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At least 235 records · Page 13Linked to original sources

PubMed1994

Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: II. Follow up of affected workers by questionnaire, spirometry, and assessment of bronchial responsiveness 18 to 24 months after exposure ended.

OBJECTIVE: The aim was to determine the prevalence of persistent respiratory symptoms and bronchial hyper-responsiveness due to reactive airways dysfunction syndrome in a population of construction workers at moderate to high risk of developing the syndrome, at an interval of 18 to 24 months after multiple exposures to chlorine gas during renovations to a pulp and paper mill. DESIGN AND PARTICIPANTS: 71 of 289 exposed workers (25%) were identified on the basis of an exposure and the onset of respiratory symptoms shortly after this event (moderate to high risk). A standardised respiratory questionnaire was first presented, followed by spirometry and a methacholine inhalation test on those whose questionnaire suggested the persistence of respiratory symptoms. RESULTS: 64 of 71 (90%) subjects completed the respiratory questionnaire at the time of the follow up. The questionnaire suggested a persistence of respiratory symptoms in 58 of the 64 workers (91%). Of the 58 subjects, 51 underwent spirometry and assessment of bronchial responsiveness. All of them used bronchodilators as required (not regularly) and four required inhaled anti-inflammatory preparations. Sixteen had bronchial obstruction (forced expiratory volume in one second) (FEV1 < 80% predicted) and 29 showed significant bronchial hyper-responsiveness. CONCLUSION: Of the subjects (n = 71) who were at moderate to high risk of developing reactive airways dysfunction syndrome after being exposed to chlorine and were seen 18 to 24 months after exposure ended, 58 (82%) still had respiratory symptoms, 16 (23%) had evidence of bronchial obstruction, and 29 (41%) had bronchial hyper-responsiveness.

Adult↗

PubMed1991

Lung function abnormalities and decline of spirometry in scleroderma: an overrated danger?

To document the prevalence and progression of pulmonary involvement in scleroderma (systemic sclerosis including the CREST syndrome), the clinical notes and lung function records of 113 cases were reviewed. Lung function was normal in 39 cases, isolated impairment of DLCO was found in 38 patients, a restrictive defect was present in 27 cases and there was evidence of airflow obstruction in 9 cases. The median duration of symptoms was 10 years. Dyspnoea and an interstitial pattern on chest X-ray were associated with impaired lung function. Death during the period of review was significantly related to initial impairment of the DLCO. Sixty-six patients (53 women and 13 men) underwent repeat spirometry at least 1 year after initial testing. The rates of change in VC and FEV1 were no more rapid than would be expected for normal subjects. There was no significant difference in rates of change between men and women or between dyspnoeic patients and those who were asymptomatic. The extent of skin involvement and the presence of interstitial fibrosis on chest X-ray were unrelated to the rate of loss of lung function. It is concluded that most scleroderma patients in this study had abnormal lung function when first tested, but overall significant worsening of spirometry was not found.

Adolescent↗

PubMed1986

Quantitative assessment of the value of spirometry.

To determine the value of simple spirometric measurements in the diagnostic assessment of breathless patients, doctors requesting such tests were asked to predict the likely ventilatory abnormality, expressing these pretest predictions as probabilities. Comparison of these pretest predictions with the test results allowed an analysis of the doctors' ability to identify lung function abnormalities and an assessment of the diagnostic usefulness of the test. Predictions and spirometric measurements were made in 123 patients. Doctors expressed preference for a particular spirometric category in 112 cases, of which 13 were predicted to have a restrictive defect, 77 were predicted to have an obstructive defect, and 22 were predicted to be normal. Spirometry showed that nine patients had a restrictive defect, 79 had an obstructive defect, and 24 had normal indices. The study showed that 61% of the tests gave a result that doctors predicted as being unlikely. The study also showed that doctors had difficulty in identifying the reversibility of airflow obstruction in patients in whom they correctly predicted obstruction. Spirometry fulfils a useful role in the diagnosis of breathless patients.

Adolescent↗

PubMed2001

Methacholine versus histamine: paradoxical response of spirometry and ventilation distribution.

We investigated the differential effect of histamine and methacholine on spirometry and ventilation distribution (where indexes S(cond) and S(acin) represent conductive and acinar ventilation heterogeneity; Verbanck S, Schuermans D, Van Muylem A, Noppen M, Paiva M, and Vincken W. J Appl Physiol 83: 1807-1816, 1997). Thirty normal subjects were challenged with cumulative doses of 6.52 micromol histamine and, on a separate day, with either 6.67 micromol methacholine (equal-dose group; n = 15) or 13.3 micromol methacholine (double-dose group; n = 15). Largest average forced expiratory volume in 1 s (FEV(1)) decreases or S(cond) increases obtained in either group were -9% and +286%, respectively; S(acin) remained unaffected at all times. In the equal-dose group, a smaller FEV(1) decline (P = 0.002) after methacholine was paralleled by a smaller S(cond) increase (P = 0.041) than with histamine. However, in the double-dose group, methacholine maintained a smaller FEV(1) decline (P = 0.009) while inducing a larger S(cond) increase (P = 0.006) than did histamine. The differential action of histamine and methacholine is confined to the conductive airways, where histamine likely causes the greatest overall airway narrowing and methacholine induces the largest parallel heterogeneity in airway narrowing, probably at the level of the large and small conductive airways, respectively. The observed ventilation heterogeneities predict a risk for dissociation between ventilation-perfusion mismatch and spirometry, particularly after methacholine challenge.

Bronchoconstrictor Agents↗

PubMed1994

Limitations of spirometry in detecting rejection after single-lung transplantation.

Pulmonary function testing has been extensively studied in the heart-lung transplant (HLT) population and has been advocated as a screening test for rejection or infection; however, few data are available in the single-lung transplant (SLT) population. The effect of acute episodes of infection, rejection, and bronchiolitis on the pulmonary function of 30 SLT patients with varying underlying disease states was prospectively evaluated. The native disease process was obstructive in 17 (SLT-OBS), restrictive in six (SLT-IPF), and pulmonary vascular in seven (SLT-PVD). Rejection was associated with a drop in FVC from 71 +/- 15 to 62 +/- 14% of predicted, with a significant drop seen in all three subgroups. Statistically significant drops in FEV1 were also seen in the SLT-OBS and SLT-PVD subgroups but not in the SLT-IPF subgroup. A drop in FEV25-75% was seen only in SLT-PVD. The greatest fall in FVC, FEV1, and FEF25-75% was seen with bronchiolitis, followed by acute rejection. The sensitivity and specificity of spirometry as a predictor of infection or rejection were significantly lower than those previously reported for HLT, with SLT-PVD having the most and SLT-OBS the least clinically useful values. We conclude that a fall in spirometry is seen in infection and rejection in SLT and that the underlying disease state has a significant influence on the diagnostic utility of specific spirometric indices.

Adult↗

PubMed1994

Bronchial hyperresponsiveness can improve while spirometry plateaus two to three years after repeated exposure to chlorine causing respiratory symptoms.

Repeated exposure to chlorine in pulp mills and paper can induce persistent asthma-like symptoms such as bronchial hyperresponsiveness and variable changes in airway caliber. The long-term time course of bronchial hyperresponsiveness has not been examined. We studied 20 of 29 subjects (69% participation rate) who demonstrated bronchial hyperresponsiveness to methacholine when they were first assessed, 18 to 24 mo after repeatedly inhaling "puffs" of high concentrations of chlorine in a paper mill over a 3-mo period. Each subject answered a respiratory questionnaire and underwent spirometry and a methacholine inhalation test 12 mo after the initial survey, 30 to 36 mo after the chlorine inhalations. Three subjects required inhaled steroids at the time of the initial survey and three at the time of the second, including two who carried on using these preparations. Only one subject changed smoking habits. There were no significant overall changes in FEV1 on the two occasions, nine subjects having a FEV1 < 80% on the first occasion and eight on the second. Six of the 18 subjects (33%) who underwent a methacholine inhalation test on both occasions had significantly improved PC20 results, including five for whom the PC20 value was within the normal range. All six subjects had normal FEV1 values on both assessments. Although changes in spirometry induced by repeated exposure to chlorine seem to persist, bronchial hyperresponsiveness can improve significantly in those with normal airway caliber. This suggests that less pronounced bronchial alterations induced by repeated exposures to chlorine may be reversible.

Adult↗

PubMed1996

Decrements in spirometry values associated with chlorine gassing events and pulp mill work.

In a previous study of older pulp and paper workers in Berlin, New Hampshire, decrements in spirometry results associated with accidental exposures to high levels of irritant gases depended on cumulative levels of pulp mill exposure and cigarette smoking. Many of those subjects were older and retired. A new study was initiated to assess whether gassing events were a problem among current workers. Three hundred white male pulp and paper workers from the mill in Berlin, New Hampshire, were surveyed in 1992. Testing included spirometry and questionnaires. The mean age was 40.4 yr, and the mean tenure with the company was 18.5 yr. A total of 105 of the 300 subjects (35%) reported ever having an episode of high exposure to chlorine gases (i.e., being gassed). The percentage gassed was 51% for pulp mill workers and only 13% for other employees. For subjects with no more than 26 pack-years of cigarette smoking, obstruction (i.e., abnormally low FEV1 and FEV1/FVC) was observed only among those with a history of gassing. Also, the combination of high cigarette smoking (i.e., > 26 pack-years) and gassing had a greater than additive effect on obstruction. These findings suggest that additional controls are needed to minimize the number of gassing events in this and other chemical pulp mills.

Adult↗

PubMed1996

Coal mine dust exposure and spirometry in experienced miners.

In a previous study of new miners from the National Study of Coal Workers' Pneumoconiosis (NSCWP), researchers examined changes in spirometry values associated with coal mine dust exposure (Br J Ind Med 1993; 50:929-937). An unusual pattern of dust-related effects was observed: initial sharp decrements in FVC and FEV1 were followed by partial recovery. In the current study, similar methods were used to analyze data from experienced miners. Each of 1,915 male subjects contributed data from two of the NSCWP field surveys: either Round 1 (1969-71) and Round 2 (1972-75) and Round 4 (1985-88). From the cross-sectional analysis at Round 1 or Round 2 (R1/R2), changes of +0.6 ml FVC and -0.5 ml FEV1 were associated with each mg/m3-yr of cumulative coal mine dust exposure, but were not statistically significant (p > 0.05). From the analysis of longitudinal change in spirometry from R1/R2 to Round 4 (R4), annual declines in FVC (-0.10 ml/yr per mg/m3-yr, p = 0.003) and FEV1 (-0.07 ml/yr per mg/m3-yr, p = 0.006) were associated with pre-R1/R2 exposure. Both the pattern and the magnitude of the exposure-response relationship were different for experienced versus new miners. Possible reasons for these contrasts include differences in cumulative exposure between the two groups and the healthy worker effect among experienced miners.

Coal↗

PubMed2001

Changes in spirometry over time as a prognostic marker in patients with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) causes a progressive impairment of muscle function leading to hypercapnic respiratory failure. Most studies of respiratory function in DMD have been cross-sectional rather than longitudinal, and these data have not been related to survival. We retrospectively studied 58 patients with DMD with at least 2 yr of follow-up spirometry and known vital status. Spirometry was abnormal at entry: median FEV(1) 1.60 L (range 0.4 to 2.6 L), FVC 1.65 L (range 0.45 to 2.75 L), FVC 64% predicted (range 29 to 97%). Individual rates of change of vital capacity varied, with a median annual change of -0.18 L (range 0.04 to -0.74 L), -8.0% predicted FVC (range 2 to -39%). During the study 37 patients died; the median age of death, calculated by Kaplan-Meier analysis, was 21.5 yr (range 15 to 28.5 yr). The age when vital capacity fell below 1 L was a strong marker of subsequent mortality (5-yr survival 8%). The maximal vital capacity recorded and its rate of decline (however expressed) predicted survival time. Repeated spirometric measurement provides a simple and relatively powerful means of assessing disease progression in these patients and should be considered when planning treatment trials.

Adolescent↗

PubMed1980

Within-subject variability and per cent change for significance of spirometry in normal subjects and in patients with cystic fibrosis.

We studied 15 normal subjects and 15 patients with cystic fibrosis (CF), to determine the within-subject variability of spirometry, moment analysis, and slope ratios, and to calculate the per cent change for significance. Common sources of variability, such as patient and technician training, equipment errors, lung volume history, posture, and circadian variation, were controlled. Flow-time curves were analyzed with a digital computer. The coefficient of variations of spirometry were smallest for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and peak flow (PF), and were largest for root moments (M) and slope ratios (SR) in both normal subjects and patients with CF. The coefficient of variations of all tests, except PF, were larger in patients with CF than in normal subjects. Significant change was calculated from the sample variance, mean, and the number of trials using a modified equation for sample size. This calculation estimated the degree of change for significance for each participant that was required in subsequent testing.

Adolescent↗

PubMed2002

Spirometry in 3- to 6-year-old children with cystic fibrosis.

Spirometry is routinely used to assess pulmonary function of older children and adults with cystic fibrosis (CF); however, few data exist concerning the preschool age group. We have reported normative spirometric data for 3- to 6-year-old children. The current study was designed to assess a similarly aged group of clinically stable patients with CF. Thirty-three of 38 children with CF were able to perform 2 or 3 technically acceptable maneuvers. These patients had significantly decreased FVC, FEV(1), FEV(1)/FVC, and FEF(25-75) when expressed as z scores (number of SD from predicted): -0.75 +/- 1.63, -1.23 +/- 1.97, -0.87 +/- 1.33, and -0.74 +/- 1.63, respectively. There were significant positive correlations of the Brasfield radiological score with FVC and FEV(1) z scores (r(2) = 0.26, p < 0.01 and r(2) = 0.24, p < 0.01). In addition, homozygous patients for the DeltaF508 mutation had lower z scores for FVC (-1.21 versus 0.47, p < 0.01) and FEV(1) (-1.38 versus 0.21, p < 0.05) than heterozygous patients. Of the 14 patients who had full flow-volume spirometric measurements during infancy, 10 had FEF(25-75) z scores greater than -2 at both evaluations. Our findings suggest that spirometry can successfully be used to assess lung function in preschool children with CF and has the potential for longitudinal assessment from infancy through adulthood.

Age Factors↗

PubMed2005

Prevalence of chronic obstructive pulmonary disease in Korea: a population-based spirometry survey.

RATIONALE: Although chronic obstructive pulmonary disease is a leading cause of mortality and morbidity worldwide, there are only limited data on its prevalence, especially in Asia. OBJECTIVES: A population-based epidemiologic survey of chronic obstructive pulmonary disease in a representative national sample was conducted using spirometry. METHODS: A stratified multistage clustered probability design was used to select a nationally representative sample. The survey was performed in conjunction with the second Korean National Health and Nutrition Examination Survey of 9,243 adults over the age of 18 years. The participation rate was 88.8% for questionnaires and 52.1% for spirometry. RESULTS: The prevalence of chronic obstructive pulmonary disease based on Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (a ratio of FEV1 to FVC of less than 0.7) was 17.2% (men, 25.8%; women, 9.6%) among subjects older than 45 years. Among adults of all ages (age>18 years), the prevalence of airflow obstruction was 7.8% (10.9% in men, 4.9% in women). The majority of these cases were found to be mild in degree, and only a minority of these subjects had received physician diagnosis or treatment. Multivariate analysis revealed that age over 65 years, male sex, smoking more than 20 pack-years, and low income were independent predictors for chronic obstructive pulmonary disease. CONCLUSIONS: Seventeen percent of Korean adults over the age of 45 years have mild chronic obstructive pulmonary disease.

Aged↗

PubMed2006

Post-bronchodilator spirometry reference values in adults and implications for disease management.

RATIONALE: International guidelines promote the use of post-bronchodilator spirometry values in the definition and severity classification of chronic obstructive pulmonary disease. However, post-bronchodilator reference values have not yet been developed. OBJECTIVES: To derive reference values for post-bronchodilator forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, and to compare these reference values with locally derived and existing pre-bronchodilator reference values. METHODS: Based on a random sample of a general adult population, 2,235 subjects (70% of invited subjects) performed spirometry with reversibility testing. A reference population of healthy never-smokers constituted 23% of the study population (n=515). Reference values for median and lower-limit-of-normal pre- and post-bronchodilator lung function and bronchodilator response were modeled using quantile regression analyses. MAIN RESULTS: The reference population had equal proportions of men and women in the age range 26-82 yr. Both FEV1 and FVC decreased with age and increased with height. FEV1/FVC decreased with age, although this trend was not statistically significant for men after bronchodilatation. Linear models gave the best overall fit. Lower-limit-of-normal post-bronchodilator FEV1/FVC exceeded 0.7 for both sexes. Post-bronchodilator prediction equations gave higher predicted FEV1 and FEV1/FVC than both locally derived and existing pre-bronchodilator equations. The bronchodilator response decreased with age. CONCLUSIONS: The present study is the first to develop reference values for post-bronchodilator lung function. Post-bronchodilator prediction equations can facilitate better management of patients with chronic obstructive pulmonary disease by avoiding falsely high FEV1% predicted with a subsequent underestimation of disease severity.

Adult↗

PubMed2006

Virtual respiratory system for education and research: simulation of expiratory flow limitation for spirometry.

BACKGROUND: Due to economic and ethical problems, virtual organs may appear more convenient than experiments on animals or limited investigations on patients. In particular, a virtual respiratory system (VRS) may be useful for tasks such as respirators and support methods testing, education, staff (medical and technical) training, (initial) testing of scientific hypotheses. METHODS: A comparative study of simulated and real spirometric results for different patient states (healthy lungs, restrictive lung disease, and obstructive lung disease of different localization and degree) was performed. The volume-flow curve and such standard parameters as FEV1, FEV1%VC, MEF75 etc. were analyzed. RESULTS: A mathematical description of collapsing bronchi was proposed. All fundamental phenomena present during spirometry also appeared in VRS, especially characteristic dependence between lung volume and air flow for forced expiration. In particular, both airway resistance and the flow limitation were described with one formula derived from commonly known dependence of the resistance on lung volume. Generally there were no significant differences between simulated results and those seen in clinical practice. Only simulation of obstruction in upper airways gave incorrect results, which suggested a different flow limitation mechanism (perhaps wave-speed limitation). CONCLUSIONS: Our VRS can already be used in medical education, e.g. courses of spirometry, and in some other applications. It seems that the significance of the wave-speed criterion has been overestimated.

Computer Simulation↗

PubMedDate not supplied

Commentary: quality of spirometry testing.

Spirometry is necessary for the diagnosis and monitoring of both obstructive and restrictive lung diseases. Today, the most rapidly growing health problem in the United States is chronic obstructive pulmonary disease (COPD). COPD is now the fourth most common cause of death and the only cause of death that is rising among the top ten causes. There is also an increasing prevalence of interstitial lung diseases. Both obstructive and interstitial lung diseases are identified and monitored by spirometry.

Calibration↗

PubMed2001

Forced expiratory manoeuvres in children: do they meet ATS and ERS criteria for spirometry?

The aim of this study was to evaluate the applicability of American Thoracic Society and European Respiratory Society criteria for spirometry in children. Maximal expiratory flow/volume (MEFV) measurements from 446 school-age children, experienced in performing MEFV manoeuvres, were studied and acceptability (start-of-test (backward extrapolated volume as a percentage of forced vital capacity (FVC) ([Vbc%FVC) or as an absolute value (Vbe), end-of-test (forced expiratory time (FET)) and reproducibility criteria (absolute and percentage difference between best and second-best FVC and forced expiratory volume in one second (FEV1) (deltaFVC, deltaFVC %, deltaFEV1 and deltaFEV1 %)) were applied to these manoeuvres. The Vbe%FVC criterion was met by 91.5%, the Vbe <0.15 L criterion by 94.8% and the Vbe <0.10 L by 60.1% of children. Vbe <0.15 L appeared to be a more useful parameter than Vbe%FVC. The FET criterion was met by only 15.3% of children. deltaFVC <0.2 L and deltaFEV1 <0.2 L were met by 97.1% and 98.4%, and deltaFVC <0.1 L and deltaFEV1 <0.1 L by 79.8% and 84.3% of the children, respectively. These criteria appeared to be less useful compared to percentage criteria (deltaFVC % and deltaFEV1 %). Even experienced children did not meet all international criteria for spirometry. However, most of their MEFV curves are useful for interpretation. Based on the performance of these children, a re-evaluation of criteria for maximal expiratory flow/volume measurements in children is proposed.

Adolescent↗

PubMed1999

Differences in spirometry reference values: a statistical comparison of a Mongolian and a Caucasian study.

New reference value studies for spirometry are commonly compared to existing reference value studies using average data derived from existing reference equations. Such comparisons are inherently flawed because they do not account for differences in distributions of the independent and dependent variables and they do not have identical methodologies. This study was undertaken 1) to derive reference equations for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) for natives of Mongolia and 2) to compare the Mongolian data with data from a 1981 reference study of Caucasians in Salt Lake City, UT, USA. Spirometry was performed on 344 (176 male, 168 female) healthy, nonsmoking urban natives of Mongolia to generate reference equations for FVC, FEV1, and FEV1/FVC. These data were compared with data from a 1981 reference study of Caucasians in Salt Lake City, using both an analysis of covariance of the raw data and parametric and nonparametric comparisons of a matched pair subset. Average measured forced vital capacity and forced expiratory volume in one second in native Mongolians were within 1-2% of the Caucasian predicted values. These small differences are not statistically significant in any of the multiple methods of comparisons. Power analysis suggests that, if real differences exist, the differences in forced vital capacity are <155 mL for males, <105 mL for females, and the differences in forced expiratory volume in one second are <107 mL for males and <76 mL for females.

Adolescent↗

PubMed1992

Spirometry and chest roentgenographic appearance in adults with cystic fibrosis.

The pathophysiologic manifestations of cystic fibrosis are continually evolving as more patients survive into their adult years. Although the correlation between chest roentgenographic appearance and pulmonary function testing is well described in children with cystic fibrosis, to our knowledge, there are no data that evaluate this relationship in adults. We analyzed 66 paired studies of chest roentgenographic appearance (Brasfield score) and spirometry in 27 adults with cystic fibrosis between the ages of 18 and 40 years. There was a very good correlation between spirometry and the Brasfield score in adults with cystic fibrosis. The strongest correlation was between the percent predicted FEV1 and the Brasfield score (r = 0.68, p less than 0.001). These correlations were found to remain significant in the patients in whom longitudinal data were available. The FEV1 declined 104 +/- 26 ml/yr in 11 patients who were followed up for a mean duration of 5.8 +/- 0.5 years. The decline in FEV1 per year in adults with cystic fibrosis was significantly greater than in nonsmoking or smoking adults of similar age.

Adolescent↗