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Objective: The aim of the study was to explore the influence of the measurement plane on regional lung function assessed via electrical impedance tomography (EIT). Methods: The forced vital capacity (FVC) maneuver was prospectively performed in 30 healthy male volunteers. Simultaneously, EIT measurements were conducted at the 3rd, 4th, and 5th intercostal spaces (ICS). The EIT-based spirometry parameters are calculated in a similar manner to their original definitions. The spatial and temporal distributions of the corresponding functional images were assessed and compared among the measurement planes. Results: All subjects but one were able to perform the FVC maneuver according to the guidelines. Significant differences were found in 67% (6 out of 9) of the EIT-based parameters assessing the spatial and temporal distribution. The fEIT images were most homogeneous at ICS 4 compared to the other two measurement planes, except for the time required for 75% of FVC. The fEIT image FVCEIT distributed toward dorsal regions when the measurement planes moved from ICS 3 to ICS 5, whereas the identified lung areas became smaller. Conclusion: The spatial and temporal distribution of the regional lung function measured via EIT was influenced by the measurement planes. We recommend adhering to the same measurement plane for before–after comparison. ICS 4 was recommended for the sitting subjects performing lung function testing. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to explore the influence of the measurement plane on regional lung function assessed via electrical impedance tomography (EIT). Methods: The forced vital capacity (FVC) maneuver was prospectively performed in 30 healthy male volunteers. Simultaneously, EIT measurements were conducted at the 3rd, 4th, and 5th intercostal spaces (ICS). The EIT-based spirometry parameters are calculated in a similar manner to their original definitions. The spatial and temporal distributions of the corresponding functional images were assessed and compared among the measurement planes. Results: All subjects but one were able to perform the FVC maneuver according to the guidelines. Significant differences were found in 67% (6 out of 9) of the EITbased parameters assessing the spatial and temporal distribution. The fEIT images were most homogeneous at ICS 4 compared to the other two measurement planes, except for the time required for 75% of FVC. The fEIT image FVCEIT distributed toward dorsal regions when the measurement planes moved from ICS 3 to ICS 5, whereas the identified lung areas became smaller. Conclusion: The spatial and temporal distribution of the regional lung function measured via EIT was influenced by the measurement planes. We recommend adhering to the same measurement plane for before-after comparison. ICS 4 was recommended for the sitting subjects performing lung function testing. [ABSTRACT FROM AUTHOR]

• This study provides evidence of a possible positive effect of RNS60 on ALS outcomes. • Median survival was 6 months longer in people randomized to RNS60 compared to placebo. • Association of rate of respiratory decline with survival was evaluated. • RNS60 group experienced slower rates of respiratory decline. • The rate of respiratory decline was inversely associated with long-term survival. Positive effects of RNS60 on respiratory and bulbar function were observed in a phase 2 randomized, placebo-controlled trial in people with amyotrophic lateral sclerosis (ALS). Objective: to investigate the long-term survival of trial participants and its association with respiratory status and biomarkers of neurodegeneration and inflammation. A randomized, double blind, phase 2 clinical trial was conducted. Trial participants were enrolled at 22 Italian Expert ALS Centres from May 2017 to January 2020. Vital status of all participants was ascertained thirty-three months after the trial's last patient last visit (LPLV). Participants were patients with Amyotrophic Lateral Sclerosis, classified as slow or fast progressors based on forced vital capacity (FVC) slope during trial treatment. Demographic, clinical, and biomarker levels and their association with survival were also evaluated. Mean duration of follow-up was 2.8 years. Long-term median survival was six months longer in the RNS60 group (p = 0.0519). Baseline FVC, and rates of FVC decline during the first 4 weeks of trial participation, were balanced between the active and placebo treatment arms. After 6 months of randomized, placebo-controlled treatment, FVC decline was significantly slower in the RNS60 group compared to the placebo group. Rates of FVC progression during the treatment were strongly associated with long-term survival (median survival: 3.7 years in slow FVC progressors; 1.6 years in fast FVC progressors). The effect of RNS60 in prolonging long-term survival was higher in participants with low neurofilament light chain (NfL) (median survival: >4 years in low NfL − RNS60 group; 3.3 years in low NfL − placebo group; 1.9 years in high NfL − RNS60 group; 1.8 years in high NfL − placebo group) and Monocyte Chemoattractant Protein-1 (MCP-1) (median survival: 3.7 years in low MCP-1 − RNS60 group; 2.3 years in low MCP-1 − placebo group; 2.8 years in high MCP-1 − RNS60 group; 2.6 years in high MCP-1 − placebo group) levels at baseline. In this post-hoc analysis, long term survival was longer in participants randomized to RNS60 compared with those randomized to placebo and was correlated with slower FVC progression rates, suggesting that longer survival may be mediated by the drug's effect on respiratory function. In these post-hoc analyses, the beneficial effect of RNS60 on survival was most pronounced in participants with low NfL and MCP-1 levels at study entry, suggesting that this could be a subgroup to target in future studies investigating the effects of RNS60 on survival. Study preregistered on 13/Jan/2017 in EUDRA-CT (2016-002382-62). The study was also registered at ClinicalTrials.gov number NCT03456882. [ABSTRACT FROM AUTHOR]

• Forced vital capacity and expiratory volume first improved but declined by year 6. • Motor completeness influenced pulmonary function improvement and decline. To investigate mean values of pulmonary function tests (PFT) at specific time points to assess long-term progression in patients with spinal cord injury (SCI). Retrospective cohort study from 1997-2022. National rehabilitation hospital, providing scheduled admission for potential SCI-related issues. Follow-up assessments are recommended annually, guiding the observation period into consecutive 1-year intervals. This study included 1394 adult patients who were admitted at least twice to the National Rehabilitation Center between 1997 and 2022, selected from an initial pool of 1510. Overall, 116 patients were excluded owing to the absence of any PFT results. Not applicable. Changes in PFT values over time, specifically assessing for a potential 2-phase pattern after injury. The hypothesis that PFT values would initially improve before declining was formulated based on existing literature. Significant changes in pulmonary function were noted among 1394 adults with SCI. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) initially increased within the first 1-2 years after injury but declined to below baseline levels after 6 years. Pronounced changes occurred between <1 year and 1-2 years after injury (FVC: Δ=4.89, SE=0.87, P <.001; FEV1: Δ=4.28, SE=1.09, P =.002) and 1-2 years to >6 years (FVC: Δ= −5.83, SE=0.94, P <.001; FEV1: Δ= −6.49, SE=1.18, P <.001). No significant changes in the FEV1/FVC ratio. Motor completeness was significantly associated with the increase and decline phase, showing a steeper increase and less decline compared with the motor-incomplete group. Pulmonary function in SCI initially increases but declines over time, falling below initial levels by 6 years. Further evaluation with more complete datasets is warranted to elucidate the factors influencing these changes. [ABSTRACT FROM AUTHOR]

Background: Halo-pelvic traction (HPT) is acknowledged for enhancing pulmonary function and reducing neurological complications in severe and rigid scoliosis and kyphoscoliosis. While its role in improving coronal balance is established, its impact on sagittal kyphosis remains under-researched. This study aims to assess HPT's effects on sagittal alignment in these conditions. Methods: A retrospective review of 37 patients with severe and rigid scoliosis or kyphoscoliosis was conducted to evaluate HPT's efficacy. The analysis focused on the impact of HPT on coronal and sagittal parameters, pulmonary function tests (PFTs) and complications. Radiographic assessments included main cobb angle in coronal, sagittal major kyphosis. Results: HPT was applied for an average of 2.9 months, significantly reducing the primary coronal curve from 127.7°±30.3° to 74.9°±28.3° (P < 0.05), achieving a 41.3% correction rate. Sagittal kyphosis correction was more pronounced, with angles decreasing from 80.4°±26.4° to 41.3°±24.4° (P < 0.05), resulting in a 48.6% correction rate. Pulmonary function tests showed improvements in forced vital capacity (FVC) (from 1.32 ± 0.91 to 1.55 ± 0.83) and forced expiratory volume in 1 s (FEV1) (from 1.03 ± 0.76 to 1.28 ± 0.72), with percentage predicted values also increasing (FVC%: 40.4%±24.3–51.4%±23.1%; FEV1%: 37.8%±25.2–48.1%±22.7%; all P < 0.05). Conclusion: HPT effectively reduces spinal deformity severity and improves pulmonary function in patients with severe and rigid scoliosis and kyphoscoliosis. Sagittal kyphosis correction was notably greater than coronal scoliosis correction. The correlation between PFT improvements and coronal curve adjustments suggests that correcting the coronal Cobb angle is pivotal for pulmonary function enhancement. [ABSTRACT FROM AUTHOR]

• Respiratory impairment is present in up to one-third-of patients with dysferlinopathy. • Spirometry is the gold standard for diagnosis and monitoring of respiratory impairment but is not always easily accessible. • The performance of upper limb (PUL) module is a clinical scale developed for patients with NMD to test upper extremity function. • There is a significant relationship between the PUL entry item and FVC in male and female patients with dysferlinopathy. • Where spirometry equipment is not available, the PUL entry item can be used to identify patients with dysferlinopathy in whom comprehensive respiratory testing is warranted. Dysferlin-deficient limb girdle muscular dystrophy (LGMD R2), also referred to as dysferlinopathy, can be associated with respiratory muscle weakness as the disease progresses. Clinical practice guidelines recommend biennial lung function assessments in patients with dysferlinopathy to screen for respiratory impairment. However, lack of universal access to spirometry equipment and trained specialists makes regular monitoring challenging. This study investigated the use of the Performance of Upper Limb (PUL) clinical scale entry item as a low-cost screening tool to identify patients with dysferlinopathy at risk of respiratory impairment. Using data from 193 patients from the Jain Foundation's International Clinical Outcomes Study, modelling identified a significant positive relationship between the PUL entry item and forced vital capacity (FVC). Eighty-eight percent of patients with the lowest PUL entry item score of 1 presented with FVC % predicted values of <60 %, suggestive of respiratory impairment. By contrast, only 10 % of the remainder of the cohort (PUL entry item of 2 or more) had an FVC of <60 %. This relationship also held true when accounting for ambulatory status, age, and sex as possible confounding factors. In summary, our results suggest that the PUL entry item could be implemented in clinical practice to screen for respiratory impairment where spirometry is not readily available. [ABSTRACT FROM AUTHOR]

Background: Idiopathic pulmonary fibrosis (IPF) is a serious, progressive lung disease for which treatments are scarce. Pirfenidone has been approved for the treatment of IPF in Taiwan since 2016. This study aimed to gain a better insight into pirfenidone's real-world safety and effectiveness in adult IPF patients in Taiwan. Methods: We conducted a prospective, multicenter, post-marketing surveillance study, and analyzed data from a small sample of 50 IPF patients treated with pirfenidone. Results: Most patients were men, with a mean age of 72.8 years (±10.3). They were in physiology stage I or II with a baseline mean forced vital capacity (FVC) of 2.236 L (73.8% of predicted value). After treatment with pirfenidone, the mean FVC decreased by 0.088 L at week 24 and 0.127 L at week 52. The mean 6 min walk test was 325.5 m at baseline, increased by 8.1 m at week 24, but then decreased by 23.0 m at week 52. These changes from baseline did not reach statistical significance. Pirfenidone prevented worsening of cough but did not stabilize dyspnea. During 52 weeks of treatment, the incidence of total adverse drug reactions was 62.0%, with decreased appetite (32.0%) and pruritis (10.0%) being the most common. The adverse events leading to treatment discontinuation were decreased appetite (8.0%), nausea (4.0%), and respiratory failure (4.0%). No safety concern was raised by the study. Treatment with pirfenidone stabilized both FVC and the subjective symptom of cough in most patients. Conclusions: This post-marketing surveillance study demonstrated that pirfenidone is an effective, safe, and well-tolerated treatment in patients with IPF in Taiwan. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to identify useful clinical indicators for predicting the relapse of interstitial lung disease (ILD) complicated with anti-aminoacyltRNA synthetase (ARS) antibodies (anti-ARS-ILD), being treated with prednisolone and calcineurin inhibitors. Methods: Fifty patients with anti-ARS-ILD were enrolled between October 2014 and August 2022. All patients were treated with prednisolone and calcineurin inhibitors as remission induction therapy and followed up for over a year with these combination therapies. We examined patients who experienced ILD relapse after immunosuppressive treatment. We explored the risk factors for predicting ILD relapse in these patients by comparing demographic, clinical, laboratory, and radiological findings and treatments between the relapsed and non-relapsed groups on admission. Results: Of the 50 patients, 19 (38%) relapsed during a median follow-up of 4.8 years. Univariate and multivariate Cox regression analyses identified the presence of acute/subacute (A/S)-ILD, higher serum aldolase (ALD) and surfactant protein-D (SP-D) levels, and lower %forced vital capacity (FVC) as risk factors for relapse in patients with anti-ARS-ILD. Using the receiver operating curve analysis, ALD =6.3 U/L, SP-D =207 ng/mL, and %FVC =76.8% were determined as the cut-off levels for indicating a poor prognosis. The 5-year relapse rate was significantly higher in patients with A/S-ILD, serum ALD=6.3 U/L, serum SP-D =207 ng/mL, or %FVC of =76.8% than in those without these parameters. (P=0.009, 0.0005, 0.0007, 0.0004, respectively) Serum ALD levels were significantly correlated with the disease activity indicators of anti-ARS-ILD. Conclusion: The presence of A/S-ILD, higher serum ALD and SP-D levels, and lower %FVC are useful indicators for predicting anti-ARS-ILD relapse. [ABSTRACT FROM AUTHOR]

Context Forward head posture (FHP) is a prevalent abnormal posture, leading to abnormal postural angles, diminished respiratory parameters, and decline in cervical proprioception. Aim The study aimed to improve head posture along with improvement in respiratory functions and cervical proprioception in FHP individuals using feedback respiratory exercises (FRE) and myofascial release (MFR) technique. Settings and Design The study was a randomized controlled pilot trial, conducted at the Outpatient Department of Guru Jambheshwar University of Science and Technology, Hisar. Materials and Methods Forty-eight participants of 20–45 years having FHP were randomly assigned to four groups, i.e., Group A (control group), Group B (MFR group), Group C (FRE group), and Group D (combined group). The outcome measures such as craniovertebral angle, cranial rotation angle, cranial angle, forward shoulder angle, pectoralis minor length, neck disability index, chest expansion, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and cervical proprioception were assessed pre- and postintervention (after 6 weeks). Statistical Analysis Used The comparison between the groups at baseline and postintervention was done using one-way ANOVA test and within group was performed using a paired t-test. Results The results indicated significant difference in all outcome measures in all four groups during within-group comparison. Similarly, a significant difference was observed between the groups except for cervical proprioception. In addition, recruitment and retention rates were 90.56% and 100%, respectively. Conclusions The study concludes MFR and FRE when given along with conventional treatment provides additional benefits in all outcome measures except cervical proprioception.

Abstract Background Halo-pelvic traction (HPT) is acknowledged for enhancing pulmonary function and reducing neurological complications in severe and rigid scoliosis and kyphoscoliosis. While its role in improving coronal balance is established, its impact on sagittal kyphosis remains under-researched. This study aims to assess HPT’s effects on sagittal alignment in these conditions. Methods A retrospective review of 37 patients with severe and rigid scoliosis or kyphoscoliosis was conducted to evaluate HPT’s efficacy. The analysis focused on the impact of HPT on coronal and sagittal parameters, pulmonary function tests (PFTs) and complications. Radiographic assessments included main cobb angle in coronal, sagittal major kyphosis. Results HPT was applied for an average of 2.9 months, significantly reducing the primary coronal curve from 127.7°±30.3° to 74.9°±28.3° (P

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A severe and progressive interstitial lung disease (ILD) known as idiopathic pulmonary fibrosis (IPF) has an unknown etiology with poorly defined mechanisms of development. Among the currently prescribed pharmacological interventions for IPF, nintedanib demonstrates the ability to decelerate the deterioration of lung function and yield positive clinical outcomes. Multiple randomized placebo-controlled trials have confirmed the efficacy and acceptable safety profile of nintedanib. Real-world evidence studies also support the use of nintedanib in IPF, being an efficient and well-tolerated treatment option. It has the potential to stabilize the disease progression in patients with ILD. Patients with IPF frequently have comorbidities like diabetes and hypertension, which can exacerbate the course of disease, reduce quality of life, and decrease treatment adherence. For well-informed decision-making, it is important for healthcare professionals to recognize the position of nintedanib therapy in IPF with comorbidities. The gastrointestinal adverse effects, notably diarrhea, dominate the nintedanib safety profile. These can be effectively controlled by closely monitoring side effects, administering anti-diarrheal and anti-emetic drugs, reducing the nintedanib dose, and discontinuing it in case of severe symptoms with an option to reintroduce the treatment after side effects subside. Symptomatic interventions and monitoring of liver enzymes may reduce the occurrence of permanent treatment discontinuations. [ABSTRACT FROM AUTHOR]

Abstract Purpose The study aimed to investigate whether there is a difference in pulmonary function between individuals with forward head posture and those with neutral head posture. Methods A systematic search was conducted using the ResearchGate, PubMed, and Scholar databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The eligibility criteria for the studies were that they investigated the relationship between Forward Head Posture (FHP) and Forced Vital Capacity (FVC) and/or Forced Expiratory Volume in one second (FEV1). Results A total of four comparison studies and two correlation studies met the inclusion criteria for this study. Across these four studies, encompassing a total of 115 participants, the observed reduction range for FVC was between -0.25 L and -0.81 L, while the reduction values for FEV1 ranged from -0.16 to -0.93 L. According to the results of the correlation studies, a positive correlation was observed between craniovertebral angle (CVA) and dynamic pulmonary volumes. Conclusion The existing evidence indicates that FHP can potentially cause abnormalities in pulmonary function. In this context, it is suggested that individuals with FHP should be monitored for changes in pulmonary function.

Pulmonary function tests (PFTs) constitute a set of non-invasive diagnostic procedures designed to evaluate the functional capabilities of the respiratory system. These tests hold pivotal significance in the identification, tracking, and treatment of diverse respiratory conditions, including asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and restrictive lung disorders. This review article aims to provide medical students with a comprehensive overview of PFTs and their interpretation, offering valuable insights into their crucial role in the diagnosis and management of respiratory ailments.

Asthma is a common chronic respiratory diseases, and the relationship between pulmonary ventilation function and the prognosis of patients with suspected asthma is not well understood. This study aims to explore the impact of pulmonary ventilation functions on the prognosis of patients with suspected asthma. This retrospective observational study included patients with suspected asthma who were diagnosed and treated at the Guangdong Provincial Hospital of Traditional Chinese Medicine between August 2015 and January 2020. The primary outcome of interest was improvement in asthma symptoms, as measured by bronchial provocation test (BPT) results within one year after diagnosis. The impact of pulmonary ventilation functions on prognosis was explored by multivariable logistic regression analysis. Seventy-two patients were included in the study. Patients with normal (OR = 0.123, p =.004) or generally normal (OR = 0.075, p =.039) pulmonary ventilation function were more likely to achieve improvement in asthma symptoms compared with patients with mild obstruction. There were no significant differences between the improvement and non-improvement groups in baseline characteristics. These results suggest that suspected asthma patients with normal or generally normal pulmonary ventilation function are more likely to achieve improvement in asthma symptoms within one year compared to patients with mild obstruction. [ABSTRACT FROM AUTHOR]

Background: Chronic respiratory insufficiency from progressive muscle weakness causes morbidity and mortality in late-onset Pompe disease (LOPD). Previous Pompe Registry (NCT00231400) analyses for ≤ 5 years' alglucosidase alfa treatment showed a single linear time trend of stable forced vital capacity (FVC) % predicted. Methods: To assess longer term Pompe Registry data, piecewise linear mixed model regression analyses estimated FVC% predicted trajectories in invasive-ventilator-free patients with LOPD aged ≥ 5 years. We estimated annual FVC change 0–6 months, > 6 months–5 years, and > 5–13 years from treatment initiation, adjusting for baseline age, sex, and non-invasive ventilation. Findings: Among 485 patients (4612 FVC measurements; 8.3 years median follow-up), median ages at symptom onset, diagnosis, and alglucosidase alfa initiation were 34.3, 41.1, and 44.9 years, respectively. FVC% increased during the first 6 months' treatment (slope 1.83%/year; 95% confidence interval: 0.66, 3.01; P = 0.0023), then modestly declined −0.54%/year (−0.79, −0.30; P < 0.0001) during > 6 months–5 years, and −1.00%/year (−1.36, −0.63; P < 0.0001) during > 5–13 years. The latter two periods' slopes were not significantly different from each other (Pdifference = 0.0654) and were less steep than published natural history slopes (−1% to −4.6%/year). Estimated individual slopes were ≥ 0%/year in 96.1%, 30.3%, and 13.2% of patients during the 0–6 month, > 6 month–5 year, and > 5–13 year periods, respectively. Conclusion: These real-world data indicate an alglucosidase alfa benefit on FVC trajectory that persists at least 13 years compared with published natural history data. Nevertheless, unmet need remains since most individuals demonstrate lung function decline 5 years after initiating treatment. Whether altered FVC trajectory impacts respiratory failure incidence remains undetermined. Trial registration: This study was registered (NCT00231400) on ClinicalTrials.gov on September 30, 2005, retrospectively registered. [ABSTRACT FROM AUTHOR]

• In a large cohort of myasthenia gravis patients with mild respiratory symptoms and disability, portable respiratory function tests were useful to screen those at risk of deterioration. • MIP and SNIPs were good indicators of respiratory muscle weakness and MIP best correlated with measures of disability and quality of life. • Females had a higher likelihood of presenting with an abnormal FVC and MIP than males. Patients with myasthenia gravis (MG) can present with respiratory dysfunction, ranging from exercise intolerance to overt respiratory failure, increased fatigue, or sleep-disordered breathing. To investigate the value of multiple respiratory tests in MG, we performed clinical and respiratory assessments in patients with mild to moderate generalized disease. One-hundred and thirty-six patients completed the myasthenia gravis quality-of-life score(MG-QOL-15), myasthenia gravis impairment index(MGII), Epworth sleepiness scale(ESS), University of California-San Diego Shortness of Breath Questionnaire(UCSD-SOB), Modified Medical Research Council Dyspnea Scales(MRC-DS), supine and upright forced vital capacity(FVC), maximal inspiratory pressures(MIPs) and sniff nasal inspiratory pressures(SNIP). Seventy-three (54 %) had respiratory and/or bulbar symptoms and 45 (33 %) had baseline abnormal FVC, with no significant postural changes (p = 0.89); 55 (40.4 %) had abnormal MIPs and 50 (37 %) had abnormal SNIPs. Overall, there were low scores on respiratory and disability scales. Females had increased odds of presenting with abnormal FVC (OR 2.89, p = 0.01) and MIPs (OR 2.48, p = 0.022). There were significant correlations between MIPs, FVC and SNIPs; between MGII/MG-QOL15 and UCSD-SOB/MRC-DS and between ESS and respiratory scales in the whole group. Our data suggests that office-based respiratory measurements are a useful screening method for stable MG patients, even when presenting with minimal respiratory symptoms and no significant disability. [ABSTRACT FROM AUTHOR]

Background The long-term pulmonary sequelae of mild coronavirus disease 2019 (COVID-19) remains unknown. In this study, we aimed to characterize lung function trajectories in individuals with mild COVID-19 from preinfection to 2 years postinfection. Methods We reinvited participants 2 years after infection from our matched cohort study of the Copenhagen General Population who had initially been examined 5.4 months after infection. We repeated lung tests and questionnaires. Linear mixed models were used to estimate dynamics in lung volumes in individuals with COVID-19 patients versus uninfected controls over two intervals: from pre-infection to 6 months postinfection and 6 months postinfection to 2 years postinfection. Results 52 individuals (48.6%) attended the 2-year examination at median 1.9 years (interquartile range, 1.8–2.4) after COVID-19, all with mild infection. Individuals with COVID-19 had an adjusted excess decline in forced expiratory volume in 1 second (FEV1) of 13.0 mL per year (95% confidence interval [CI], −23.5 to −2.5; P =.02) from before infection to 6 months after infection compared to uninfected controls. From 6 to 24 months after infection, they had an excess decline of 7.5 mL per year (95% CI, −25.6–9.6; P =.40). A similar pattern was observed for forced vital capacity (FVC). Participants had a mean increase in diffusing capacity for carbon monoxide (DLco) of 3.33 (SD 7.97) between the 6- and 24-month examination. Conclusions Our results indicate that mild COVID-19 infection affects lung function at the time of infection with limited recovery 2 years after infection. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to investigate whether there is a difference in pulmonary function between individuals with forward head posture and those with neutral head posture. Methods: A systematic search was conducted using the ResearchGate, PubMed, and Scholar databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The eligibility criteria for the studies were that they investigated the relationship between Forward Head Posture (FHP) and Forced Vital Capacity (FVC) and/or Forced Expiratory Volume in one second (FEV1). Results: A total of four comparison studies and two correlation studies met the inclusion criteria for this study. Across these four studies, encompassing a total of 115 participants, the observed reduction range for FVC was between -0.25 L and -0.81 L, while the reduction values for FEV1 ranged from -0.16 to -0.93 L. According to the results of the correlation studies, a positive correlation was observed between craniovertebral angle (CVA) and dynamic pulmonary volumes. Conclusion: The existing evidence indicates that FHP can potentially cause abnormalities in pulmonary function. In this context, it is suggested that individuals with FHP should be monitored for changes in pulmonary function. [ABSTRACT FROM AUTHOR]

Pirfenidone and Nintedanib are specific drugs used against idiopathic pulmonary fibrosis (IPF) that showed efficacy in non-IPF fibrosing interstitial lung diseases (ILD). Both drugs have side effects that affect patients in different ways and have different levels of severity, making treatment even more challenging for patients and clinicians. The present review aims to assess the effectiveness and potential complications of Pirfenidone and Nintedanib treatment regimens across various ILD diseases. A detailed search was performed in relevant articles published between 2018 and 2023 listed in PubMed, UpToDate, Google Scholar, and ResearchGate, supplemented with manual research. The following keywords were searched in the databases in all possible combinations: Nintedanib; Pirfenidone, interstitial lung disease, and idiopathic pulmonary fibrosis. The most widely accepted method for evaluating the progression of ILD is through the decline in forced vital capacity (FVC), as determined by respiratory function tests. Specifically, a decrease in FVC over a 6–12-month period correlates directly with increased mortality rates. Antifibrotic drugs Pirfenidone and Nintedanib have been extensively validated; however, some patients reported several side effects, predominantly gastrointestinal symptoms (such as diarrhea, dyspepsia, and vomiting), as well as photosensitivity and skin rashes, particularly associated with Pirfenidone. In cases where the side effects are extremely severe and are more threatening than the disease itself, the treatment has to be discontinued. However, further research is needed to optimize the use of antifibrotic agents in patients with PF-ILDs, which could slow disease progression and decrease all-cause mortality. Finally, other studies are requested to establish the treatments that can stop ILD progression. [ABSTRACT FROM AUTHOR]

Pulmonary function tests (PFTs) constitute a set of non-invasive diagnostic procedures designed to evaluate the functional capabilities of the respiratory system. These tests hold pivotal significance in the identification, tracking, and treatment of diverse respiratory conditions, including asthma, chronic obstructive pulmonary disease, interstitial lung diseases, and restrictive lung disorders. This review article aims to provide medical students with a comprehensive overview of PFTs and their interpretation, offering valuable insights into their crucial role in the diagnosis and management of respiratory ailments. [ABSTRACT FROM AUTHOR]

• Incorporating early bedside cycling into inpatient cardiac rehabilitation programs after heart valve surgery could lead to more recovery of walking functional capacity, ADL autonomy, and pulmonary function. • Adding early bedside cycling to routine inpatient cardiac rehabilitation following heart valve surgery could lead to shorter ICU and total hospital stays. • The better physical function and shorter hospital stays that could result from adopting early bedside cycling following heart valve surgery can have several practical implications. To assess whether adding bedside cycling to inpatient cardiac rehabilitation (CR) early after heart valve surgery could lead to better physical function and shorter length of hospital stays. This is a single-centered, randomized, controlled, parallel-group intervention study. This study was conducted at the National Heart Institute from December 2022 to June 2023. Thirty-one patients following heart valve surgery completed this study after being randomized into 2 groups: an intervention group (n 1 =16) and an active control group (n 2 =15). Eligibility criteria were heart valve surgery with median sternotomy, clinical stability, and age from 20 to 40 years. The intervention group received early bedside cycling for the lower limbs, using a mini bike, in addition to an inpatient CR program, and the control group received the inpatient CR program alone. The primary outcome was the physical functional capacity assessed by the 6-minute walk distance (6MWD). The secondary outcomes were the Barthel Index (BI), the forced vital capacity (FVC), the length of intensive care unit (ICU) stay, the total length of hospital stay, and the physical component summary (PCS) of the 12-item Short Form (SF-12) Health Survey. Compared with the control group, the intervention group showed significantly greater 6MWD (P <.001), BI score (P <.001), and FVC (P =.006) at hospital discharge, and shorter ICU stay (P =.002) and total hospital stay (P =.015). At 1-month follow-up, the intervention group showed a non-significantly higher PCS mean score than the control group (P =.057). Adding early bedside cycling to a usual inpatient CR program after heart valve surgery could induce significantly greater short-term physical functional capacity as assessed by the 6MWD, better activities of daily living as evaluated by the BI, higher pulmonary function as measured by the FVC, and shorter lengths of ICU and total hospital stays than the usual inpatient CR program alone. [ABSTRACT FROM AUTHOR]

Diver training improves physical and mental fitness, which can also benefit other sports. This study investigates the effect of eight weeks of static apnea training on maximum apnea time, and on the physiological parameters of runners, swimmers, and sedentary participants, such as forced vital capacity (FVC), minimum heart rate (HR), and oxygen saturation (SpO2). The study followed 19 participants, including five runners, swimmers, sedentary participants, and four competitive divers for reference values. The minimum value of SpO2, HR, maximum duration of apnea, and FVC were measured. Apnea training occurred four times weekly, consisting of six apneas with 60 s breathing pauses. Apnea duration was gradually increased by 30 s. The measurement started with a 30 s apnea and ended with maximal apnea. There was a change in SpO2 decreased by 6.8%, maximum apnea length increased by 15.8%, HR decreased by 9.1%, and FVC increased by 12.4% for the groups (p < 0.05). There were intra-groups changes, but no significant inter-groups difference was observed. Eight weeks of apnea training improved the maximum duration of apnea, FVC values and reduced the minimum values of SpO2 and HR in all groups. No differences were noted between groups after training. This training may benefit cardiorespiratory parameters in the population. [ABSTRACT FROM AUTHOR]

Abstract Background Spirofy™ is India’s first portable, pneumotach flow-sensor-based digital spirometer developed to diagnose asthma and chronic obstructive pulmonary disease (COPD). In this study, we compared the performance of the Spirofy™ device with that of the Vitalograph Alpha Touch™ spirometer in measuring the lung capacities of healthy individuals, asthmatics, and COPD patients. We also assessed the inter-device variability between two Spirofy™ devices. Methods In a randomized, three-way crossover, open-label study, we measured the differences in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) between the Spirofy™ and Vitalograph Alpha Touch™ spirometers. A proportion of the FEV1/FVC ratio distribution of

Abstract Objective Pulmonary function test (PFT) results are recorded variably across hospitals in the Department of Veterans Affairs (VA) electronic health record (EHR), using both unstructured and semi-structured notes. We developed and validated a hospital-specific code to extract pre-bronchodilator measures of obstruction (ratio of forced expiratory volume in one second [FEV1] to forced vital capacity [FVC]) and severity of obstruction (percent predicted of FEV1). Results Among 36 VA facilities with the most PFTs completed between 2018 and 2022 from a parent cohort of veterans receiving long-acting controller inhalers, 12 had a consistent syntactical convention or template for reporting PFT data in the EHR. Of the 42,718 PFTs identified from these 12 facilities, the hospital-specific text processing pipeline yielded 24,860 values for the FEV1:FVC ratio and 23,729 values for FEV1. A ratio of FEV1:FVC less than 0.7 was identified in 17,615 of 24,922 studies (70.7%); 8864 of 24,922 (35.6%) had a severe or very severe reduction in FEV1 (

Background: Spirofy™ is India's first portable, pneumotach flow-sensor-based digital spirometer developed to diagnose asthma and chronic obstructive pulmonary disease (COPD). In this study, we compared the performance of the Spirofy™ device with that of the Vitalograph Alpha Touch™ spirometer in measuring the lung capacities of healthy individuals, asthmatics, and COPD patients. We also assessed the inter-device variability between two Spirofy™ devices. Methods: In a randomized, three-way crossover, open-label study, we measured the differences in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) between the Spirofy™ and Vitalograph Alpha Touch™ spirometers. A proportion of the FEV1/FVC ratio distribution of < 0.7 was used to compare the diagnostic accuracies of the Spirofy™ with Vitalograph™ Alpha Touch™ spirometers. Results: Ninety subjects participated in this study. The mean ± SD FVC values obtained from the Spirofy™ 1, Spirofy™ 2, and Vitalograph Alpha Touch™ devices were 2.60 ± 1.05 L, 2.64 ± 1.04 L, and 2.67 ± 1.04 L, respectively. The mean ± SD FEV1 values obtained from the Spirofy™ 1, Spirofy™ 2, and Vitalograph Alpha Touch™ devices were 1.87 ± 0.92 (L), 1.88 ± 0.92 (L), and 1.93 ± 0.93 (L), respectively. A significant positive correlation was found between the FVC and FEV1 values recorded by Vitalograph Alpha Touch™, Spirofy™ 1, and Spirofy™ 2. As compared to Vitalograph Alpha Touch™, the Spirofy™ device showed good sensitivity (97%), specificity (90%), and overall accuracy (93.3%) at an FEV1/FVC ratio < 0.7. No inter-device variability was observed between the two Spirofy™ devices. Conclusion: Spirofy™ is a portable and easy-to-use device and is as accurate as the standard Vitalograph Alpha Touch™ spirometer for the diagnosis of COPD and asthma. Trial registration: CTRI/2021/09/036492 (Clinical Trials Registry - India) [ABSTRACT FROM AUTHOR]

Background and purpose: Pompe disease is a rare, inheritable, progressive metabolic myopathy. This study aimed to estimate the minimal clinically important difference (MCID) for an improvement in forced vital capacity in the upright seated position (FVCup) and the 6‐min walk test (6MWT) after a year of treatment with enzyme replacement therapy. Methods: Data were obtained from two prospective follow‐up studies. Between‐group and within‐group MCIDs were estimated using anchor‐based methods. Additionally, a distribution‐based method was used to generate supportive evidence. As anchors, self‐reported change in health and in physical functioning, shortness of breath and a categorization of the Short‐Form 36 Physical Component Summary score were used. Anchor appropriateness was assessed using Spearman correlations (absolute values ≥0.29) and a sufficient number of observations in each category. Results: In all, 102 patients had at least one FVCup or 6MWT measurement during enzyme replacement therapy. Based on the anchors assessed as appropriate, the between‐group MCID for an improvement in FVCup ranged from 2.47% to 4.83% points. For the 6MWT, it ranged from 0.35% to 7.47% points which is equivalent to a distance of 2.18–46.61 m and 1.97–42.13 m for, respectively, a man and a woman of age 50, height 1.75 m and weight 80 kg. The results of the distribution‐based method were within these ranges when applied to change in the outcome values. Conclusion: The MCIDs for FVCup and 6MWT derived in this study can be used to interpret differences between and within groups of patients with Pompe disease in clinical trials and cohort studies. [ABSTRACT FROM AUTHOR]

Rationale: A phase II trial reported clinical benefit over 28 weeks in patients with idiopathic pulmonary fibrosis (IPF) who received zinpentraxin alfa. Objectives: To investigate the efficacy and safety of zinpentraxin alfa in patients with IPF in a phase III trial. Methods: This 52-week phase III, double-blind, placebo-controlled, pivotal trial was conducted at 275 sites in 29 countries. Patients with IPF were randomized 1:1 to intravenous placebo or zinpentraxin alfa 10 mg/kg every 4 weeks. The primary endpoint was absolute change from baseline to Week 52 in FVC. Secondary endpoints included absolute change from baseline to Week 52 in percent predicted FVC and 6-minute walk distance. Safety was monitored via adverse events. Post hoc analysis of the phase II and phase III data explored changes in FVC and their impact on the efficacy results. Measurements and Main Results: Of 664 randomized patients, 333 were assigned to placebo and 331 to zinpentraxin alfa. Four of the 664 randomized patients were never administered study drug. The trial was terminated early after a prespecified futility analysis that demonstrated no treatment benefit of zinpentraxin alfa over placebo. In the final analysis, absolute change from baseline to Week 52 in FVC was similar between placebo and zinpentraxin alfa (−214.89 ml and −235.72 ml; P = 0.5420); there were no apparent treatment effects on secondary endpoints. Overall, 72.3% and 74.6% of patients receiving placebo and zinpentraxin alfa, respectively, experienced one or more adverse events. Post hoc analysis revealed that extreme FVC decline in two placebo-treated patients resulted in the clinical benefit of zinpentraxin alfa reported by phase II. Conclusions: Zinpentraxin alfa treatment did not benefit patients with IPF over placebo. Learnings from this program may help improve decision making around trials in IPF. Clinical trial registered with (NCT04552899). [ABSTRACT FROM AUTHOR]

Objective Pulmonary function test (PFT) results are recorded variably across hospitals in the Department of Veterans Affairs (VA) electronic health record (EHR), using both unstructured and semi-structured notes. We developed and validated a hospital-specific code to extract pre-bronchodilator measures of obstruction (ratio of forced expiratory volume in one second [FEV1] to forced vital capacity [FVC]) and severity of obstruction (percent predicted of FEV1). Results Among 36 VA facilities with the most PFTs completed between 2018 and 2022 from a parent cohort of veterans receiving long-acting controller inhalers, 12 had a consistent syntactical convention or template for reporting PFT data in the EHR. Of the 42,718 PFTs identified from these 12 facilities, the hospital-specific text processing pipeline yielded 24,860 values for the FEV1:FVC ratio and 23,729 values for FEV1. A ratio of FEV1:FVC less than 0.7 was identified in 17,615 of 24,922 studies (70.7%); 8864 of 24,922 (35.6%) had a severe or very severe reduction in FEV1 (<50% of the predicted value). Among 100 randomly selected PFT reports reviewed by two pulmonary physicians, the coding solution correctly identified the presence of obstruction in 99 out of 100 studies and the degree of obstruction in 96 out of 100 studies. [ABSTRACT FROM AUTHOR]

Background/objective: Insufficiency of respiratory muscles is the most important reason for mortality in the natural history of SMA. Thus, improvement or stabilization of respiratory function by disease-modifying therapies (DMT) is a very important issue. Methods: We examined respiratory function using forced vital capacity (FVC) in 42 adult SMA patients (2 SMA type 1, 15 SMA type 2, 24 SMA type 3, 1 SMA type 4, median age 37 years, range 17-61 years) treated with nusinersen for a median of 22.1 months (range 2.1 to 46.7 months). Change in FVC was assessed using mixed effects linear regression models. Results: Baseline FVC differed significantly between SMA type 1 (4.0, 8.0%), 2 (median 22.0%, IQR 18.0-44.0), 3 (median 81.0%, IQR 67.0-90.8) and, respectively, type 4 (84.0%) patients reflecting the heterogeneity of respiratory impairment based on the SMA type in adulthood (p < 0.0001). FVC remained stable during follow-up (mean -0.047, 95% CI -0.115 to 0.020, p = 0.17); however, subgroup analysis showed an increase in FVC of type 2 patients (mean 0.144, 95% CI 0.086 to 0.202, p < 0.0001) and a decrease in FVC of type 3/4 patients (-0.142, 95% CI -0.239 to -0.044, p = 0.005). Conclusion: The observed improvement in FVC in patients with SMA type 2 can be seen as a therapeutic response differing from the progressive decline typically seen in the spontaneous course. For SMA type 3/4 patients approaching normal spirometry at baseline, FVC may only be of limited use as an outcome parameter due to ceiling effects. [ABSTRACT FROM AUTHOR]

Objective: This study investigates if an inpatient rehabilitation therapy (brace therapy and Schroth therapy) for six weeks contributes to an improvement in lung function of the patients. Design: Retrospective study. Setting: Scoliosis rehabilitation clinic “Asklepios Katharina-Schroth-Klinik” (Bad Sobernheim, Germany). Participants: In 253 female patients a lung function examination was performed at entry and at the end of their inpatient rehabilitation stay. Of these, 61 patients underwent Schroth therapy (group 1); 192 patients underwent the combination of brace and Schroth therapy (group 2). Intervention: Lung function parameters under the influence of Schroth and Schroth and brace therapy within a rehabilitative stay. Main measures: The parameters of IVC (inspiratory vital capacity), FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 s) and the Tiffeneau index (FEV/FVC) related to patient-specific reference values were evaluated with regard to potential ventilation disorders. Results: There were significant improvements for IVC +2.56 %, FVC +3.99 %, FEV1 +2.36 % for the first stay (IVC and FVC 2nd, 3rd stay). The comparison of patients with vs. without additional brace therapy showed no significances. For the long-term analysis the parameters approached the reference values of age-matched, healthy female subjects. The greater the Cobb angle in the thoracic region, the significantly worse almost each of the measured parameters are. Conclusion: An inpatient rehabilitation therapy contributes to an improvement in lung function (IVC, FVC and FEV1). A second, and even a third, follow-up stay still led to a measurable improvement in lung function, albeit to a lesser extent.

Introduction: Obstructive airway diseases are a leading cause of respiratory morbidity and mortality worldwide, particularly Chronic Obstructive Lung Disease (COPD). The diagnosis of COPD is confirmed by a post-bronchodilator ratio of Forced Expiratory Volume in the first second (FEV1) to Forced Vital Capacity (FVC), i.e., FEV1/FVC

Abstract Background Nintedanib was approved for the treatment of scleroderma and scleroderma-related interstitial lung disease, as it decrease the forced expiratory volume. Case presentation A 48-year-old Asian female patient with systemic scleroderma 6 years ago developed breathlessness, nausea, heart palpation, and sudden severe occipital headache over the preceding week. She was receiving aspirin 81 mg/day and amlodipine 5 mg/day. Her diagnosis was diffuse scleroderma with pulmonary hypertension, interstitial lung involvement, and renal crisis. The modified Rodnan score was 18. We begin captopril at a dose of 12.5 mg, progressively escalating to 200 mg/day, and oral nintedanib was started at 150 mg. A total of 12 months after initiation of treatment, the patient’s kidney function was normal. The pulmonary function tests improved. The modified Rodnan score was reduced to 10. We did not encounter any side effects in our case due to nintedanib treatment. Conclusion Treatment with nintedanib is crucial for slowing lung function decline. Diarrhea was the most common adverse event. Scleroderma renal crisis occurs in 10% of patients and typically presents with an abrupt onset of hypertension and kidney failure. The optimal antihypertensive agent for scleroderma renal crisis is an ACE inhibitor. The mainstay of therapy in scleroderma renal crisis has been shown to improve or stabilize renal function in approximately 70% of patients and improve survival in nearly 80% at 1 year. Nintedanib may be effective, and fairly safe to use. Further exploration is anticipated to advance a new period of systemic sclerosis treatment.

Background: Chronic obstructive pulmonary disease (COPD) patients often have a lower ability to exercise and muscle weakness, both decreasing their quality of life. The 6 min walk test (6MWT) offers insightful data on the functional capacity of respiratory variables on exercise performance. A significant reduction in oxygen saturation (SpO2) throughout the test signifies a lower tolerance for exercise or additional oxygen requirement. Aims and Objectives: This study focuses to investigate desaturation in COPD patients with normal resting oxygen levels (normoxemic) employing the 6MWT. The objective of the study defines to analyze different clinical parameters such as smoking behavior, 6MWT, and clinical parameters of COPD patients to diagnose respiratory performance. Materials and Methods: Between June 2019 and May 2020 study was conducted on patients presenting to our OPD, who were above 40 years and diagnosed with COPD, with baseline SpO2 ≥90%. 6MWT was performed on them as per American Thoracic Society guidelines. Noting their distance covered and desaturation if present. Results: The study group included 60 patients; the group was divided into 35 desaturators (DS) and 25 Non-DS (NDS) based on fall in SpO2 during 6MWT, all current smokers were in the DS group and had low body mass index values, DS group covered less distance when compared to NDS, DS had low mean forced vital capacity and forced expiratory volume 1 second values. Conclusion: This study established the relationship between COPD risk variables and 6MWT. The 6MWT was identified as a useful method to examine respiratory performance by noting exercise-induced desaturation and in turn the respiratory capacity among COPD patients.

Background: Idiopathic pulmonary fibrosis (IPF) is a serious, progressive lung disease for which treatments are scarce. Pirfenidone has been approved for the treatment of IPF in Taiwan since 2016. This study aimed to gain a better insight into pirfenidone’s real-world safety and effectiveness in adult IPF patients in Taiwan. Methods: We conducted a prospective, multicenter, post-marketing surveillance study, and analyzed data from a small sample of 50 IPF patients treated with pirfenidone. Results: Most patients were men, with a mean age of 72.8 years (±10.3). They were in physiology stage I or II with a baseline mean forced vital capacity (FVC) of 2.236 L (73.8% of predicted value). After treatment with pirfenidone, the mean FVC decreased by 0.088 L at week 24 and 0.127 L at week 52. The mean 6 min walk test was 325.5 m at baseline, increased by 8.1 m at week 24, but then decreased by 23.0 m at week 52. These changes from baseline did not reach statistical significance. Pirfenidone prevented worsening of cough but did not stabilize dyspnea. During 52 weeks of treatment, the incidence of total adverse drug reactions was 62.0%, with decreased appetite (32.0%) and pruritis (10.0%) being the most common. The adverse events leading to treatment discontinuation were decreased appetite (8.0%), nausea (4.0%), and respiratory failure (4.0%). No safety concern was raised by the study. Treatment with pirfenidone stabilized both FVC and the subjective symptom of cough in most patients. Conclusions: This post-marketing surveillance study demonstrated that pirfenidone is an effective, safe, and well-tolerated treatment in patients with IPF in Taiwan.

BACKGROUND: Despite the availability of effective asthma medications, the condition remains poorly controlled, making it one of the most common emergency room and physician visits each year. Appropriate asthma education programs are needed to maintain or improve optimal lung function in asthmatics. This study aimed to evaluate changes in lung function parameters in adult asthmatics before and after a structured educational intervention. METHODS AND MATERIALS: We conducted a quasi-experimental study with 157 adult asthma patients in the Pneumology Department of the Hassan II University Hospital in Fez, Morocco. The study was performed in three phases: patient recruitment and baseline data collection (March–May 2022), planning and implementation of educational sessions (June–July 2022), and lung function evaluation 3 months later (September–October 2022) after training. Sociodemographic and clinical data were collected through a questionnaire. Spirometry was also performed before education and 3 months after. All patients received a structured and collective educational intervention. Pre- and post-education results were compared using the Wilcoxon test for qualitative variables and the paired sample t-test for quantitative variables. RESULTS: There was a statistically significant improvement (P < 0.001) in pulmonary function parameters (as a percentage of the reference value): forced expiratory volume in one second (FEV1), forced vital capacity (FCV), and peak expiratory flow rate (PEFR) sequentially increased from 66.73 ± 20.84 to 70.64 ± 19.06; 74.74 ± 17.29 to 79.67 ± 16.15 and 67.51 ± 23.39 to 71.93 ± 21.57. CONCLUSIONS: Our results suggest that an educational intervention can be beneficial in reducing alterations in lung function in adult asthmatics.

Background: Nintedanib was approved for the treatment of scleroderma and scleroderma-related interstitial lung disease, as it decrease the forced expiratory volume. Case presentation: A 48-year-old Asian female patient with systemic scleroderma 6 years ago developed breathlessness, nausea, heart palpation, and sudden severe occipital headache over the preceding week. She was receiving aspirin 81 mg/day and amlodipine 5 mg/day. Her diagnosis was diffuse scleroderma with pulmonary hypertension, interstitial lung involvement, and renal crisis. The modified Rodnan score was 18. We begin captopril at a dose of 12.5 mg, progressively escalating to 200 mg/day, and oral nintedanib was started at 150 mg. A total of 12 months after initiation of treatment, the patient's kidney function was normal. The pulmonary function tests improved. The modified Rodnan score was reduced to 10. We did not encounter any side effects in our case due to nintedanib treatment. Conclusion: Treatment with nintedanib is crucial for slowing lung function decline. Diarrhea was the most common adverse event. Scleroderma renal crisis occurs in 10% of patients and typically presents with an abrupt onset of hypertension and kidney failure. The optimal antihypertensive agent for scleroderma renal crisis is an ACE inhibitor. The mainstay of therapy in scleroderma renal crisis has been shown to improve or stabilize renal function in approximately 70% of patients and improve survival in nearly 80% at 1 year. Nintedanib may be effective, and fairly safe to use. Further exploration is anticipated to advance a new period of systemic sclerosis treatment. [ABSTRACT FROM AUTHOR]

Respiratory failure assessment is among the most debatable research topics in amyotrophic lateral sclerosis (ALS) clinical research due to the wide heterogeneity of its presentation. Among the different pulmonary function tests (PFTs), maximal voluntary ventilation (MVV) has shown potential utility as a diagnostic and monitoring marker, able to capture early respiratory modification in neuromuscular disorders. In the present study, we explored calculated MVV (cMVV) as a prognostic biomarker in a center-based, retrospective ALS population belonging to the Piemonte and Valle d'Aosta registry for ALS (PARALS). A Spearman's correlation analysis with clinical data and PFTs showed a good correlation of cMVV with forced vital capacity (FVC) and a moderate correlation with some other features such as bulbar involvement, ALSFRS-R total score, blood oxygen (pO2), carbonate (HCO3−), and base excess (BE), measured with arterial blood gas analysis. Both the Cox proportional hazard models for survival and the time to non-invasive ventilation (NIV) measurement highlighted that cMVV at diagnosis (considering cMVV(40) ≥ 80) is able to stratify patients across different risk levels for death/tracheostomy and NIV indication, especially considering patients with FVC% ≥ 80. In conclusion, cMVV is a useful marker of early respiratory failure in ALS, and is easily derivable from standard PFTs, especially in asymptomatic ALS patients with normal FVC measures. [ABSTRACT FROM AUTHOR]

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

Background: Coal mining in India has a long history of nearly 200 years. Coal mining can also increase the risk of coal workers' pneumoconiosis, asthma, and chronic obstructive pulmonary diseases such as emphysema and chronic bronchitis. Objectives: This study was conducted with the objective of knowing the health effects of coal mining workers. Material and Methods: A cross-sectional study was conducted in an open-cast mine in Eastern India. Two hundred and fifty coal mine workers were included in the study. A questionnaire survey followed by a health examination of the study subjects was carried out. Workers actively involved in mining activity were included in this study. Results: The most common symptom complained by study subjects was musculoskeletal pain (16.8%). As far as the pulmonary function status of study subjects is concerned, about 7% of subjects had a restrictive type of abnormality. Obstructive type of abnormality was also present in a similar number of subjects. Conclusion: The current study has shown a higher prevalence of musculoskeletal pain than the national prevalence. Morbidity is more than the normal population. Health education was imparted among workers regarding chronic diseases and their risk factors. [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]

Purpose: To develop a natural language processing (NLP) tool to extract forced vital capacity (FVC) values from electronic health record (EHR) notes in patients with rheumatoid arthritis‐interstitial lung disease (RA‐ILD). Methods: We selected RA‐ILD patients (n = 7485) in the Veterans Health Administration (VA) between 2000 and 2020 using validated ICD‐9/10 codes. We identified numeric values in proximity to FVC string patterns from clinical notes in the EHR. Subsequently, we performed processing steps to account for variability in note structure, related pulmonary function test (PFT) output, and values copied across notes, then assigned dates from linked administrative procedure records. NLP‐derived FVC values were compared to values recorded directly from PFT equipment available on a subset of patients. Results: We identified 5911 FVC values (n = 1844 patients) from PFT equipment and 15 383 values (n = 4982 patients) by NLP. Among 2610 date‐matched FVC values from NLP and PFT equipment, 95.8% of values were within 5% predicted. The mean (SD) difference was 0.09% (5.9), and values strongly correlated (r = 0.94, p < 0.001), with a precision of 0.87 (95% CI 0.86, 0.88). NLP captured more patients with longitudinal FVC values (n = 3069 vs. n = 1164). Mean (SD) change in FVC %‐predicted per year was similar between sources (−1.5 [30.0] NLP vs. −0.9 [16.6] PFT equipment; standardized response mean = 0.05 for both). Conclusions: NLP of EHR notes increases the capture of accurate, longitudinal FVC values by three‐fold over PFT equipment. Use of this NLP tool can facilitate pharmacoepidemiologic research in RA‐ILD and other lung diseases by capturing this critical measure of disease severity. [ABSTRACT FROM AUTHOR]

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, age-related interstitial lung disease (ILD) with limited therapeutic options. Despite the wide variety of different in vivo models for IPF, these preclinical models have shown limitations that may significantly impair their translational potential. Among the most relevant limitations are the methodologies used to assess the efficacy of anti-fibrotic treatments, that are not the ones used in humans. In this scenario, the goal of the work presented in this paper is to provide translational relevance to the bleomycin (BLM)-induced pulmonary fibrosis mouse model, introducing and validating novel readouts to evaluate the efficacy of treatments for IPF. Methods: The BLM model was optimized by introducing the use of functional assessments such as the Forced Vital Capacity (FVC) and the Diffusion Factor for Carbon Monoxide (DFCO), that are respectively the primary and secondary endpoints in clinical trials for IPF, comparing them to more common readouts such as lung histology, improved by the application of Artificial Intelligence (AI) to detect and quantify fibrotic tissue deposition, and metalloproitenase-7 (MMP-7), a clinical prognostic biomarker. Results: Lung function measurement and DFCO changes well correlated with Ashcroft score, the current gold-standard for the assessment of pulmonary fibrosis in mice. The relevance and robustness of these novel readouts in the BLM model was confirmed by the results obtained testing Nintedanib and Pirfenidone, the only drugs approved for the treatment of IPF patients: in fact, both drugs administered therapeutically, significantly affected the changes in these parameters induced by BLM treatment, with results that closely reflected the efficacy observed in the clinic. Changes in biomarkers such as MMP-7 were also evaluated, and well correlated with the modifications of FVC and DFCO. Conclusion: Novel functional readouts such as FVC and DFCO can be efficiently used to assess pathology progression in the BLM-induced pulmonary fibrosis mouse model as well as compound efficacy, substantially improving its translational and predictivity potential. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) patients often have a lower ability to exercise and muscle weakness, both decreasing their quality of life. The 6 min walk test (6MWT) offers insightful data on the functional capacity of respiratory variables on exercise performance. A significant reduction in oxygen saturation (SpO2) throughout the test signifies a lower tolerance for exercise or additional oxygen requirement. Aims and Objectives: This study focuses to investigate desaturation in COPD patients with normal resting oxygen levels (normoxemic) employing the 6MWT. The objective of the study defines to analyze different clinical parameters such as smoking behavior, 6MWT, and clinical parameters of COPD patients to diagnose respiratory performance. Materials and Methods: Between June 2019 and May 2020 study was conducted on patients presenting to our OPD, who were above 40 years and diagnosed with COPD, with baseline SpO2 =90%. 6MWT was performed on them as per American Thoracic Society guidelines. Noting their distance covered and desaturation if present. Results: The study group included 60 patients; the group was divided into 35 desaturators (DS) and 25 Non-DS (NDS) based on fall in SpO2 during 6MWT, all current smokers were in the DS group and had low body mass index values, DS group covered less distance when compared to NDS, DS had low mean forced vital capacity and forced expiratory volume 1 second values. Conclusion: This study established the relationship between COPD risk variables and 6MWT. The 6MWT was identified as a useful method to examine respiratory performance by noting exercise-induced desaturation and in turn the respiratory capacity among COPD patients. [ABSTRACT FROM AUTHOR]

BackgroundThe relationship between obstructive sleep apnea syndrome (OSAS) and diabetic microangiopathy remains controversial.ObjectiveThis study aimed to use bidirectional two-sample Mendelian Randomization (MR) to assess the causal relationship between OSAS and diabetic microangiopathy.MethodsFirst, we used the Linkage Disequilibrium Score Regression(LDSC) analysis to assess the genetic correlation. Then, the bidirectional two-sample MR study was conducted in two stages: OSAS and lung function-related indicators (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) were investigated as exposures, with diabetic microangiopathy as the outcome in the first stage, and genetic tools were used as proxy variables for OSAS and lung function-related measures in the second step. Genome-wide association study data came from the open GWAS database. We used Inverse-Variance Weighted (IVW), MR-Egger regression, Weighted median, Simple mode, and Weighted mode for effect estimation and pleiotropy testing. We also performed sensitivity analyses to test the robustness of the results. Furthermore, we performed multivariate and mediation MR analyses.ResultsIn the LDSC analysis, We found a genetic correlation between OSAS, FVC, FEV 1, and diabetic microangiopathy. In the MR analysis, based on IVW analysis, genetically predicted OSAS was positively correlated with the incidence of diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic neuropathy (DN). In the subgroup analysis of DR, there was a significant causal relationship between OSAS and background diabetic retinopathy (BDR) and proliferative diabetic retinopathy (PDR). The reverse MR did not show a correlation between the incidence of diabetic microangiopathy and OSAS. Reduced FVC had a potential causal relationship with increased incidence of DR and PDR. Reduced FEV1 had a potential causal relationship with the increased incidence of BDR, PDR, and DKD. Multivariate MR analysis showed that the association between OSAS and diabetic microangiopathy remained significant after adjusting for confounding factors. However, we did not find the significant mediating factors.ConclusionOur results suggest that OSAS may be a cause of the development of diabetic microangiopathy, and OSAS may also be associated with a high risk of diabetic microangiopathy, providing a reference for a better understanding of the prevention of diabetic microangiopathy.

Background/objectiveInsufficiency of respiratory muscles is the most important reason for mortality in the natural history of SMA. Thus, improvement or stabilization of respiratory function by disease-modifying therapies (DMT) is a very important issue.MethodsWe examined respiratory function using forced vital capacity (FVC) in 42 adult SMA patients (2 SMA type 1, 15 SMA type 2, 24 SMA type 3, 1 SMA type 4, median age 37 years, range 17–61 years) treated with nusinersen for a median of 22.1 months (range 2.1 to 46.7 months). Change in FVC was assessed using mixed effects linear regression models.ResultsBaseline FVC differed significantly between SMA type 1 (4.0, 8.0%), 2 (median 22.0%, IQR 18.0–44.0), 3 (median 81.0%, IQR 67.0–90.8) and, respectively, type 4 (84.0%) patients reflecting the heterogeneity of respiratory impairment based on the SMA type in adulthood (p

Abstract Background Forced vital capacity (FVC) reflects respiratory health, but the long-term trend and heterogeneity in FVC of Chinese students were understudied. Methods Data were from Chinese National Survey on Students’ Constitution and Health 1985–2019. Super Imposition by Translation and Rotation model was used to draw FVC growth curves. Sex-, region-, and nationality-heterogeneity in FVC was evaluated. Spearman correlation and generalized additive model was used to reveal influencing factors for FVC. Results Compared to 1985, age at peak FVC velocity was 1.09, 3.17, 0.74, and 1.87 years earlier for urban male, urban female, rural male, and rural female in 2019, respectively. Peak FVC velocity first decreased and then increased during 1985–2019, only male rebounded to larger than 1985 level. FVC declined from 1985 to 2005 and then raised. Males consistently had higher FVC than females, with disparities increasing in the 13–15 age group. Urban students also had higher FVC than rural students. In 2019, FVC difference between 30 Chinese provinces and the national average showed four scenarios: consistently above national average; less than national average until age 18, then above; greater than national average until age 18, then this advantage reversed; less than national average in almost all the age. Most Chinese ethnic minority students had lower FVC levels compared to Han students. Spearman correlation and generalized additive model showed that age, sex, and height were the leading influencing factors of FVC, followed by socioeconomic and environmental factors. Conclusions Chinese students experienced advanced FVC spurt, and there was sex-, region- and nationality-heterogeneity in FVC. Routine measurement of FVC is necessary in less developed areas of China.