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The article discusses the possibilities of functional diagnostics of the respiratory function of the lungs in patients with bronchial asthma and chronic obstructive pulmonary disease. Functional diagnostic methods such as capnometry, spirometry, assessment of lung diffusivity and multiple breath nitrogen washout can be used not only to assess airway dysfunction, but also to monitor the course of the disease. There is a need for further development of methods for studying the respiratory function of the lungs and, if possible, their introduction into everyday clinical practice. The purpose of this review was the possibility of diagnostic tests to assess the ventilation and gas exchange function of the lungs in patients with bronchial asthma and chronic obstructive pulmonary disease.

Background and aims of the study: Type 1 diabetes (T1D) impacts lung function and exercise capacity in adults, but limited information is available in children. We hypothesize that T1D causes alterations in pulmonary function and cardiorespiratory fitness, i.e., exercise capacity, at early stages of the disease, due to the presence of inflammation and vascular damage. Therefore, we aim to investigate pulmonary function before and after exercise in children with T1D as compared to age matched healthy controls. Method: Twenty-four children with T1D and twenty healthy controls underwent body plethysmography, diffusion lung capacity for carbon monoxide and fractional exhaled nitric oxide at rest and after cardio-pulmonary exercise test. Results: In children with T1D, baseline total lung capacity and diffusion lung capacity for carbon monoxide were reduced as compared to healthy controls. Children with T1D also showed a reduced exercise capacity associated with poor aerobic fitness. Accordingly, diffusion lung capacity for carbon monoxide tended to increase with exercise in healthy controls, while no change was observed in children with T1D. Fractional exhaled nitric oxide was significantly higher at baseline and tended to increase with exercise in children with T1D, while no changes were observed in healthy controls. Conclusions: Altered diffusion lung capacity for carbon monoxide, increased fractional exhaled nitric oxide and a poor aerobic fitness to exercise suggests the presence of early pulmonary abnormalities in children with T1D. [ABSTRACT FROM AUTHOR]

Background. Impulse oscillometry (IOS) is an effort independent method of studying lung mechanics. Aim. To study the diagnostic significance of IOS in assessing lung mechanics after COVID-19. Materials and methods. Spirometry, body plethysmography, diffusion test (DLco), IOS parameters were analyzed in 315 patients (the median age 48 years), the median period from the beginning of COVID-19 to the study was 50 days. Statistical analysis included descriptive statistics, correlation analysis and one-dimensional logistic regression analysis with an assessment of odds ratios. Results. In general group, spirometry and body plethysmography parameters were in normal values, while DLCO was reduced in 61% of patients. Parameters of IOS were analyzed in the general group and between the groups, depending on the value of DLco and total lung capacity (TLC): normal or reduced. In general group, reactance area (AX), hererogeneity of resistance Rrs5–Rrs20, resistance at 5 Hz (Rrs5), reactance at 5 Hz (ΔXrs5) were increased in 29.8%, 17.8%, 6%, 4.8% of patients, respectively, and were statistically significantly higher in the group with reduced TLC, whereas in the group with reduced DLco AX, Rrs5–Rrs20 were statistically significantly higher. Logistic regression analysis showed that patients with Rrs5-Rrs200.07 kPa×sec/l or AX0.32 kPa/l had a 1.99-fold and 2.24-fold increased risk for decrease DLco, respectively, while the risk of decrease in TLC was 2.25-fold (p=0.012) and 3.16-fold (p0.001) higher, respectively. Conclusion. IOS allow to detect both dysfunction of small airways (if AX or Rrs5–Rrs20 are increased) and the risk of restrictive pattern and lung diffusion impairment after COVID-19.

Background. Gunshot injuries occupy one of the leading places in a number of injuries (combat injuries) that occur in military conflicts. Aim. To study the effect of gunshot wounds of the chest (penetrating and non-penetrating), as well as closed chest trauma on the respiratory function. Materials and methods. The study included 78 patients with a diagnosis of combined trauma, including a gunshot penetrating/non-penetrating wound of the chest or closed chest injuries. The median period from injury to the time of lung function tests was 17 [15; 22] days. Results. A prospective cross-sectional study was performed. All patients (100% males) underwent spirometry, body plethysmography, and diffusion test. The total sample was divided into two groups: group 1 (median age 27.5 [23.0; 36.0] years) 68 patients with gunshot penetrating chest wound, group 2 (median age 26.5 [20.0; 30.5] years) 10 patients with gunshot non-penetrating wound or closed chest trauma. In group 1, the medians of the vital capacity, forced vital capacity, inspiratory capacity, forced exhalation volume in 1 second, lung diffusion capacity (determined by the value of the carbon monoxide transfer-factor DLCO) and alveolar volume were reduced. In group 2, pulmonary ventilation parameters were within normal values while the median of DLCO was reduced. There were no statistically significant differences between the groups. Conclusion. Both gunshot penetrating wounds of the chest and gunshot non-penetrating wounds of the chest and closed chest injuries have a negative impact, including on the respiratory function, to a greater extent on lung diffusion capacity. It is necessary to create programs of drug correction and longer rehabilitation treatment of this category of patients.

Systemic scleroderma (SSD) is a rare immune-inflammatory systemic disease of connective tissue with a typical lesion of skin, blood vessels, musculoskeletal system and internal organs (lungs, heart, digestive tract, kidneys). The SSD pathogenesis is based on activation of a cascade of complex immune interactions that lead to vasculopathy. The presence of many pathophysiological links in the progression of the disease causes a variety of clinical manifestations in various patients with SSD. A full assessment of all stages of SSD development is still being carried out and every newly open element of the interaction of immunological subjects completes the overall picture of the disease. A number of studies show a correlation between level of several biomarkers and both disease prognosis and estimated therapy effectiveness. Recent data confirm importance of the biomarkers for formation of patterns of a particular disease phenotype in a specific patient. Depending on relation of the biomarkers to various biological processes, several of their categories are distinguished: biomarkers expressed in lung tissue, cellular units of immunity, nucleic acids, acute phase indicators, connective tissue growth factors, matrix proteinases and their inhibitors, chemokines and cytokines, as well as biomarkers of endothelial activation. Discovery of a novel set of the indicators can be decisive in determining the management tactics and forecasting the response to therapy of some groups of patients with SSD. By combining the most recent data on significant markers obtained in the framework of extensive studies, we have described the most significant biomarkers of SSD and their link to interstitial lung disease (ILD) that is formed in SSD.

Exposure to fine particulate matter (PM2.5) impairs the respiratory system and increases the morbidity and mortality of respiratory diseases. Even though aerobic exercise is known to improve pulmonary function in diverse populations, it can lead to an increase in the inhalation of PM2.5 in polluted environments. We aimed to investigate the effects of aerobic exercise under high PM2.5 conditions on the pulmonary function in young adults. Nine healthy young men performed indoor treadmill running in both high and low PM2.5 conditions (59.0 ± 2.1 vs. 7.8 ± 1.0 μg/m3) by a crossover study design. Pulmonary function was assessed by spirometry and diffusing capacity for carbon monoxide (DLCO) at pre- and 1-h post-exercise. There was no difference in the response of pulmonary function and lung diffusion capacity to the acute aerobic exercise in high and low PM2.5 conditions (p ≥ 0.09). These findings indicate that aerobic exercise in high PM2.5 conditions may not adversely affect pulmonary function in healthy young adults. [ABSTRACT FROM AUTHOR]

Exposure to fine particulate matter (PM2.5) impairs the respiratory system and increases the morbidity and mortality of respiratory diseases. Even though aerobic exercise is known to improve pulmonary function in diverse populations, it can lead to an increase in the inhalation of PM2.5 in polluted environments. We aimed to investigate the effects of aerobic exercise under high PM2.5 conditions on the pulmonary function in young adults. Nine healthy young men performed indoor treadmill running in both high and low PM2.5 conditions (59.0 ± 2.1 vs. 7.8 ± 1.0 μg/m3) by a crossover study design. Pulmonary function was assessed by spirometry and diffusing capacity for carbon monoxide (DLCO) at pre- and 1-h post-exercise. There was no difference in the response of pulmonary function and lung diffusion capacity to the acute aerobic exercise in high and low PM2.5 conditions (p ≥ 0.09). These findings indicate that aerobic exercise in high PM2.5 conditions may not adversely affect pulmonary function in healthy young adults.

Coronavirus disease 2019 (COVID-19) survivors are reporting residual abnormalities after discharge from hospital. Limited information is available about this stage of recovery or the lingering effects of the virus on pulmonary function and inflammation. This study aimed to describe lung function in patients recovering from COVID-19 hospitalization and to identify biomarkers in serum and induced sputum samples from these patients. Patients admitted to Spanish hospitals with laboratory-confirmed COVID-19 infection by a real-time PCR (RT-PCR) assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited for this study. Each hospital screened their lists of discharged patients at least 45 days after symptom onset. SARS-CoV-2-infected patients were divided into mild/moderate and severe disease groups according to the severity of their symptoms during hospitalization. Patients' epidemiological and medical histories, comorbidities, chronic treatments, and laboratory parameters were evaluated. Pulmonary function tests, the standardized 6-minute walk test (6MWT) and chest computed tomography (CT) were also performed. The levels of proteases, their inhibitors, and shed receptors were measured in serum and induced sputum samples. A total of 100 patients with respiratory function tests were included in this study. The median number of days after the onset of symptoms was 104 (IQR 89.25, 126.75). COVID-19 was severe in 47% of patients (47/100). CT was normal in 48% of patients (48/100). Lung function was normal forced expiratory volume in one second (FEV1) ≥80%, forced vital capacity (FVC) ≥80%, FEV1/FVC ≥0.7, and diffusing capacity for carbon monoxide (DLCO) ≥80% in 92% (92/100), 94% (94/100), 100% (100/100) and 48% (48/100) of patients, respectively. Multivariate analysis showed that a DLCO <80% (OR 5.92; 95%CI 2.28–15.37; p < 0.0001) and a lower serum lactate dehydrogenase level (OR 0.98; 95%CI 0.97–0.99) were associated with the severe disease group of SARS-CoV-2 cases during hospital stay. A diffusion deficit (DLCO <80%) was still present after hospital discharge and was associated with the most severe SARS-CoV-2 cases. [ABSTRACT FROM AUTHOR]

Abstract Background Chronic diabetic complications may afflict all organ tissues, including those of the respiratory system. The six-minute walk test (6MWT) is an alternative and widely used method of assessing functional capacity and is simple to perform. However, to our knowledge, the impact of diabetes mellitus on 6MWT performance has not been investigated previously. This research aimed to compare the functional exercise capacity and pulmonary functions in patients with diabetes and in healthy persons. Methods The study included 131 participants: 64 patients with type 1 and 2 diabetes mellitus (DM) and 67 healthy participants (CG). All of the participants were nonsmoking and did not have pulmonary disorders that affected the pulmonary function tests or 6MWT. Metabolic parameters and biochemical markers of inflammation were assessed. Full lung function tests and a 6MWT were performed. Results In the DM group, the walking distance was 109 m shorter than that in the CG (P

Diffusion capacity is useful for measuring ability of pulmonary microcirculation to transfer oxygen and carbon dioxide from alveoli to capillaries. Physiological examination of diffusion is a continuation of physiological examination of ventilation. Diffusion capacity is measured by DLCO (Diffusing capacity for Carbon Monoxide). Measurement of oxygen diffusion capacity directly is very difficult so that indirect methods are used using carbonmonoxide (DLCO). Diffusion capacity of oxygen is equivalent to DLCO multiplied by 1.23. Normal value of DLCO is 20-30 ml/minute mmHg. Some factors that affect DLCO are Hb levels, COHb in smokers, and alveolar volume. Some techniques for measuring DLCO include Steady-state, Three-equation Single-breath, Nitrogen Washout, and Intra-breath DLCO. This test is indicated in pulmonary parenchymal disease (pulmonary fibrosis, asbestosis, sarcoidosis, interstitial lung disease), cystic fibrosis, pulmonary hypertension, and pulmonary bleeding. DLCO is increased in asthma patients, obesity, polycythemia, intraalveolar bleeding, and right-left heart shunting. DLCO is decreased in emphysematous lung patients, pulmonary post resection, bronchial obstruction, multiple pulmonary embolism, anemia, idiopathic pulmonary fibrosis, asbestosis, sarcoidosis, vascular collagen disease, hypersensitive pneumonitis, and alveolar proteinosis.

Pulmonary arterial hypertension (PAH) is a progressive and irreversible disease characterized by a steady increase in pulmonary vascular resistance (PVR) and death. Introduction of current PAH-specific drugs has not solved the problem of follow-up of critical patients with PAH associated with systemic sclerosis (SSc). Clinical trials have shown that 1-, 2- and 3-year survival rates are 77, 46, and 33%, respectively. Arguments in favor of starting triple PAH-specific therapy that substantially improves the prognosis of this critical group of patients are being accumulated. The paper describes Russia’s first clinical case of successful up-front triple combination therapy (iloprost, bosentan and sildenafil) in a 40 year old female with SSc and diagnosed functional class (FC) IV PAH. There were clinical, laboratory, and hemodynamic improvements already at 2 weeks after therapy initiation. Thirty-month therapy resulted in a reversal of FC from IV to II, relieved the signs of right ventricular failure, complete right ventricular reverse remodeling and subnormalization of hemodynamic parameters. Hemodynamic improvement including reductions in right atrial pressure to 4 mm Hg, mean pulmonary arterial pressure to 26 mm Hg, and PVR to 2.2 Wood units and an increase in cardiac output up to 7.4 l/min, despite preserved elevated uric acid levels (432 μmol/l). The intriguing feature of this case is critically low values of % predicted/carbon monoxide lung diffusion capacity, which rose from 17% to only 22%, in the presence of positive changes. This clinical case demonstrates the predictive capabilities of up-front triple combination therapy for severe PAH associated with SSc.

Study Question: What is the functional relevance of decreased pulmonary vascular distensibility in adolescents conceived by IVF?Summary Answer: Children born by IVF have a slight decrease in pulmonary vascular distensibility observed during normoxic exercise that is not associated with altered right ventricular function and aerobic exercise capacity.What Is Known Already: General vascular dysfunction and increased hypoxic pulmonary hypertension have been reported in ART children as compared to controls. Pulmonary hypertension or decreased pulmonary vascular distensibility may affect right ventricular function and thereby possibly limit maximal cardiac output and aerobic exercise capacity.Study Design, Size, Duration: This prospective case-control study enrolled 15 apparently healthy adolescents conceived by IVF/ICSI after fresh embryo transfer paired in a 2 to 1 ratio to 30 naturally conceived adolescents between March 2015 and May 2018.Participants/materials, Setting, Methods: Fifteen IVF/ICSI adolescents and 30 controls from singleton gestations matched by age, gender, weight, height and physical activity underwent exercise echocardiography, lung diffusion capacity measurements and a cycloergometer cardiopulmonary exercise test. A pulmonary vascular distensibility coefficient α was determined from the pulmonary arterial pressure (PAP) versus cardiac output (Q) relationships. Pulmonary capillary volume (Vc) was calculated from single breath nitric oxide and carbon monoxide lung diffusion capacity measurements (DLCO and DLNO) at rest and during exercise (100 W). Eight of the IVF subjects and eight controls underwent a 30 min hypoxic challenge at rest with a fraction of inspired oxygen of 0.12 to assess hypoxic pulmonary vasoconstriction.Main Results and the Role Of Chance: In normoxia, oxygen uptake (VO2), blood pressure, DLCO, DLNO, echocardiographic indices of right ventricular function, Q and PAP at rest and during exercise were similar in both groups. However, IVF children had a lower pulmonary vascular distensibility coefficient α (1.2 ± 0.3 versus 1.5 ± 0.3%/mmHg, P = 0.02) and a blunted exercise-induced increase in Vc (24 versus 32%, P < 0.05). Hypoxic-induced increase in pulmonary vascular resistance in eight IVF subjects versus eight controls was similar.Limitations, Reasons For Caution: The IVF cohort was small, and thus type I or II errors could have occurred in spite of careful matching of each case with two controls. ART evolved over the years, so that it is not certain that the presently reported subtle changes will be reproducible in the future. As the study was limited to singletons born after fresh embryo transfers, our observations cannot be extrapolated to singletons born after frozen embryo transfer.Wider Implications Of the Findings: The present study suggests that adolescents conceived by IVF have preserved right ventricular function and aerobic exercise capacity despite a slight alteration in pulmonary vascular distensibility as assessed by two entirely different methods, i.e. exercise echocardiography and lung diffusing capacity measurements. However, the long-term prognostic relevance of this slight decrease in pulmonary vascular distensibility needs to be evaluated in prospective large scale and long-term outcome studies.Study Funding/competing Interest(s): Dr Caravita was supported by an ERS PAH short term research training fellowship (STRTF2014-5264). Dr Pezzuto was funded by an Italian Society of cardiology grant. Dr Motoji was supported by a grant from the Cardiac Surgery Funds, Belgium. All authors have no conflicts of interests to declare. [ABSTRACT FROM AUTHOR]

Childhood leukaemia survivors (CLS) are known to have developed long-term impairment of lung function. The reasons for that complication are only partially known. The aims of this study were to assess pulmonary function in CLS and identify (1) risk factors and (2) clinical manifestations for the impairment of airflow and lung diffusion. The study group included 74 CLS: 46 treated with chemotherapy alone (HSCT-), 28 with chemotherapy and haematopoietic stem cell transplantation (HSCT+), and 84 healthy subjects (control group (CG)). Spirometry and diffusion limit of carbon monoxide (DLCO) tests were performed in all subjects. Ten (14%) survivors had restrictive, five (7%) had obstructive pattern, and 47 (66%) had reduced DLCO. The age at diagnosis, type of transplant, and type of conditioning regimen did not significantly affect the pulmonary function tests. The DLCO%pv were lower in CLS than in CG (p < 0.03) and in the HSCT+ than in the HSCT- survivors (p < 0.05). The pulmonary infection increased the risk of diffusion impairment (OR 5.1, CI 1.16-22.9, p = 0.019). DLCO was reduced in survivors who experienced CMV lung infection (p < 0.001). The main symptom of impaired lung diffusion was poor tolerance of exercise (p < 0.005). The lower lung diffusion capacity is the most frequent abnormality in CLS. HSCT and pulmonary infection, in particular with CMV infection, are strong risk factors for impairment of lung diffusion capacity in CLS. Clinical manifestation of DLCO impairment is poor exercise tolerance. A screening for respiratory abnormalities in CLS seems to be of significant importance. [ABSTRACT FROM AUTHOR]

The damage of the respiratory system is a quite common extra-articular manifestation of rheumatoid arthritis (RA). It is important to note that its clinical symptoms occur in only 20–30% of patients; however, subclinical forms identified by active screening are observed in 70–80% of patients.Objective: to compare the significance of pulmonary complaints, the results of physical examination, and the data of instrumental studies for the detection of lung injury in patients with RA.Subjects and methods. The study enrolled 70 RA patients (63 women and 7 men) aged 24 to 83 years. Only 10% of them had clinically evident lung injury associated with RA. Patients with other pulmonary diseases, such as asthma, chronic obstructive pulmonary disease, etc., were excluded. Physical examination, radiography/fluoroscopy, high-resolution computed tomography (HRCT), single-photon emission computed tomography (SPECT) of the lung, and lung function testing (LFT) with the determination of lung diffusion capacity.Results and discussion. The data of physical examination were nonspecific and unconvincing. Pulmonary complaints (dyspnea, cough, expectoration) were seen in 65% of the patients; an objective assessment revealed changes (vesiculotympanitic resonance, harsh breathing, and pleural friction rub) in 40%. The X-ray films/fluorograms displayed abnormalities (pulmonary fibrosis, focal changes) in only 10% of cases. 92% of the patients had lung HRCT changes including moderate (bronchial obstruction (40%), rheumatoid nodules (10%), ground glass opacities (60%), bronchial thickening (20%), pleural effusion (10%), tree-in-bud opacities (3%)) and severe (pulmonary hypertension (10%), bronchiectasis (10%), emphysema (5%) and lung tissue fibrotic changes as the honeycomb lung (2%)) ones. SPECT showed local hypoperfusion in the mantle and mediastinal parts of the lungs in 80% of cases. LFT analysis demonstrated reduced lung diffusion capacity in 41% of the patients, restrictive disorders in 30%, and bronchial obstruction in 70%. Conclusion. Comparing the clinical and instrumental findings permits one to diagnose subclinical lung injury in patients with RA. Thus, the early detection of pulmonary involvement in RA requires the use of more sensitive methods.

Purpose Central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) are highly prevalent in heart failure (HF) and are linked to increased mortality. Impaired pulmonary diffusion capacity [DLCO] and [KCO]) have been suggested to play a key role in CSA-CSR pathophysiology. This study investigated the relationship between HF, CSR, DLCO and KCO in well-characterized HF patients. Methods This prospective study included HF patients with CSR, all patients underwent full overnight polysomnography (PSG) and lung function testing. Results A total of 100 patients were included (age 70.7 ± 9.7 years, 95% male, body mass index 28.9 ± 5.3kg/m 2 , left ventricular ejection fraction 33.5 ± 7.7%, New York Heart Association class III 65%. DLCO and oxygenation were significantly correlated with hypoxemic burden (p < 0.05). Mean oxygen saturation, oxygen desaturation, C-reactive protein level and pH were significantly associated with CSA-CSR severity (p < 0.05). Conclusion The finding that lung diffusion capacity is significantly associated with hypoxemic burden in HF patients with CSA-CSR highlights the important of lung function in HF patients. [ABSTRACT FROM AUTHOR]

Aim. To assess the differences in the lung diffusion capacity and non-specific inflammation markers among patients with coronary heart disease (CHD) and the combination of CHD and Type 2 diabetes mellitus (DM-2). Material and methods. The study included 70 CHD patients: with DM-2 (n=40; 57,1%) and without DM-2 (n=30; 42,9%). Lung diffusion capacity (DIco) was assessed with the single-breath method and subsequent correction by haemoglobin levels (DIco cor). The levels of the following non-specific inflammation markers were also assessed: IL-1

High gestational loads have been associated with a range of ecological costs, such as decreased locomotor ability; however, the physiological mechanisms that underpin these changes are poorly understood. In this study, breathing patterns, metabolic rates, lung volume and lung diffusing capacity were measured at rest and during exercise in the pregnant skink Tiliqua nigrolutea. Breathing patterns were largely unaffected by gestation; however, decreases in metabolic rate (rate of oxygen consumption) in the late stages of pregnancy induced a relative hyperventilation. The reductions in metabolic rate during late pregnancy prevent the calculation of the maintenance cost of pregnancy based on post-partum and neonatal metabolic rates. Despite the high relative litter mass of 38.9±5.3%, lung diffusing capacity was maintained during all stages of pregnancy, suggesting that alterations in diffusion at the alveolar capillary membrane were not responsible for the relative hyperventilation. Lung volume was increased during pregnancy compared with non-pregnant females, but lung volume was significantly lower during pregnancy compared with post-partum lung volume. Pregnant females were unable to produce the same metabolic and ventilatory changes induced by exercise in nonpregnant females. This lack of ability to respond to increased respiratory drive during exercise may underpin the locomotor impairment measured during gestation in previous studies. [ABSTRACT FROM AUTHOR]

Resting lung diffusing capacity (DLCO) decreases during the early and late-follicular phases of the menstrual cycle presumably due to capillary blood volume ( V C ) changes; however, it is not known if these differences exist during exercise. We hypothesized that DLCO would increase during the mid-luteal phase of the menstrual cycle due to increases in V C . Eight normally menstruating females (21.4 ± 0.7 yrs) were studied. Subjects completed a discontinuous treadmill V ˙ O 2max test during the early-follicular (EF), late-follicular (LF), and mid-luteal (ML) phases of the menstrual cycle. Metabolic measurements were made from a breath-by-breath automated cart, and DLCO via the single-breath exhalation technique during exercise. During exercise, DLCO was lesser during EF compared to ML at 90% and 100% V ˙ O 2max ( p < 0.05) (90%: 37.8 ± 3.7 EF vs 41.6 ± 4.0 ML, 100%: 37.7 ± 3.7 EF vs 42.6 ± 4.3 ML mL/mmHg/min). V C was significantly greater during the ML phase when compared to the EF at 80%, 90%, and 100% V ˙ O 2max . These results demonstrate DLCO and V C are influenced by the menstrual cycle during heavy exercise. [ABSTRACT FROM AUTHOR]

Background and Aims Albinterferon is a fusion of albumin and interferon-α2b developed to improve the pharmacokinetics, convenience, and potential efficacy of interferon-α for the treatment of chronic hepatitis infections. Methods This open-label, randomized, active-controlled, multicenter study investigated the safety and efficacy of albinterferon in patients with chronic hepatitis B virus ( HBV) infection who were e-antigen ( HBeAg) positive. One hundred and forty-one patients received one of four albinterferon doses/regimens or pegylated-interferon-α2a. Primary efficacy outcomes were changes in serum HBeAg and antibody, HBV- DNA, and alanine aminotransferase. Principal safety outcomes were changes in laboratory values, pulmonary function, and adverse events. Results The study was prematurely terminated as phase III trials in hepatitis C infection indicated noninferior efficacy but inferior safety compared with pegylated-interferon-α2a. Here, all treatment groups had a significant reduction in HBV- DNA from baseline. Reductions in HBV- DNA were not significantly different, except the 1200 μg every 4 weeks albinterferon dose which was inferior compared with pegylated-interferon-α2a. The serum alanine aminotransferase levels decreased in all arms. The per-patient incidence of adverse events was not significantly different for albinterferon (96.4-100%) and pegylated-interferon-α2a (93.1%). Total adverse events, however, were higher for albinterferon and correlated to dose. Decreased lung function was found in all arms (∼93% of patients), and was more common in some albinterferon groups. Conclusions Albinterferon doses with similar anti- HBV efficacy to pegylated-interferon-α2a had higher rates of certain adverse events, particularly changes in lung diffusion capacity ( number NCT00964665). [ABSTRACT FROM AUTHOR]

Background: No biological marker is currently available for evaluating pulmonary involvement and/or for monitoring the clinical course of sarcoidosis. The present pilot study focused on possible relationships between circulating plasma levels of surfactant protein type B (SP-B) and plasma receptor for advanced glycation end products (RAGE) and lung function abnormalities in patients with pulmonary sarcoidosis, since both SP-B and RAGE have been previously suggested as lung injury markers. The plasmatic levels of these two proteins were also investigated with respect to functional capacity, as assessed by a cardiopulmonary exercise test (CPET). Methods: Thirty pulmonary sarcoidosis outpatients and fifteen volunteers (Control Group) underwent lung function tests and CPET. Resting SP-B and RAGE plasma levels were also determined. Patients were then categorized according to the severity of their pulmonary involvement, as assessed in terms of lung diffusion for carbon monoxide (DLCO) values. Results: Group B showed SP-B levels higher and RAGE levels lower than Group A and Control Group (p < 0.01). Group A showed lower RAGE levels than Control Group (p < 0.01), whereas SP-B levels did not differ between these two groups. A significant univariate relationship was found between both SP-B and RAGE and several lung function data, particularly with DLCO (SP-B Vs DLCO: r: -0.437, p = 0.016; RAGE Vs DLCO: r: -0.451, p = 0.012). Conclusions: Circulating plasma levels of SP-B and RAGE showed an opposite behavior in patients with pulmonary sarcoidosis. SP-B values are directly related to alveolar unit damage, supporting a possible role of SP-B as a marker of disease severity in these patients. Differently, RAGE decreases in severe sarcoidosis, suggesting more complex underlying mechanisms. [ABSTRACT FROM AUTHOR]

Abstract: Background: Lung diffusion for carbon monoxide (DLCO) has been shown to associate with the risk of pulmonary arterial hypertension development and, most likely, with right ventricular (RV) myocardial dysfunction in sarcoidosis patients. Besides its known role as a marker of left ventricular dysfunction, experimental evidence suggests a role of NT-proAtrial Natriuretic Peptide (NT-proANP) also in modulating pulmonary circulation. We therefore investigated possible relationships between NT-proANP, lung diffusion impairment and RV dysfunction. Methods: Thirty-two pulmonary sarcoidosis outpatients and eighteen volunteers underwent full clinical assessment, including full lung function tests and Doppler echocardiography integrated with tissue Doppler imaging (TDI) study. Resting circulating NT-proBNP and NT-proANP plasma levels were also determined. Results: NT-proANP and RV-myocardial performance index (RV-MPI) were significantly higher in those patients with the greatest DLCO impairment, whereas no differences were found for NT-proBNP values. At multivariable analysis, only DLCO (β: −0.496; standard error: 3.38; p=0.000) and RV-MPI (β: 0.373; standard error: 6.56; p=0.031) remained significantly associated with NT-proANP levels. Conclusions: Our finding may support a key role of NT-proANP in the complex mechanisms underlying modulation of lung function. An early increase in pulmonary vascular resistance may stimulate NT-proANP increase, thus explaining its association with signs of early RV myocardial dysfunction. This hypothesis warrants further confirmation. [Copyright &y& Elsevier]

Abstract: The effects of repeated short-term hypoxia on exercise tolerance in patients at risk for, or with mild COPD were investigated. Eighteen patients (10 males, 8 females; 33–72 years) were randomly assigned in a double-blind fashion to receive 15 sessions of intermittent hypoxia (FiO2: 0.15–0.12) or normoxia within 3 weeks. Three weeks of intermittent hypoxia increased total haemoglobin mass (+4% vs. 0%, p <0.05), total exercise time (+9.7% vs. 0%, p <0.05) and the exercise time to the anaerobic threshold (+13% vs. −7.8%, p <0.05) compared to controls. Changes in the total exercise time were positively related to the changes in total haemoglobin mass (r =0.59, p <0.05) and changes in the time to the anaerobic threshold were positively related to the changes in the lung diffusion capacity for carbon monoxide (r =0.48, p <0.05). Intermittent hypoxia treatment may be a valuable addition to therapy designed to improve exercise tolerance in patients at risk for, or with mild COPD. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of this study is to evaluate the long-term respiratory outcome of patients who underwent pneumonectomy for non-small cell lung cancer (NSCLC), analysing functional tests. Materials and methods: Twenty-seven consecutive patients who were candidates for pneumonectomy performed spirometry before and at least 24 months after surgery in the same laboratory. Diffusion of carbon monoxide and the most common dynamic and static lung volumes were evaluated in percentage of predicted and compared. Results: A significant inverse correlation was observed between the preoperative FEV1 (%) and FVC (%) and their postoperative loss, respectively r =−641 (p <0.0001) and r =−789 (p <0.0001). Also the correlation between the RV/TLC ratio and the FEV1 loss confirmed a better postoperative outcome in patients with major airway obstruction (p =0.02). To investigate these data, the series were divided into two groups: group A included BPCO patients with a FEV1 lower than 80%, the others were considered group B. Group B showed a significant major postoperative FEV1 (%) and FVC (%) impairment, 31% versus 12%, p =0.005, and FVC (%) loss, 37% versus 16% (p =0.02), meanwhile group A showed a significant major postoperative RV (%) reduction, 43% versus 17%, p =0.03. Despite being significantly higher preoperatively in BPCO patients, the RV% becomes similar between the two groups in the postoperative. Conclusions: In our experience patients with major preoperative airway obstruction who underwent pneumonectomy had lower impairment in FEV1% at almost one year after surgery than those with normal respiratory function. The resection of a certain amount of non-functional parenchyma associated with the mediastinal shift, with an improvement of the chest cavity for the remaining lung, could give a reduction volume effect in BPCO/emphysematous patients. [Copyright &y& Elsevier]

Chronic exposure to tobacco smoking may damage lung and heart function. The aim of this study was to assess maximal exercise capacity and its relationship with lung function in apparently healthy smokers. We recruited 15 heavy smokers (age 47 years ± 7, BMI 25 kg/m² ± 3, pack/years 32 ± 9) without any cardiovascular or pulmonary signs and symptoms. Fifteen healthy non smoking subjects were enrolled as a control group. All subjects underwent pulmonary function tests, electrocardiograms at rest and graded cycle exercise tests. In smokers and controls, resting lung and cardiac function parameters were in the normal range, apart from diffusing lung capacity (TLCO) values which were significantly lower in smokers (p < 0.05). As compared to controls, smokers presented lower maximal exercise capacity with lower values at peak of exercise of oxygen uptake (peak VO2), workload, oxygen uptake/watt ratio and oxygen pulse (p < 0.05) and higher dyspnoea perception (p < 0.05). Moreover, peak VO2, maximal workload and oxygen pulse at peak exercise were related to and predicted by TLCO (p < 0.05). Our study confirms that maximal exercise capacity is reduced in apparently healthy heavy smokers, and shows that TLCO explains some of the variance in maximal exercise. [ABSTRACT FROM AUTHOR]

Arterial desaturation during exercise is common in endurance-trained athletes, a phenomenon often more pronounced when the muscle mass engaged in the exercise is large. With this background, the present study monitored seven international-level cross country skiers performing on a treadmill while running (RUN), double poling (DP; upper body exercise) and diagonal skiing (DIA; arm and leg exercise). Static and dynamic lung function tests were performed and oxygen uptake was measured during submaximal and maximal exercise. Lung function variables (including the diffusion capacity) were only 5–20% higher than reported in sedentary men. Vital capacity was considerably lower than expected from the skiers' maximal oxygen uptake (VO2max), but the maximal ventilation followed a linear relationship with VO2max. None or only a mild desaturation was observed in DP, RUN and DIA. Blood lactate concentration was slightly higher in DIA than in DP but not different from RUN. In DIA, VO2max was 6.23 ± 0.47 L/min (mean ± SD), which was 3.8% and 13.9% higher than in RUN and DP, respectively, with similar peak heart rates for the three exercise modes. No relationships were present either between the degree of desaturation and pulmonary functions tests, or with peak oxygen uptakes. The low blood lactate accumulation during the exhaustive efforts contributed to the arterial oxygen saturation being mild in spite of the very high oxygen uptake observed in these skiers. [ABSTRACT FROM AUTHOR]

The article presents information on smoking, which can also cause asthma and its response to treatment by influencing the underlying airway inflammatory process. Variable airway obstruction and hyperresponsiveness attributed to an underlying inflammatory process and bronchial structural changes characterize asthma, a common chronic inflammatory condition. It is seen that in asthma patients, smoking is highly prevalent. In fact, many asthmatic smokers do not want to believe they are at any personal risk from smoking. Nonasthmatic smokers frequently show signs of small-airways dysfunction, airway hyperresponsiveness, and a reduction of bronchodilator response.

Aims To evaluate whether anti-aldosteronic treatment influences lung diffusion (DLCO) in chronic heart failure (HF) patients. Spironolactone improves clinical conditions and prognosis in chronic HF and reduces connective tissue matrix turnover; DLCO abnormalities in chronic HF are related to increase in fibrosis and connective tissue derangement. [ABSTRACT FROM PUBLISHER]

: BackgroundIn type II diabetes mellitus there are few data concerning pulmonary function abnormalities. In normal subjects and in patients with primary Raynaud phenomenon, cold pressor test induces a decrease in carbon monoxide single-breath diffusing capacity (DL,co) but not in secondary Raynaud phenomenon. Our objective was to assess evaluation of lung diffusion capacity postural changes in diabetes mellitus and in secondary Raynaud phenomenon, two diseases with different pulmonary capillaries functional disorders.: MethodsTwenty-five patients with type II diabetes mellitus (mean age 52.24 years), 17 patients with secondary Raynaud phenomenon (mean age 47.06 years), non-smokers without pulmonary or heart disease, and 26 healthy matched subjects (mean age 47.50 years) underwent lung diffusion capacity measurements by single-breath method also corrected by alveolar volume (DL,co) in sitting and supine positions.: ResultsPatients with diabetes mellitus exhibited lower values of DL,co and DL,co/VA measurements in comparison with subjects with Raynaud phenomenon and control group (p <0.01). Additionally, they had a significant decrease in DL,co in supine compared to sitting position (83.88 ± 16.53 vs. 89.68 ± 18.03, p = 0.023). To the contrary, supine position in secondary Raynaud phenomenon and in control group after cold pressor test showed a significant increase in DL,co/VA (120.93 vs. 109.78 in Raynaud and 114.36 vs. 99.47 in control group, p <0.001).: ConclusionsPostural changes of lung diffusion capacity could be used as a simple, non-invasive method to detect vascular disease resulting from different pathophysiologic mechanisms such as diabetes mellitus and Raynaud phenomenon. [Copyright &y& Elsevier]