC 9/320 μg bid or continued the same dose of SFC for 12 weeks. Asthma Control Questionnaire, 5-item version (ACQ5) score, peak expiratory flow, spirometry, FeNO, alveolar NO concentration (CANO), and maximal NO flux in the conductive airways (J’awNO) were measured. Results: Sixty-one patients completed the study. The proportion of patients with an improvement in ACQ5 was significantly higher in the FBC group than in the SFC group (51.6% vs 16.7%, respectively, p = 0.003). A significant decrease in CANO was observed in the FBC group (from 8.8 ± 9.2 ppb to 4.0 ± 2.6 ppb; p = 0.007) compared to the SFC group (from 7.4 ± 7.8 ppb to 6.4 ± 5.0 ppb; p = 0.266) although there was no significant difference in the changes in pulmonary functions between the 2 groups. Similar significant differences were found in the CANO corrected for the axial back diffusion of NO (FBC, from 6.5 ± 8.2 ppb to 2.3 ± 2.5 ppb; and SFC, from 4.3 ± 5.3 ppb to 3.9 ± 4.3 ppb). There was no difference in the changes in FeNO or J’awNO between the 2 groups. Conclusions: Switching therapy from SFC to FBC improves asthma control and peripheral airway/alveolar inflammation even though there is no improvement in pulmonary functions, and FeNO in asthmatic patients. [ABSTRACT FROM AUTHOR]

Abstract: The increase in asthma and allergies has been attributed to declining exposure to environmental microorganisms. The main source of these is soil, the composition of which varies geographically and which is a major component (40–45%) of household dust. Our hypothesis-generating study aimed to investigate associations between soil components, respiratory health and allergy in a Scottish birth cohort. The cohort was recruited in utero in 1997/8, and followed up at one, two and five years for the development of wheezing, asthma and eczema. Lung function, exhaled nitric oxide and allergic sensitization were measured at age five in a subset. The Scottish Soils Database held at The James Hutton Institute was linked to the birth cohort data by the residential postcode at birth and five years. The soil database contained information on size separates, organic matter concentration, pH and a range of inorganic elements. Soil and clinical outcome data were available for 869, 790 and 727 children at one, two and five years. Three hundred and fifty nine (35%) of children had the same address at birth and five years. No associations were found between childhood outcomes and soil content in the residential area at age five. The soil silt content (2–20μm particle size) of the residential area at birth was associated with childhood wheeze (adjusted OR 1.20, 95% CI [1.05; 1.37]), wheeze without a cold (1.41 [1.18; 1.69]), doctor-diagnosed asthma (1.54 [1.04; 2.28]), lung function (FEV1: beta −0.025 [−0.047;−0.001]) and airway inflammation (FENO: beta 0.15 [0.03; 0.27]) at age five, but not with allergic status or eczema. Whilst residual confounding is the most likely explanation for the associations reported, the results of this study lead us to hypothesise that early life exposure to residential soil silt may adversely influence childhood respiratory health, possibly because of the organic components of silt. [Copyright &y& Elsevier]

Abstract: Depression is common among lung cancer patients. Increasing evidence has suggested that hypothalamic–pituitary–adrenal (HPA) axis and pro-inflammatory cytokines may play a key role in the pathophysiology of depression as well as cancer. This pilot study investigated the efficacy of sputum interleukin (IL)-6, tumor necrosis factor (TNF)-α and salivary cortisol as new markers to support the diagnosis of depression in lung cancer patients. The diurnal rhythms of sputum IL-6, sputum TNF-α and salivary cortisol were measured in lung cancer patients with and without depression as well as depressed controls and healthy controls. The area under the diurnal variation curves (AUC) over the 24h time course and relative diurnal variation (VAR) were calculated. Receiver operating characteristic (ROC) analysis was performed. Patients with co-morbid depression and lung cancer showed highest level of sputum IL-6 AUC, sputum TNF-α AUC and lowest level of cortisol VAR (P<0.001). As a biomarker for depression, salivary cortisol VAR demonstrated an optimal cutoff point at 77.8% (AUC=0.94; 95% CI, 0.85–0.98), which is associated with a sensitivity of 82.1% and a specificity of 96.0%. Sputum IL-6 AUC demonstrated a sensitivity of 74.4% and a specificity of 92.0% (AUC=0.81; 95% CI, 0.69–0.90). These findings suggested that higher 24h overall levels of sputum IL-6, TNF-α and flattened diurnal salivary cortisol slopes were associated with depression in lung cancer patients. Sputum IL-6 AUC and salivary cortisol VAR performed best as biomarkers in the diagnosis of depression in lung cancer patients. [Copyright &y& Elsevier]

Abstract: The reactions between terpenes and ozone (or other oxidants) produce a wide variety of both gas- and particle-phase products. Terpenes are biogenic volatile organic compounds (VOCs) that are also contained in many consumer products. Ozone is present indoors since it infiltrates into the indoor environment and is emitted by some office and consumer equipment. Some of the gaseous products formed are irritating to biological tissues, while the condensed-phase products have received attention due to their contribution to ambient fine particulate matter (PM2.5) and its respective health significance. Despite common scientific questions, the indoor and ambient air research communities have tended to operate in isolation regarding this topic. This review critically evaluates the literature related to terpene oxidation products and attempts to synthesize results of indoor and ambient air studies to better understand the health significance of these materials and identify knowledge gaps. The review documents the results of a literature search covering terpene oxidation chemistry, epidemiological, toxicological, and controlled human exposure studies, as well as health studies focused more generically on secondary organic aerosol (SOA). The literature shows a clear role for gas-phase terpene oxidation products in adverse airway effects at high concentrations; however, whether these effects occur at more environmentally relevant levels is unclear. The evidence for toxicity of particle-phase products is less conclusive. Knowledge gaps and future research needs are outlined, and include the need for more consistency in study designs, incorporation of reaction product measurements into epidemiological studies conducted in both indoor and ambient settings, and more focused research on the toxicity of SOA, especially SOA of biogenic origin. [Copyright &y& Elsevier]

Highlights: [•] Study subjects relocated between areas with different air pollution contents. [•] PM2.5 showed the most consistent inverse associations with pulmonary function. [•] Cu, Cd, As and Sn were consistently associated with reduced pulmonary function. [•] Carbonaceous fractions, SO4 2− and Sb were also associated with pulmonary function. [•] Sources may include traffic, industry, coal burning, and long range transported dust. [Copyright &y& Elsevier]

Abstract: Concentrations of volatile organic compounds (VOCs) in office environments are generally too low to cause sensory irritation in the eyes and airways on the basis of estimated thresholds for sensory irritation. Furthermore, effects in the lungs, e.g. inflammatory effects, have not been substantiated at indoor relevant concentrations. Some VOCs, including formaldehyde, in combination may under certain environmental and occupational conditions result in reported sensory irritation. The odour thresholds of several VOCs are low enough to influence the perceived air quality that result in a number of acute effects from reported sensory irritation in eyes and airways and deterioration of performance. The odour perception (air quality) depends on a number of factors that may influence the odour impact. There is neither clear indication that office dust particles may cause sensory effects, even not particles spiked with glucans, aldehydes or phthalates, nor lung effects; some inflammatory effects may be observed among asthmatics. Ozone-initiated terpene reaction products may be of concern in ozone-enriched environments (≥0.1mg/m3) and elevated limonene concentrations, partly due to the production of formaldehyde. Ambient particles may cause cardio-pulmonary effects, especially in susceptible people (e.g. elderly and sick people); even, short-term effects, e.g. from traffic emission and candle smoke may possibly have modulating and delayed effects on the heart, but otherwise adverse effects in the airways and lung functions have not been observed. Secondary organic aerosols generated in indoor ozone-initiated terpene reactions appear not to cause adverse effects in the airways; rather the gaseous products are relevant. Combined exposure to particles and ozone may evoke effects in subgroups of asthmatics. Based on an analysis of thresholds for odour and sensory irritation selected compounds are recommended for measurements to assess the indoor air quality and to minimize reports of irritation symptoms, deteriorated performance, and cardiovascular and pulmonary effects. [Copyright &y& Elsevier]

Asthma is a disease that affects over 300 million people worldwide and is disproportionately observed in the developing world where air pollution is sometimes more prevalent. This disease can range in severity, causing the airways of the lungs to constrict and inflame, and no known therapies can completely and permanently ameliorate the disease's effects on the respiratory system. Doctors can, however, treat most chronic and acute asthma symptoms with medication regimens. It is therefore important to develop accurate devices to monitor the disease symptoms so doctors can take appropriate steps to treat the patient with proper medication. One effective way to track asthma symptoms is to monitor a patient's peak expiratory flow (PEF). There are presently many different handheld PEF monitors commercially available, and these suffer from a variety of different limitations. Many current PEF meters are inaccurate, inconvenient to use, bulky, expensive, and rarely include real-time data plotting capabilities. We have created a user-friendly, accurate, and moderately inexpensive external mobile device accessory that records and stores the user's PEF, and graphs this data over time. We also have created a custom software interface to forward this stored data electron- ically. E-mail forwarding and "telemedicine" capabilities will give physicians a better way to monitor the patient's PEF over time, leading to a more convenient method for physicians to make appropriate changes in patient medication regimens. [ABSTRACT FROM PUBLISHER]

Background: Analysis of NO2−/NO3− in expired breath condensate (EBC) has been proposed as a marker of inflammation in various lung diseases. Methods: NO2− and total NO3−/NO2− concentrations were determined in EBC collected from healthy and asthmatic subjects. The NO3− was first reduced to NO2−, and total NO2− was detected by colorimetric Griess reaction. Two methods of NO3− reduction were compared. To reduce NO3−, cadmium (600 μl EBC-macromethod) and enzyme–NADPH–nitrate reductase (60 μl EBC-micromethod) were used. Results: Macromethod: Mean NO2− concentrations in EBC were 1.64±0.24 μmol/l in healthy subjects and 0.42±0.17 μmol/l in asthmatic patients. Mean total NO2−/NO3− levels were 3.64±0.43 μmol/l in healthy subjects and 3.27±0.34 μmol/l in asthmatic. Micromethod: NO2− level: 1.69±0.23 μmol/l in healthy subjects and 0.53±0.21 μmol/l in asthmatics. Total NO2−/NO3− levels: 3.56±0.37 μmol/l in healthy subjects and 3.57±1.17 μmol/l in asthmatics. Variability index was 27% and 6% for macro- and micromethod, respectively. Recovery of NO3− added to EBC was 100% for enzymatic and almost 88% for cadmium reduction. There was no correlation between total NO2−/NO3− levels determined by macro- and micromethod. Conclusions: We recommend enzymatic reduction as a better method for NO3− determination in EBC. [Copyright &y& Elsevier]

ABSTRACT: To find out the effects of coal power plant related air pollution on complete blood count and peak expiratory flow. After taking a detailed history and written consent, detailed data of 50 young persons was collected, excluding patients suffering from cardiac and respiratory problem. Peak expiratory flow meter was used to measure peak expiratory flow and complete blood count was calculated with an automated analyzer. 50% of young students recruited, had a peak expiratory flow below the normal range which suggests how coal induced pollution is affecting younger people. On observing complete blood count it was seen that most of the patients had a low Mean Corpuscular Hemoglobin Concentration(MCHC) and mean corpuscular volume(MCV), suggesting that high levels of pollutants in air are also contributing to changes in blood picture in almost 50% of our patients. [ABSTRACT FROM AUTHOR]

Background: The study aimed to investigate the correlation between peak expiratory flow (PEF) and postoperative pulmonary complications (PPCs) for lung cancer patients undergoing lobectomy., Methods: Patients who were diagnosed with resected non-small cell lung cancer (NSCLC) (n=725) were prospectively analyzed and the relationship between the preoperative PEF and PPCs was evaluated based on patients' basic characteristics and clinical data in hospital., Results: Among the 725 included patients, 144 of them were presented PPCs in 30 days after lobectomy, which were divided into PPCs group. PEF value (294.2±85.1 vs. 344.7±89.6 L/min; P<0.001) were found lower in PPCs group, compared with non-PPCs group; PEF (OR, 0.984, 95% CI: 0.980-0.987, P<0.001) was a significant independent predictor for the occurrence of PPCs; based on an receiver operating characteristic (ROC) curve, with the consideration of balancing the sensitivity and specificity, a cutoff value of 300 (L/min) (Youden index: 0.484, sensitivity: 69.4%, specificity: 79.0%) was selected and a PEF ≤300 L/min indicated a 8-fold increase in odds of having PPCs after lung surgery (OR, 8.551, 95% CI: 5.692-12.845, P<0.001). With regard to PPCs rate, patients with PEF value ≤300 L/min had high PPCs rate than those with PEF >300 L/min (45.0%, 100/222 vs. 8.7%, 44/503, P<0.001); Meanwhile, pneumonia (24.8%, 55/222 vs. 6.4%, 32/503, P<0.001), atelectasis (9.5%, 21/222 vs. 4.0%, 20/503, P=0.003) and mechanical ventilation >48 h (5.4%, 12/222 vs. 2.4%, 12/503, P=0.036) were higher in the group with PEF value ≤300 L/min., Conclusions: The presented study revealed a significant correlation between a low PEF value and PPCs in surgical lung cancer patients receiving lobectomy, indicating the potential of a low PEF as an independent risk factor for the occurrence of PPCs and a PPC-guided (PEF value ≤300 L/min) risk assessment could be meaningful for the perioperative management of lung cancer candidates waiting for surgery., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Guidelines of the Global Initiative for Asthma recommend the use of peak expiratory flow (PEF) in the assessment and management of patients with asthma. However, normal PEF values for Chinese children have not been thoroughly investigated., Methods: This was a cross-sectional study of 3,169 healthy children aged 5-14 years from research centers in five cities of China: Guangzhou, Suzhou, Chengdu, Xi'an, and Beijing. We established pediatric reference values for PEF using a mini peak flow meter. PEF values recorded by the mini peak flow meter were compared with those obtained using a spirometer., Results: Height was the biometric variable with greatest correlation to PEF for both sexes. Significant differences were noted between males and females. The regression equation for boys was calculated as PEF =4.39× height (cm) -300.48 (R 2 =0.76, P<0.001); for girls, this equation was PEF =4.13× height (cm) -278.04 (R 2 =0.72, P<0.001). PEF values for Chinese children according to age were close to those of Irish, Turkish, and British children but were lower than those of children in Greece; PEF values according to height were similar to those of Turkish and Danish children but lower than values for children in Ireland., Conclusions: We established normal PEF values and developed predictive equations using linear regression analysis for Chinese children aged 5-14 years, while Greece and Ireland references were inappropriate for Chinese children., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: This study compared the efficacy and safety of fluticasone propionate (FP) inhalation n solution with budesonide (BUD) suspension for inhalation administered via nebulizer, in Chinese adult patients with severe, persistent asthma., Methods: This was a multicenter, randomized, active-controlled, single-blind, parallel-group study, conducted at 26 clinical sites in China. Participants were randomized 1:1 to FP nebules 1 mg twice daily or BUD 2 mg twice daily via nebulizer for 12 weeks., Results: A total of 317 adult patients were randomized. The primary endpoint was mean change in morning peak expiratory flow (PEF) over weeks 1-12 from baseline, and analyzed in the ITT (n=315) and PP populations (n=283). Week 12 PEF increase from baseline was 26.7 L/min (14.1%) and 28.0 L/min (15.3%) in the ITT population, and 29.1 L/min (15.7%) and 30.1 L/min (16.2%) in the PP population, in the FP and BUD groups, respectively; all improvements were of clinical significance. Lower limits of the two-sided 95% CIs for the least squares (LS) mean treatment difference (FP minus BUD) were -12.19 L/min (ITT) and -12.95 L/min (PP), both above the pre-specified non-inferiority criteria -12.00 L/min and not clinically meaningful. There was no significant difference in the week 12 mean FEV 1 increase between the FP and BUD groups (0.237 L/16.79% vs . 0.236 L/17.73%). Lower limits of the 95% CIs for LS mean treatment difference in morning PEF change from baseline over weeks 1-4 in a post hoc analysis were -10.41 and -11.96 L/min in the ITT and PP populations respectively; both above -12.00 L/min. A review of safety data indicated that rates of AEs, SAEs, and drug-related AEs were similar between two groups., Conclusions: The 12-week treatment of FP inhalation solution administered via nebulizer is safe and effectively for treating severe, persistent asthma in Chinese patients over 12 week., Competing Interests: Conflicts of Interest: Sponsorship and provision of all investigational products for use in this study was provided by GlaxoSmithKline (China) R&D Co., Ltd. JL has received speaker’s and consultancy fees and has had study involvement with AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis. PC has received speaker’s fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis. ChL has received speaker’s and consultancy fees and has had study involvement with AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, MSD and Novartis. JK has received fees for study involvement from Boehringer Ingelheim and speaker’s and consultancy fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis. WX has received speaker’s fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis. ZC has received speaker’s and/or consultancy fees from AstraZeneca, Bayer, Eli Lilly, and GlaxoSmithKline. HT has received speaker’s fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Novartis. XD, CL and LL are employees of GlaxoSmithKline (China) R&D Co., Ltd.

Background: Asthma is a disease with marked heterogeneity in its clinical course and response to treatment. IL-13 is central to type 2 inflammation, which contributes to many key features of asthma. Lebrikizumab is an anti–IL-13 mAb previously reported to significantly improve lung function in patients with inadequately controlled asthma despite inhaled corticosteroid therapy, especially in periostin-high patients. Objective: This phase II study investigated the efficacy and safety of IL-13 blockade with different doses of lebrikizumab in asthmatic patients not receiving inhaled corticosteroids. Methods: Patients were randomized to receive 125, 250, or 500 mg of lebrikizumab or placebo subcutaneously monthly for 12 weeks with an 8-week follow-up period. The primary efficacy end point was the relative change in prebronchodilator FEV1 from baseline to week 12. Results: A total of 212 patients were randomized. The mean relative change in FEV1 was numerically higher in all lebrikizumab dose groups versus the placebo group, although the difference was neither statistically nor clinically significant. There were no meaningful differences in changes in FEV1 between the dose groups and the placebo group by the periostin subgroup. Lebrikizumab treatment was associated with a reduced risk of treatment failure at all doses versus placebo (P < .001), and results were similar by the periostin subgroup, with no apparent differences between doses of lebrikizumab. Lebrikizumab was generally well tolerated. Conclusion: Blocking IL-13, a single cytokine, in this population of asthmatic patients is insufficient to improve lung function. There is evidence that IL-13 blockade may improve disease control, as measured by prevention of protocol-defined treatment failure in these patients. [Copyright &y& Elsevier]