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Exercise-induced bronchospasm (EIB) is a problem encountered by many people, and although it can be controlled, it is often overlooked or attributed to deconditioning. Children and elite athletes tend to have an increased incidence of EIB, but this condition is also encountered in others. Unfortunately, many who must deal with this disease tend to limit the level of exercise that provokes symptoms or avoid exercise altogether. EIB can occur alone or in association with underlying asthma. This article discusses EIB, its management, and strategies for nurses when caring for patients with EIB. [ABSTRACT FROM AUTHOR]

Introduction: Survivors of severe COVID-19 face complex challenges and a high degree of pulmonary sequelae. Therefore, we aim to describe their ongoing health burden. Methods: In this single-center prospective cohort study, COVID-19 ICU survivors were invited 3 and 6 months after ICU discharge. We examined pulmonary function with pulmonary function tests (PFT) and cardiopulmonary exercise testing (CPET), and we established health-related quality of life (HRQL) and health status (HS) with the EuroQol five-dimension five-level (EQ-5D-5L), the short-form health survey 12 (SF-12), and the modified British Medical Research Council dyspnea scale (mMRC) questionnaires. Results: Out of the 53 individuals screened, 23 participated in this study. Throughout both assessment points, participants maintained PFT results within range, apart from a decline in the transfer factor of the lung for carbon monoxide (TLCO). CPET showed improved fitness but persistent ventilatory deficiencies, indicated by altered dead space ventilation (VD/VT) and elevated arterial-alveoli gradient for oxygen (AaDO2). HRQL and HS remained compromised, with both physical (PCS) and mental component summary (MCS) scores significantly lower than the standardized norm population scores. Also, there was a rise in the prevalence of issues related to mobility, pain/discomfort, and anxiety/depression, and an increase in reported dyspnea. Conclusion: These results enhance our comprehension of the complex difficulties faced by COVID-19 ICU survivors. Six months post-discharge, CPET revealed the presence of ventilatory insufficiencies. Additionally, there was a decline in HRQL and HS, notably affected by mental health concerns and an increase in the level of dyspnea. [ABSTRACT FROM AUTHOR]

Background: The US Department of Labor (DOL) does not fund diffusing capacity (DLCO) or metabolic measurements from cardiopulmonary exercise testing (CPET) for coal miners' disability evaluations. Although exercise arterial blood gas testing is covered, many miners are unable to perform maximal tests, and sampling at peak exercise can be challenging. We explored the relationship between resting DLCO, radiographic disease severity, and CPET abnormalities in former US coal miners. Methods: We analyzed data from miners evaluated between 2005 and 2015. Multivariable linear and logistic regression analyses were used to examine relationships between percent predicted (pp) forced expiratory volume in 1 s (FEV1pp), DLCOpp, VO2maxpp, A‐a oxygen gradient (A‐a)pp, dead space fraction (Vd/Vt), disabling oxygen tension (PO2), and radiographic findings of pneumoconiosis. Results: Data from 2015 male coal miners was analyzed. Mean tenure was 28 years (SD 8.6). Thirty‐twopercent had an abnormal A‐a gradient (>150 pp), 20% had elevated Vd/Vt (>0.33), and 34% a VO2max < 60 pp. DLCOpp strongly predicted a disabling PO2, with an odds ratio (OR) of 2.33 [2.09−2.60], compared to 1.18 [1.08−1.29] for FEV1. Each increase in subcategory of small opacity (simple) pneumoconiosis increased the odds of a disabling PO2 by 42% [1.29−1.57], controlling for age, body mass index, pack‐years of tobacco smoke exposure, and years of coal mine employment. Conclusions: DLCO is the best resting pulmonary function test predictor of CPET abnormalities. Radiographic severity of pneumoconiosis was also associated with CPET abnormalities. These findings support funding DLCO testing for impairment and suggest the term "small opacity" should replace "simple" pneumoconiosis to reflect significant associations with impairment. [ABSTRACT FROM AUTHOR]

Jean Z Wang,1,2 Ryan Chow,1 Sheojung Shin,1,2 Sarah Yang,1 Preshit Ambade,3 Sadia Jama,4 Razan Frances,2 Smita Pakhale1,2,4 1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 2Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; 3Department of Health Management, Economics and Policy, Augusta University, Augusta, Georgia, USA; 4Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaCorrespondence: Smita Pakhale, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Tel +1-613-737-8899 ext. 79428, Email spakhale@toh.caPurpose: Race-based correction is widely utilized in clinical practice, but may contribute to overestimation of lung function, underdiagnoses in minority groups, and exclusion of minority groups from research trials. The aim of this systematic review is to examine the usage of race-based correction in pulmonary function testing (PFT) within chronic obstructive lung disease (COPD) research and its impact on the exclusion of minority groups from research trials.Methods: We systematically searched Medline from 2010 to 2022 to identify randomized controlled trials (RCTs) that examine inhaler therapy for COPD. Article screening, critical appraisal, and data extraction were completed in duplicate by independent reviewers. Data regarding study design, inclusion criteria, demographics, and race-based correction were extracted and synthesized narratively.Results: Of the 774 screened articles, we included 21 RCTs in the review, which were multinational trials involving 70696 study participants. All studies had an inclusion criteria of an FEV1 cutoff of 50% to 80%. Racial minorities remained underrepresented in the trials, with the proportion of black participants ranging from < 1% to 4.7%. Four studies directly mentioned race-based correction, while the remainder of the studies did not provide any explicit details. After obtaining additional information by contacting authors and reviewing the citations, 15 were estimated to utilize race-based correction.Conclusion: Race-based correction may be frequently utilized in major COPD RCTs, but there remains inconsistent reporting regarding the usage of race-based correction. This may contribute to the exclusion of racialized populations from research trials as there remains significant underrepresentation of racialized populations from research.Keywords: chronic obstructive lung disease, pulmonary function testing, race-based correction, racial disparities, ethnic representation in research

Aim and Background: A noticeable gap in the literature is observed in factors associated with the occurrence of respiratory illness among people working in garment industries. This study aims to investigate whether spirometry screening is warranted for individuals employed within the garment industry. Subjects and Methods: This is an observational cross-sectional pilot study conducted in asymptomatic workers of various sectors in a garment industry using spirometry to check for the presence of small airway obstruction. Duration of work along with the nature of work was taken into consideration to see if any correlation exists with the small airway obstruction. Results: A random sample of 40 asymptomatic individuals was drawn consisting of 16 males and 24 females with 47.5% of them working for around 5–10 years. Ninety-five percentage showed no evidence of small airway obstruction and only 5% showed small airway obstruction showing that no correlation exists between the duration of work and the development of small airway obstruction in the garment industry. Conclusion: There appears to be no significant link between the duration of employment in the garment industry and the development of small airway obstruction as compared to the textile/cotton industry, yet annual screening could be integrated into routine health assessments.

No abstract available. Manuscript truncated after 150 words. History of Present Illness: A 55-year-old woman is self-referred for dizziness, fatigue, and difficulty concentrating. She was well until 2 months prior to this visit. She says she feels like she is in a “fog”. She also complains of a “tight chest”. PMH, SH, and FH: She has a past medical history of hypertension and presently takes metoprolol. She has had a tubal ligation and a breast lumpectomy in the past. There is a questionable history of a positive Cardiolite nuclear stress test. She is divorced and lives alone in a small town in Iowa. She does not smoke, drink to excess or used illicit drugs. She has worked assembling bird houses for 20 years. She attributes her problems to a workplace exposure because she seems worse when opens the large shipping containers with the birdhouse parts. Although she worked 20 years previously without problems, her symptoms began 2 months …

Pulmonary function tests are vital for detecting pathologies, especially chronic obstructive pulmonary diseases (COPD), emphasizing the importance of assessing lung parenchyma involvement in maintaining proper gas exchange. Electrical impedance tomography (EIT) offers a non-invasive alternative for respiratory function evaluation while preserving natural breathing. We propose using EIT to detect lung parenchyma conditions by analyzing tidal volume patterns (by averaging the impedance image) in the frequency domain. Twenty COPD patients underwent simultaneous evaluation with a pneumotachometer and an EIT device, performing three 30-second respiratory maneuvers. FFT spectra analysis yielded parameters, including the area under the curve and quartiles (25 %, 50 %, 75 %) of power values in six frequency regions. Correlations between these parameters and clinical test results (pulmonary diffusing capacity and arterial blood gas analysis) revealed significant associations, particularly with PCO2. Multiple linear regression analysis predicted PCO2 with an R2adj = 0.827, suggesting the potential for noninvasively detecting lung parenchyma affectation by correlating FFT bioimpedance ventilatory patterns with gas exchange performance in COPD patients. [ABSTRACT FROM AUTHOR]

Interinstitutional differences in clinical pediatric exercise laboratory (CPEL) practices may affect patient care and efficacy of multicenter research. Purpose: To describe current practices/procedures in CPELs and explore differences in CPELs employing exercise physiologists to those that do not. Methods: A 40-item survey was distributed to CPELs in North America focusing on (1) staffing; (2) exercise stress testing (EST) volumes, reporting, and interpretation; and (3) EST procedures/protocols. Results: Of the 55 responses, 89% were in the United States, 85% were children's hospitals with university affiliation, and 58% were cardiology specific. Exercise physiologists were employed in 56% of CPELs, and 78% had master's degrees or higher. Certifications were required in most CPELs (92% emergency life-support, 27% professional, and 21% clinical). Median volume was 201 to 400 ESTs per year, 80% used treadmill, and 10% used cycle ergometer as primary modalities. Ninety-three percent of CPELs offered metabolic ESTs, 87% offered pulmonary function testing, 20% used institution-specific EST protocols, and 72% offered additional services such as cardiac/pulmonary rehabilitation. CPELS staffing exercise physiologists performed higher volumes of ESTs (P =.004), were more likely to perform metabolic ESTs (P =.028), participated in more research (P <.001), and provided services in addition to ESTs (P =.001). Conclusions: Heterogeneity in CPELs staffing and operation indicates need for standardization. [ABSTRACT FROM AUTHOR]

BackgroundPrior studies have found that human immunodeficiency virus (HIV) infection is associated with impaired lung function and increased risk of chronic lung disease, but few have included large numbers of women. In this study, we investigate whether HIV infection is associated with differences in lung function in women.MethodsThis was a cross-sectional analysis of participants in the Women's Interagency HIV Study, a racially and ethnically diverse multicenter cohort of women with and without HIV. In 2018-2019, participants at 9 clinical sites were invited to perform spirometry. Single-breath diffusing capacity for carbon monoxide (DLCO) was also measured at selected sites. The primary outcomes were the post-bronchodilator forced expiratory volume in 1 second (FEV1) and DLCO. Multivariable regression modeling was used to analyze the association of HIV infection and lung function outcomes after adjustment for confounding exposures.ResultsFEV1 measurements from 1489 women (1062 with HIV, 427 without HIV) and DLCO measurements from 671 women (463 with HIV, 208 without HIV) met standards for quality and reproducibility. There was no significant difference in FEV1 between women with and without HIV. Women with HIV had lower DLCO measurements (adjusted difference, -0.73 mL/min/mm Hg; 95% confidence interval, -1.33 to -.14). Among women with HIV, lower nadir CD4 + cell counts and hepatitis C virus infection were associated with lower DLCO measurements.ConclusionsHIV was associated with impaired respiratory gas exchange in women. Among women with HIV, lower nadir CD4 + cell counts and hepatitis C infection were associated with decreased respiratory gas exchange.

Abstract Background The 2017 ATS/ERS technical standard for measuring the single-breath diffusing capacity (DLCO) proposed the “rapid-gas-analyzer” (RGA) or, equivalently, “total-breath” (TB) method for the determination of total lung capacity (TLC). In this study, we compared DLCO and TLC values estimated using the TB and conventional method, and how estimated TLC using these two methods compared to that determined by body plethysmography. Method A total of 95 people with COPD (GOLD grades 1–4) and 23 healthy subjects were studied using the EasyOne Pro (ndd Medical Technologies, Switzerland) and Master Screen Body (Vyaire Medical, Höchberg, Germany). Results On average the TB method resulted in higher values of DLCO (mean ± SD Δ = 0.469 ± 0.267; 95%CI: 0.420; 0.517 mmol*min-1*kPa-1) and TLC (Δ = 0.495 ± 0.371; 95%CI: 0.427; 0.562 L) compared with the conventional method. In healthy subjects the ratio between TB and conventional DLCO was close to one. TLC estimated using both methods was lower than that determined by plethysmography. The difference was smaller for the TB method (Δ = 1.064 ± 0.740; 95%CI: 0.929; 1.199 L) compared with the conventional method (Δ = 1.558 ± 0.940; 95%CI: 1.387; 1.739 L). TLC from body plethysmography could be estimated as a function of TB TLC and FEV1 Z-Score with an accuracy (normalized root mean square difference) of 9.1%. Conclusion The total-breath method yielded higher values of DLCO and TLC than the conventional analysis, especially in subjects with COPD. TLC from the total-breath method can also be used to estimate plethysmographic TLC with better accuracy than the conventional method. The study is registered under clinicaltrial.gov NCT04531293.

Background and Objectives: Cardiopulmonary and skeletal muscle impairment and poor physical activity are potential contributors to reduced functional capacity in cystic fibrosis (CF). The Glittre‐ADL test (TGlittre) has great potential for clinical use in adult CF adults, as it meets the need for a comprehensive assessment of physical function using tasks similar to activities of daily living. This study aimed to evaluate the performance of TGlittre in CF adults compared to the 6‐min walk test (6MWT) and, secondarily, to quantify the associations of their results with pulmonary function, muscle strength, and health‐related quality of life (HRQoL). Methods: This cross‐sectional study evaluated 34 CF adults and compared them with 34 subjects from a control group. The participants underwent the following assessments: functional capacity using TGlittre and 6MWT; spirometry; respiratory muscle strength; handgrip strength (HGS); and HRQoL using the Cystic Fibrosis Questionnaire‐Revised (CFQ‐R). Results: While CF patients showed a longer time to perform TGlittre compared to controls (134 (119–150) versus 107 (95–126) % of the predicted time p = 0.0002), no difference between these groups was observed in the 6MWT. When the second TGlittre was compared to the first TGlittre, there was a significant decrease in total time for both CF patients (p < 0.0001) and controls (p = 0.0001). TGlittre time correlated with 6MWT distance (6MWD) (rs = −0.641, p < 0.0001), HGS (rs = −0.364, p = 0.034), peripheral oxygen saturation at the end of the test (rs = −0.463, p = 0.006) and the "digestive symptoms" domain of CFQ‐R (rs = 0.376, p = 0.028). TGlittre time was shorter in patients who engaged in regular physical activity (3.10 (2.49–3.39) min versus 3.28 (2.95–3.53) min, p = 0.016). Conclusions: TGlittre is more effective than the 6MWT in detecting limitations during exercise. There is an important learning effect of TGlittre in adult CF patients. TGlittre time was correlated with 6MWD, HGS, oxygen saturation level, and the patient's level of physical activity. [ABSTRACT FROM AUTHOR]

Introduction: The treatment approach involving a combination of three cystic fibrosis (CF) transmembrane conductance regulatory (CFTR) protein modulators (elexacaftor, tezacaftor, ivacaftor) in the treatment of CF patients has provided beneficial results on FEV1. Methods: The aim of the retrospective single-center observational study was to show the impact of elexacaftor/tezacaftor/ivacaftor with special emphasis on full body plethysmography, exercise capacity and quality of life. Adult cystic fibrosis patients were evaluated after the initiation of triple CFTR therapy between July 2020 and March 2021. A two-tailed t-test for dependent samples with Bonferroni correction was used to compare outcomes between the two visits. Results: A total of 38 adult CF-patients (20 females), aged 37.2 ± 11.6 years were included in the study. The analysis shows significant improvements in FEV1 and vital capacity (VC). The Tiffeneau-Index (FEV1/VC) only showed a minor increase from 59 ± 14% to 62 ± 13%. Hyperinflation (RV) and effective specific airway resistance (sRAWeff) significantly improved such as exercise capacity (6MWD) and CFQ-R. sRAWeff showed a strong significant association with an improvement in exercise capacity (Pearson's r=0.593; 95% CI: 0.296–0.786, p<0.001) and FEV1 (Pearson's r=0.560; 95% CI: 0.292–0.746, p<0.001) while all other parameters did not show significant correlations. Conclusions: Triple CFTR modulator therapy improves not only FEV1 but also airway resistance and pulmonary hyperinflation. This is most reliably assessed by measuring sRAWeff, which is associated with exercise capacity, representing the work of breathing. Futures studies should incorporate body plethysmography assessments especially in patients with limited ability to perform spirometry or with non-reproducible spirometry results. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of idiopathic pulmonary fibrosis (IPF) typically relies on high-resolution computed tomography imaging (HRCT) or histopathology, while monitoring disease severity is done via frequent pulmonary function testing (PFT). More reliable and convenient methods of diagnosing fibrotic interstitial lung disease (ILD) type and monitoring severity would allow for early identification and enhance current therapeutic interventions. This study tested the hypothesis that a machine learning (ML) ensemble analysis of comprehensive metabolic panel (CMP) and complete blood count (CBC) data can accurately distinguish IPF from connective tissue disease ILD (CTD-ILD) and predict disease severity as seen with PFT. Methods: Outpatient data with diagnosis of IPF or CTD-ILD (n = 103 visits by 53 patients) were analyzed via ML methodology to evaluate (1) IPF vs CTD-ILD diagnosis; (2) %predicted Diffusing Capacity of Lung for Carbon Monoxide (DLCO) moderate or mild vs severe; (3) %predicted Forced Vital Capacity (FVC) moderate or mild vs severe; and (4) %predicted FVC mild vs moderate or severe. Results: ML methodology identified IPF from CTD-ILD with AUCTEST = 0.893, while PFT was classified as DLCO moderate or mild vs severe with AUCTEST = 0.749, FVC moderate or mild vs severe with AUCTEST = 0.741, and FVC mild vs moderate or severe with AUCTEST = 0.739. Key features included albumin, alanine transaminase, %lymphocytes, hemoglobin, %eosinophils, white blood cell count, %monocytes, and %neutrophils. Conclusion: Analysis of CMP and CBC data via proposed ML methodology offers the potential to distinguish IPF from CTD-ILD and predict severity on associated PFT with accuracy that meets or exceeds current clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: The treatment approach involving a combination of three cystic fibrosis (CF) transmembrane conductance regulatory (CFTR) protein modulators (elexacaftor, tezacaftor, ivacaftor) in the treatment of CF patients has provided beneficial results on FEV1. Methods: The aim of the retrospective single-center observational study was to show the impact of elexacaftor/tezacaftor/ivacaftor with special emphasis on full body plethysmography, exercise capacity and quality of life. Adult cystic fibrosis patients were evaluated after the initiation of triple CFTR therapy between July 2020 and March 2021. A two-tailed t-test for dependent samples with Bonferroni correction was used to compare outcomes between the two visits. Results: A total of 38 adult CF-patients (20 females), aged 37.2 ± 11.6 years were included in the study. The analysis shows significant improvements in FEV1 and vital capacity (VC). The Tiffeneau-Index (FEV1/VC) only showed a minor increase from 59 ± 14% to 62 ± 13%. Hyperinflation (RV) and effective specific airway resistance (sRAWeff) significantly improved such as exercise capacity (6MWD) and CFQ-R. sRAWeff showed a strong significant association with an improvement in exercise capacity (Pearson's r=0.593; 95% CI: 0.296–0.786, p<0.001) and FEV1 (Pearson's r=0.560; 95% CI: 0.292–0.746, p<0.001) while all other parameters did not show significant correlations. Conclusions: Triple CFTR modulator therapy improves not only FEV1 but also airway resistance and pulmonary hyperinflation. This is most reliably assessed by measuring sRAWeff, which is associated with exercise capacity, representing the work of breathing. Futures studies should incorporate body plethysmography assessments especially in patients with limited ability to perform spirometry or with non-reproducible spirometry results. [ABSTRACT FROM AUTHOR]

Background The 2017 ATS/ERS technical standard for measuring the single-breath difusing capacity (DLCO) proposed the “rapid-gas-analyzer” (RGA) or, equivalently, “total-breath” (TB) method for the determination of total lung capacity (TLC). In this study, we compared DLCO and TLC values estimated using the TB and conventional method, and how estimated TLC using these two methods compared to that determined by body plethysmography. Method A total of 95 people with COPD (GOLD grades 1–4) and 23 healthy subjects were studied using the EasyOne Pro (ndd Medical Technologies, Switzerland) and Master Screen Body (Vyaire Medical, Höchberg, Germany). Results On average the TB method resulted in higher values of DLCO (mean±SD Δ=0.469±0.267; 95%CI: 0.420; 0.517 mmol*min-1*kPa-1) and TLC (Δ=0.495±0.371; 95%CI: 0.427; 0.562 L) compared with the conventional method. In healthy subjects the ratio between TB and conventional DLCO was close to one. TLC estimated using both methods was lower than that determined by plethysmography. The diference was smaller for the TB method (Δ=1.064±0.740; 95%CI: 0.929; 1.199 L) compared with the conventional method (Δ=1.558±0.940; 95%CI: 1.387; 1.739 L). TLC from body plethysmography could be estimated as a function of TB TLC and FEV1 Z-Score with an accuracy (normalized root mean square diference) of 9.1%. Conclusion The total-breath method yielded higher values of DLCO and TLC than the conventional analysis, especially in subjects with COPD. TLC from the total-breath method can also be used to estimate plethysmographic TLC with better accuracy than the conventional method. The study is registered under clinicaltrial.gov NCT04531293. [ABSTRACT FROM AUTHOR]

Background: Structured light plethysmography (SLP) is a novel light-based method that captures chest wall movements to evaluate tidal breathing. Methods: Thirty-two children who underwent lung surgery were enrolled. Their clinical history was collected along with spirometry and SLP. Results: Median age of surgery was 9 months (interquartile range 4–30). Most frequent diagnosis was congenital pulmonary airway malformation (14/32), then pulmonary sequestration (9/32), tumor (5/32), and bronchogenic cyst (4/32). The most frequent surgical approach was lobectomy (59%), segmentectomy (38%), and complete resection (3%). More than 80% had surgery when younger than 3 years of age. Eight patients had short-term complications (pleural effusion was the most frequent), while long-term effects were reported in 15 patients (19% recurrent cough, 13% thoracic deformities, 13% airway infections, 9% wheezing, 6% reduced exercise tolerance, and 3% columnar deformities). Spirometry was normal in 9/22 patients. Nine patients had a restrictive pattern, while 4 showed a mild bronco-reactivity. Ten patients did not perform spirometry because of young age. SLP revealed the presence of obstructive pattern in 10% of patients (IE50 > 1.88) and showed a significant difference between the two hemithorax in 29% of patients. Discussion: SLP may be a new method to evaluate lung function, without collaboration and radiation exposure, in children who underwent lung resection, also in preschool age. [ABSTRACT FROM AUTHOR]

Multiple-breath washout (MBW) is an established technique to assess functional residual capacity (FRC) and ventilation inhomogeneity in the lung. Indirect calculation of nitrogen concentration requires accurate measurement of gas concentrations. To investigate the accuracy of the CO2 concentration and molar mass (MM) values used for the indirect calculation of nitrogen concentration in a commercial MBW device [EasyOne Pro LAB (EOPL), ndd Medizintechnik AG, Switzerland] and its impact on outcomes. We used highprecision gas mixtures to evaluate CO2 and MM sensor output in vivo and in vitro. We developed updated algorithms to correct observed errors and assessed the impact on MBW outcomes and FRC measurement accuracy compared with body plethysmography. The respiratory exchange ratio (RER)-based adjustment of the measured CO2 signal used in the EOPL led to an overestimated CO2 signal (range -0.1% to 1.0%). In addition, an uncorrected dependence on humidity was identified. These combined effects resulted in an overestimation of expired nitrogen concentrations (range -0.7% to 2.6%), and consequently MBW outcomes. Corrected algorithms reduced the mean (SD) cumulative expired volume by 15.8% (9.7%), FRC by 6.6% (3.0%), and lung clearance index by 9.9% (7.6%). Differences in FRC between the EOPL and body plethysmography further increased. Inadequate signal correction causes RER- and humidity-dependent expired nitrogen concentration errors and overestimation of test outcomes. Updated algorithms reduce average signal error, however, RER values far from the population average still cause measurement errors. Despite improved signal accuracy, the updated algorithm increased the difference in FRC between the EOPL and body plethysmography. [ABSTRACT FROM AUTHOR]

BackgroundMultiple-breath washout (MBW) is a sensitive method for assessing lung volumes and ventilation inhomogeneity in infants, but remains prone to artefacts (e.g., sighs). There is a lack of tools for systematic retrospective analysis of existing datasets, and unlike N2-MBW in older children, there are few specific quality control (QC) criteria for artefacts in infant SF6-MBW.AimWe aimed to develop a computer-based tool for systematic evaluation of visual QC criteria of SF6-MBW measurements and to investigate interrater agreement and effects on MBW outcomes among three independent examiners.MethodsWe developed a software package for visualization of raw Spiroware (Eco Medics AG, Switzerland) and signal processed WBreath (ndd Medizintechnik AG, Switzerland) SF6-MBW signal traces. Interrater agreement among three independent examiners (two experienced, one novice) who systematically reviewed 400 MBW trials for visual artefacts and the decision to accept/reject the washin and washout were assessed.ResultsOur tool visualizes MBW signals and provides the user with (i) display options (e.g., zoom), (ii) options for a systematic QC assessment [e.g., decision to accept or reject, identification of artefacts (leak, sigh, irregular breathing pattern, breath hold), and comments], and (iii) additional information (e.g., automatic identification of sighs). Reviewer agreement was good using pre-defined QC criteria (κ 0.637–0.725). Differences in the decision to accept/reject had no substantial effect on MBW outcomes.ConclusionOur visual quality control tool supports a systematic retrospective analysis of existing data sets. Based on predefined QC criteria, even inexperienced users can achieve comparable MBW results.

No abstract available. Manuscript truncated after 150 words. A 64-year-old man was referred to our pulmonary clinic for evaluation of his pulmonary status. He had a 7-year history of rheumatoid arthritis and was treated initially with steroids and subsequently maintained on methotrexate and monthly adalimumab injections monthly. The patient reported that his rheumatoid arthritis symptoms were controlled. He experienced no joint pain or morning stiffness at the time of evaluation. From a pulmonary perspective, he denied respiratory symptoms such as exertional shortness of breath, cough, wheezing, or chest tightness. He reported no limitations in physical activities. The patient has an occupational history of 45-years as a welder, with exposure to dust, metal fumes, benzene, and sulfur gas. The patient also has a 15 pack-year smoking history but quit 35 years ago. A high-resolution chest CT (Figure 1) ordered by his rheumatologist showed normal lung parenchyma. The first pulmonary function test (PFT), conducted on the initial pulmonary clinic visit …

Abstract 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.

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]

This article discusses a study that used electrical impedance tomography (EIT) to examine the distribution of regional lung function in healthy individuals. The study found differences in ventilation distribution between different examination planes during quiet breathing and slow full expiration, but not during forced ventilation. The study highlights the importance of considering thoracoabdominal mechanics when studying regional lung function. Additionally, the document provides a compilation of references to various scientific articles and studies related to EIT and its applications in assessing lung function and respiratory disorders. These references cover a range of topics and provide a comprehensive overview of current research in the field of EIT. [Extracted from the article]

Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non-small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98-0.99]; P,0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98-0.98]; P,0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98-0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98-0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS). Results Sixteen LCS patients were subjected to resting lung function (spirometry and respiratory oscillometry-RO) and cardiopulmonary performance to exercise (Spiropalm®-equipped six-minute walk test-6MWT and cardiopulmonary exercise test-CPX). At rest, spirometry showed a normal, restrictive and obstructive pattern in 87.5%, 6.25% and 6.25% of participants, respectively. At rest, RO showed increased resonance frequency, increased integrated low-frequency reactance and increased difference between resistance at 4–20 Hz (R4-R20) in 43.7%, 50%, and 31.2% of participants, respectively. The median of six-minute walking distance (DTC6) was 434 (386–478) m, which corresponds to a value of 83% (78–97%) of predicted. Dynamic hyperinflation (DH) and reduced breathing reserve (BR) were detected in 62.5% and 12.5% of participants, respectively. At CPX, the median peak oxygen uptake (VO2peak) was 19 (14–37) ml/kg/min. There was a significant correlation of 6MWD with both R4-R20 (rs=-0.499, P = 0.039) and VO2peak (rs=0.628, P = 0.009). Our results indicate that DH and low BR are contributors to poor exercise performance, which is associated with peripheral airway disease. These are promising results considering that they were achieved with simple, portable ventilatory and metabolic systems.

No abstract available. Article truncated after 150 words. History of Present Illness A 78-year-old man presented to the emergency Department on April 7 for shortness of breath and weakness over the last 2 weeks. He was in good health prior to an outside hospitalization March 29-April 3 for pneumonia and possible a non-ST-elevation myocardial infarction (elevated troponins). He had a bronchoscopy during his recent outside hospitalization without specific pathogen identified but treated with antibiotics, discharged on levofloxacin. Since his hospital discharge 4 days previously he feels weaker and increasingly short of breath. SOB even walking around in his home. He denies fever or a productive cough. Past Medical History, Family History and Social History Atrial fibrillation, s/p ablation. On Eliquis. Prior renal cell carcinoma, s/p resection, no recurrence DM Type 2 GERD OSA Essential tremor Never smoked Medications Apixaban Aspirin Atorvastatin Flecanide Insulin Levofloxacin Lisinopril Pantoprazole Tamsulosin Physical Examination General: The patient looks comfortable and is in no …

This study aimed at evaluating the 7-year outcomes of 118 very preterm newborns (VPNs, gestational age = 26 ± 1.4 w) involved in a randomized controlled trial. They presented neonatal respiratory distress (RDS), requiring ventilation for 14 ± 2 days post-natal age (PNA). A repeated instillation of 200 mg/kg poractant alfa (SURF) did not improve early bronchopulmonary dysplasia, but the SURF infants needed less re-hospitalization than the controls for respiratory problems at 1- and 2-year PNA. There was no growth difference at 7.1 ± 0.3 years between 41 SURF infants and 36 controls (80% of the eligible children), and 7.9% SURF infants vs. 28.6% controls presented asthma (p = 0.021). The children underwent cognitive assessment (WISC IV) and pulmonary function testing (PFT), measuring their spirometry, lung volume, and airway resistance. The spirometry measures showed differences (p < 0.05) between the SURF infants and the controls (mean ± standard deviation (median z-score)) for FEV1 (L/s) (1.188 ± 0.690(−0.803) vs. 1.080 ± 0.243 (−1.446)); FEV1 after betamimetics (1.244 ± 0.183(−0.525) vs. 1.091 ± 0.20(−1.342)); FVC (L) (1.402 ± 0.217 (−0.406) vs. 1.265 ± 0.267 (−1.141)), and FVC after betamimetics (1.452 ± 0.237 (−0.241) vs. 1.279 ± 0.264 (−1.020)). PFT showed no differences in the volumes or airway resistance. The global IQ median (interquartile range) was 89 (82:99) vs. 89 (76:98), with 61% of the children >85 in both groups. Repeated surfactant treatment in VPNs presenting severe RDS led to the attenuation of early lung injuries, with an impact on long-term pulmonary sequelae, without differences in neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Exercise capacity, daily physical activity, and psychological profile are crucial aspects in the management of asthmatic patients. Whether these features are expressed in a different way in mild-moderate (MMA) and severe asthma (SA) is unknown. In this observational cross-sectional study, patients matching the American Thoracic Society/European Respiratory Society (ATS/ERS) definition for SA underwent incremental cardiopulmonary exercise testing (CPET), full lung function testing, and an evaluation of daily step count and physical activity. Questionnaires on quality of life, general fatigue, and presence of anxiety and depression traits (Hospital Anxiety and Depression Scale - HADS) were administered. Patients were compared with a cohort of age- and gender-matched MMA patients. We enrolled 16 SA, 17 MMA patients, and 16 healthy subjects. Compared to MMA, SA subjects showed a median (interquartile range) reduced peak oxygen consumption during CPET (20.4 (17.2-23.3) vs. 25.6 (18.5-30.3) ml/min/kg; p = 0.019), a reduced resting lung function (FEV1% of predicted 77 (67-84) vs. 96 (84-100); p < 0.001) and a pronounced anxiety trait at HADS (9.5 (3-11.7) vs. 4.0 (2.0-7.5); p = 0.023). In addition, SA patients showed a significantly higher reduction in inspiratory capacity from rest to peak (310 (160-520) vs. 110 (-65-325) ml; p = 0.031). We found no significant differences in mean daily step count or quality of life. Compared to MMA, SA patients present a reduced exercise capacity and a more pronounced anxiety trait, but not worse daily physical activity or quality of life. These aspects should be considered in the clinical management and research development of SA. [ABSTRACT FROM AUTHOR]

Calls have been made to discontinue the routine use of race and ethnicity in medicine. Specific to respiratory medicine, the use of race- and ethnicity-specific reference equations for the interpretation of pulmonary function test (PFT) results has been questioned. Three key questions were addressed: (1) What is the current evidence supporting the use of race- and ethnicity-specific reference equations for the interpretation of PFTs? (2) What are the potential clinical implications of the use or nonuse of race and ethnicity in interpreting PFT results? and (3) What research gaps and questions must be addressed and answered to understand better the effect of race and ethnicity on PFT results interpretation and potential clinical and occupational health implications? A joint multisociety (American College of Chest Physicians, American Association for Respiratory Care, American Thoracic Society, and Canadian Thoracic Society) expert panel was formed to undertake a comprehensive evidence review and to develop a statement with recommendations to address the research questions. Several assumptions and gaps, both in the published literature and in our evolving understanding of lung health, were identified. It seems that many past perceptions and practices regarding the effect of race and ethnicity on PFT results interpretation are based on limited scientific evidence and measures that lack reliability. A need exists for more and better research that will inform our field about these many uncertainties and will serve as a foundation for future recommendations in this area. The identified shortcomings should not be discounted or dismissed because they may enable flawed conclusions, unintended consequences, or both. Addressing the identified research gaps and needs would allow a better—a more informed—understanding of the effects of race and ethnicity on PFT results interpretation. [ABSTRACT FROM AUTHOR]

Respiratory failure is a significant concern in neuromuscular diseases (NMDs). This CHEST guideline examines the literature on the respiratory management of patients with NMD to provide evidence-based recommendations. An expert panel conducted a systematic review addressing the respiratory management of NMD and applied the Grading of Recommendations, Assessment, Development, and Evaluations approach for assessing the certainty of the evidence and formulating and grading recommendations. A modified Delphi technique was used to reach a consensus on the recommendations. Based on 128 studies, the panel generated 15 graded recommendations, one good practice statement, and one consensus-based statement. Evidence of best practices for respiratory management in NMD is limited and is based primarily on observational data in amyotrophic lateral sclerosis. The panel found that pulmonary function testing every 6 months may be beneficial and may be used to initiate noninvasive ventilation (NIV) when clinically indicated. An individualized approach to NIV settings may benefit patients with chronic respiratory failure and sleep-disordered breathing related to NMD. When resources allow, polysomnography or overnight oximetry can help to guide the initiation of NIV. The panel provided guidelines for mouthpiece ventilation, transition to home mechanical ventilation, salivary secretion management, and airway clearance therapies. The guideline panel emphasizes that NMD pathologic characteristics represent a diverse group of disorders with differing rates of decline in lung function. The clinician's role is to add evaluation at the bedside to shared decision-making with patients and families, including respect for patient preferences and treatment goals, considerations of quality of life, and appropriate use of available resources in decision-making. [ABSTRACT FROM AUTHOR]

Caspar Schiffers,1 Emiel FM Wouters,1,2 Robab Breyer-Kohansal,1,3 Roland Buhl,4 Wolfgang Pohl,5 Charles G Irvin,6 Marie-Kathrin Breyer,1,7 Sylvia Hartl1,7,8 1Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; 2NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; 3Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria; 4Pulmonology Department, Mainz University Hospital, Mainz, Germany; 5Karl Landsteiner Gesellschaft, Institute for Clinical and Experimental Pneumology, Vienna, Austria; 6Pulmonary and Critical Care, Larner College of Medicine, University of Vermont, Burlington, VT, USA; 7Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria; 8Sigmund Freud University, Faculty for Medicine, Vienna, AustriaCorrespondence: Caspar Schiffers, Ludwig Boltzmann Institute for Lung Health, Vienna, 1140, Austria, Email caspar.schiffers@lunghealth.lbg.ac.atBackground: Asthma is a chronic heterogeneous respiratory disease involving differential pathophysiological pathways and consequently distinct asthma phenotypes.Objective and Methods: In the LEAD Study, a general population cohort (n=11.423) in Vienna ranging from 6– 82 years of age, we addressed the prevalence of asthma and explored inflammatory asthma phenotypes that included allergic and non-allergic asthma, and within these phenotypes, an eosinophilic (eosinophils ≥ 300 cells/μL, or ≥ 150 cells/μL in the presence of ICS medication) or non-eosinophilic (eosinophils < 300 cells/μL, or < 150 cells/μL in the presence of ICS) phenotype. In addition, we compared various factors related to biomarkers, body composition, lung function, and symptoms in control subjects versus subjects with current asthma (current doctor’s diagnosis of asthma).Results: An overall prevalence of 4.6% was observed for current asthma. Furthermore, an age-dependent shift from allergic to non-allergic asthma was found. The non-eosinophilic phenotype was more prominent. Obesity was a prevalent condition, and body composition including visceral adipose tissue (VAT), is affected in current asthma versus controls.Conclusion: This broad-aged and large general population cohort identified differential patterns of inflammatory asthma phenotypes that were age-dependent. The presence of eosinophilia was associated with worse asthma control, increased asthma medication, increased VAT, and lower lung function, the opposite was found for the presence of an allergic asthma.Keywords: asthma, prevalence, phenotyping, pulmonary function testing, spirometry, general population, body composition

A workshop Electronic Health Records and Pulmonary Function Data: Developing an Interoperability Roadmap was held at the American Thoracic Society 2019 International Conference. Interoperability is defined as is the ability of different information-technology systems and software applications to directly communicate, exchange data, and use the information that has been exchanged. At present, pulmonary function test (PFT) equipment is not required to be interoperable with other clinical data systems, including electronic health records (EHRs). For this workshop, we assembled a diverse group of experts and stakeholders, including representatives from patient-advocacy groups, adult and pediatric general and pulmonary medicine, informatics, government and healthcare organizations, pulmonary function laboratories, and EHR and PFT equipment and software companies. The participants were tasked with two overarching Aobjectives: 1) identifying the key obstacles to achieving interoperability of PFT systems and the EHR and 2) recommending solutions to the identified obstacles. Successful interoperability of PFT data with the EHR impacts the full scope of individual patient health and clinical care, population health, and research. The existing EHR-PFT device platforms lack sufficient data standardization to promote interoperability. Cost is a major obstacle to PFT-EHR interoperability, and incentives are insufficient to justify the needed investment. The current vendor-EHR system lacks sufficient flexibility, thereby impeding interoperability. To advance the goal of achieving interoperability, next steps include identifying and standardizing priority PFT data elements. To increase the motivation of stakeholders to invest in this effort, it is necessary to demonstrate the benefits of PFT interoperability across patient care and population health.

Background and Objectives: Although peak oxygen uptake (VO2peak) is one of the most important measures in clinical practice, the high cost and time consumption have led to the search for simpler devices and the development of the estimating cardiopulmonary fitness (eCPF) equation. Since the lungs are one of the sites most affected by rheumatoid arthritis (RA), this study aimed to create a predictive equation for VO2peak obtained by simple sampling technology in women with RA‐associated interstitial lung disease (RA‐ILD). Methods: This cross‐sectional study evaluated 47 women with RA‐ILD. The participants underwent the following evaluations: computed tomography (CT); evaluation of disease activity through the Clinical Disease Activity Index (CDAI); measurement of physical function using the Health Assessment Questionnaire disability index (HAQ‐DI); pulmonary function testing, including spirometry, diffusing capacity for carbon monoxide (DlCO), nitrogen single‐breath washout (N2SBW) test, and impulse oscillometry; and cardiopulmonary exercise testing (CPET) using FitMate™. Results: VO2peak was correlated with age (r = −0.550, p < 0.0001), rheumatoid factor (r = −0.443, p = 0.002), anti‐cyclic citrullinated peptide antibodies (r = −0.410, p = 0.004), CDAI (r = −0.462, p = 0.001), HAD‐DI (r = −0.486, p = 0.0005), forced vital capacity (r = 0.491, p = 0.0004), DlCO (r = 0.621, p < 0.0001), phase III slope of N2SBW (r = −0.647, p < 0.0001), resonance frequency (Fres, r = −0.717, p < 0.0001), integrated low‐frequency reactance (r = −0.535, p = 0.0001), and the inhomogeneity of respiratory system resistance between 4 and 20 Hz (r = −0.631, p < 0.0001). In the CT examination, patients with extensive ILD had significantly lower VO2peak than patients with limited ILD (p < 0.0001). In the stepwise forward regression analysis, Fres, DlCO and age explained 61% of the VO2peak variability. Conclusions: As assessed by CPET, women with RA‐ILD show reduced cardiopulmonary fitness, which can be explained at least in part by the presence of small airway disease, deterioration of pulmonary gas exchange, and advanced age. These associations of pulmonary variables with eCPF may be clinically important and support the use of the eCPF equation to improve patient outcomes. [ABSTRACT FROM AUTHOR]

• We broadly assessed secondhand smoke exposure (SHSe) and pediatric CF lung function. • Pooled effect of SHSe on lung function was estimated with Bayesian meta-analysis. • Despite heterogeneity between studies, SHSe associated with a drop in lung function. Secondhand smoke exposure, an important environmental health factor in cystic fibrosis (CF), remains uniquely challenging to children with CF as they strive to maintain pulmonary function during early stages of growth and throughout adolescence. Despite various epidemiologic studies among CF populations, little has been done to coalesce estimates of the association between secondhand smoke exposure and lung function decline. A systematic review was performed using PRISMA guidelines. A Bayesian random-effects model was employed to estimate the association between secondhand smoke exposure and change in lung function (measured as FEV 1 % predicted). Quantitative synthesis of study estimates indicated that second-hand smoke exposure corresponded to a significant drop in FEV 1 (estimated decrease: -5.11% predicted; 95% CI: -7.20, -3.47). The estimate of between-study heterogeneity was 1.32% predicted (95% CI: 0.05, 4.26). There was moderate heterogeneity between the 6 analyzed studies that met review criteria (degree of heterogeneity: I 2 =61.9% [95% CI: 7.3–84.4%] and p = 0.022 from the frequentist method.) Our results quantify the impact at the pediatric population level and corroborate the assertion that secondhand smoke exposure negatively affects pulmonary function in children with CF. Findings highlight challenges and opportunities for future environmental health interventions in pediatric CF care. [ABSTRACT FROM AUTHOR]

Rationale: In 2017, an American Thoracic Society/European Respiratory Society Task Force report recommended further research on the effects that body mass index (BMI) has on diffusing capacity of the lung for carbon monoxide (DLCO), the transfer coefficient (KCO), and the alveolar volume (VA). Objectives: Our goals were to 1) quantify the magnitude and direction of change to measured and predicted DLCO values as BMI increases in patients free of cardiopulmonary disease and 2) identify how BMI and obesity-related changes differ by reference set. Methods: Using data from a prospective cohort study of service members free of cardiopulmonary disease, we modeled the effect that BMI has on measured values of DLCO, KCO, and VA, after adjusting for age, sex, hemoglobin (Hgb), and height. We then referenced DLCO, KCO, and VA to normal values using four different reference equations. Results: There were 380 patients with data available for analysis, and 130 had a BMI>30 kg/m² (87.7% class I obesity). After controlling for age, sex, Hgb, and height, increased BMI was significantly associated with KCO (b = 0.09, P, 0.01) and VA (b =20.15, P, 0.01) but not DLCO. After adjustment for Hgb, for every 5-kg/m² increase in BMI, themean increase in percent predicted (PPD) values ranged from4.2% to 6.5% and from 5.0% to 7.5% for DLCO and KCO, respectively; and themean decrease in VA PPD was 3.2-4.0%. In the presence of obesity (BMI>30 kg/m²), the prevalence of DLCO and KCO abnormalities dropped by 4.1-12.1% and 0.4-16.3%, respectively, across equations, whereas VA abnormalities increased from 7.7% to 9.9%. Eliminating 163 patients with abnormal trans-thoracic echocardiogram (TEE), high-resolution computed tomographic (HRCT) scan, or Hgb altered themagnitude of relationships, but significance was preserved. Conclusions: In an otherwise healthy population with predominantly class I obesity and normal TTE, HRCT scan, and Hgb, we found that KCO and VA were more affected by BMI than DLCO. Increases in PPD values varied across equations and were modest but significant and could change clinical decision making by reducing sensitivity for detecting gas-exchange abnormalities. BMI and obesity had the smallest effect on Global Lung Function Initiative PPD values. [ABSTRACT FROM AUTHOR]

Objective: To investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS). Results: Sixteen LCS patients were subjected to resting lung function (spirometry and respiratory oscillometry-RO) and cardiopulmonary performance to exercise (Spiropalm®-equipped six-minute walk test-6MWT and cardiopulmonary exercise test-CPX). At rest, spirometry showed a normal, restrictive and obstructive pattern in 87.5%, 6.25% and 6.25% of participants, respectively. At rest, RO showed increased resonance frequency, increased integrated low-frequency reactance and increased difference between resistance at 4–20 Hz (R4-R20) in 43.7%, 50%, and 31.2% of participants, respectively. The median of six-minute walking distance (DTC6) was 434 (386–478) m, which corresponds to a value of 83% (78–97%) of predicted. Dynamic hyperinflation (DH) and reduced breathing reserve (BR) were detected in 62.5% and 12.5% of participants, respectively. At CPX, the median peak oxygen uptake (VO2peak) was 19 (14–37) ml/kg/min. There was a significant correlation of 6MWD with both R4-R20 (rs=-0.499, P = 0.039) and VO2peak (rs=0.628, P = 0.009). Our results indicate that DH and low BR are contributors to poor exercise performance, which is associated with peripheral airway disease. These are promising results considering that they were achieved with simple, portable ventilatory and metabolic systems. [ABSTRACT FROM AUTHOR]

Spirometry is necessary to diagnose chronic obstructive pulmonary disease (COPD), yet a large proportion of patients are diagnosed and treated without having received testing. This study explored whether the effects of interventions using the electronic health record (EHR) to target patients diagnosed with COPD without confirmatory spirometry impacted the incidence rates of spirometry referrals and completions. This retrospective before and after study assessed the impact of provider-facing clinical decision support that identified patients who had a diagnosis of COPD but had not received spirometry. Spirometry referrals, completions, and results were ascertained 1.5 years prior to and 1.5 years after the interventions were initiated. Inhaler prescriptions by class were also tallied. There were 10,949 unique patients with a diagnosis of COPD who were eligible for inclusion. 4,895 patients (44.7%) were excluded because they had completed spirometry prior to the cohort start dates. The pre-intervention cohort consisted of 2,622 patients, while the post-intervention cohort had 3,392. Spirometry referral rates pre-intervention were 20.2% compared to 31.6% post-intervention (p

History of Present Illness A 40-year-old man was referred for management of respiratory symptoms of cough, sputum production and shortness of breath. He has a history of respiratory infections that began in early childhood. Sputum cultures were positive for Pseudomonas. He is currently using oxygen at night and occasionally during the day. Past Medical History, Family History and Social History • Childhood diagnosis of asthma. • Multiple colds and pneumonias in the past. • No family history of a similar problem. • He has never smoked. • Denies any occupational exposure. Physical Examination • Vital Signs: O2 Sat 88% on RA • Chest: diminished breath sounds, no wheezes • Heart: regular rate and rhythm without murmur • Extremities: mild clubbing present, no edema Pulmonary Function Testing Pulmonary function testing (PFTs) was performed with results as below (Figure 1). Thoracic CT Scan A thoracic CT was performed (Figure 2). Which of the following is/are true? 1. PFTs show severe obstructive …

Significance: Pulmonary involvement in childhood-onset systemic lupus erythematosus (cSLE), contributes to significant morbidity and mortality. Manifestations include chronic interstitial pneumonitis, pneumonia, pleuritis, alveolar hemorrhage, and shrinking lung syndrome. However, many patients can be asymptomatic from a respiratory standpoint and still have pulmonary function test (PFT) abnormalities. Our aim is to describe PFT abnormalities in patients with cSLE. Methods: We completed a retrospective review of 42 patients with cSLE followed at our center. These patients were at least 6 years old (so they could complete PFTs). We collected data from July 2015 to July 2020. Results: Out of the 42 patients, 10 (23.8%) had abnormal PFTs. These 10 patients had a mean age at diagnosis of 13 ± 2.9 years. Nine were female. One-fifth (20%) self-identified as Hispanic, 20% as Asian, 10% as Black or African American, and the remaining 50% as “Other.” Of the 10, 3 had restrictive disease only, 3 with diffusion impairment only, and 4 with both restrictive lung disease and diffusion impairment. Patients with restrictive patterns had a mean total lung capacity (TLC) of 72.5 ± 5.8 throughout the study period. The average diffusing capacity for carbon monoxide corrected for hemoglobin (DsbHb) among patients with diffusion limitation during the study period was 64.8 ± 8.3. Conclusions: The most common PFT abnormalities seen in patients with cSLE are alterations in diffusing capacity as well as restrictive lung disease. [ABSTRACT FROM AUTHOR]

Background: Air conditioners (AC) have become indispensable in the contemporary World. However, their effects on respiratory health need to be explored further using dynamic and static lung functions. Objectives: The objectives were: 1. To evaluate and compare dynamic parameters (FEV1, FVC, FEV1/FVC, PEFR, and FEF25-75) in AC users and non-users of Bengaluru. 2. To evaluate and compare airway resistance and specific airway conductance as additional parameters. Materials and Methods: After applying ATS-ERS criteria for lung disorders, 30 AC users and non-users of Bengaluru, aged 18-40 yrs were assessed using body plethysmography. A significant association of restrictive pattern was seen in AC users (9 AC users out of 60 participants, Chi-square 8.37, P = 0.0038) having an Odd's ratio of 26.95 (CI: 1.4876 to 488.3558, Z = 2.229, P = 0.0258). Airway resistance (Raw) was comparable in both groups further indicating a non-obstructive pathology. Conclusion: AC users had a significant decrease in flow rates (PEFR and FEF25-75) as well as an association with restrictive lung disorder suggesting the need for proper ventilation and hygiene. It is crucial to develop policies to maintain indoor air quality. [ABSTRACT FROM AUTHOR]

Background: Post-COVID-19 Interstitial Lung Disease (PC-ILD) is characterized by fibrotic-like signs at high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) abnormalities after SARS-CoV-2 infection. It is still not clear how frequent these tests should be performed to rule out long-term consequences of COVID-19 pneumonia. Objectives: The aims of our study were to evaluate the incidence and risk factors of PC-ILD and possibly to propose a long-term follow-up program. Method: One-hundred patients, hospitalized in our ward for moderate to critical COVID-19, underwent two follow-up visits at three and 15 months in which PFTs and HRCT were performed. Results: At the 15-month follow-up, 8% of patients showed residual radiological and functional signs consistent with PC-ILD. All but one of these patients had already demonstrated PFTs and HRCT alterations at first follow-up visit, and the last 1 patient showed worsening of lung function during follow-up. These findings highlight the negative predictive value of PFTs at 3-month follow-up for the development of PC-ILD. Aging, severity of COVID-19, and degree of pulmonary involvement during acute infection proved to be significant risk factors for developing PC-ILD. Conclusions: Our study highlights the importance of PFTs in the long-term follow-up of patients affected by moderate to critical COVID-19 pneumonia. Further studies are needed to confirm our hypothesis that HRCT should be performed only in patients with PFTs abnormalities. [ABSTRACT FROM AUTHOR]

BackgroundHispanic subjects with cystic fibrosis (CF) have increased morbidity and mortality than non-Hispanic white subjects. The ethnic disparity in mortality varies by region. Factors influencing pulmonary function vary by both ethnicity and region.ObjectiveTo determine if the ethnic difference in pulmonary function varies by region.MethodsThis retrospective cohort study compared differences in longitudinal pulmonary function (percent-predicted forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1 ], forced expiratory flow at 25% to 75% [FEF25-75 ], FEV1 /FVC, and FEV1 decline) between Hispanic and non-Hispanic white subjects with CF by Census region of the United States (West, South, Midwest, and Northeast). Subjects were of ages 6 to 25 years and in the CF Foundation Patient Registry from 2008 to 2013. We used linear mixed effects models with subject-specific slopes and intercepts, adjusting for 14 demographic and clinical variables.ResultsOf 14 932 subjects, 1433 (9.6%) were Hispanic and 13 499 (90.4%) were non-Hispanic white. Hispanic subjects' FEV1 was 9.0% (8.3%-9.8%) lower than non-Hispanic white subjects in the West, while Hispanic subjects' FEV1 was only 4.0% (3.0%-5.0%) lower in the Midwest, 4.4% (3.1%-5.7%) lower in the Northeast, and 4.4% (3.2%-5.5%) lower in the South. Similarly, FVC and FEF25-75 were lower among Hispanic subjects compared to non-Hispanic white subjects in all US regions, with the biggest differences in the West. Only in the West was FEV1 /FVC significantly lower in Hispanic subjects (-0.019; -0.022 to -0.015). FEV1 decline was not significantly different between ethnicities in any region.ConclusionsIn CF, Hispanic subjects have lower pulmonary function than non-Hispanic white subjects in all geographic regions with the largest difference in occurring in the West.