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PubMed1996

Pulmonary function changes after laparoscopic surgery: relation to the sites of ports and the duration of pneumoperitoneum.

Pulmonary function tests were performed for 50 patients who were undergoing different laparoscopic surgical procedures. Measurements were made 1 to 2 h before, and 24 h after the operation. There was a highly significant reduction (p < 0.001) in forced vital capacity (-10.97 +/- 1.78), forced expiratory volume in the first second (-15.39 +/- 2.43), forced expiratory volume in the third second (-13.18 +/- 2.07), peak expiratory flow rate (-20.08 +/- 3.57), forced expiratory flow rate 25-75% (-21.45 +/- 3.57), and peak inspiratory flow rate (-14.97 +/- 5.81). These changes reflect a restrictive as well as an obstructive dysfunction. Explanations have been proposed for these changes. The pulmonary function changes were found to be more pronounced with upper abdominal procedures, where the laparoscopic ports were placed in the upper half of the anterior abdominal wall, than with lower abdominal and pelvic laparoscopy, where the ports were placed in the lower half. However, the differences between these two groups did not reach the level of statistical significance for any of the tests. The duration of pneumoperitoneum proved to have a minimal influence on the changes in the first three functions, and almost no influence on the last three. The findings of this study verify the safety of laparoscopic surgery concerning pulmonary functions, irrespective of the site of ports and the duration of pneumoperitoneum.

Adolescent↗
PubMed1989

Evaluation of heart-lung transplant recipients with prospective, serial transbronchial biopsies and pulmonary function studies.

The insidious development of obliterative bronchiolitis after heart-lung transplantation is thought to be due to rejection and possibly infection (cytomegalovirus). To evaluate further, we prospectively managed the last 16 consecutive heart-lung transplant recipients with serial transbronchial biopsies with lavage and pulmonary function studies as part of a surveillance protocol or as dictated by clinical presentation. A total of 123 transbronchial biopsies with lavage were performed, 77 for clinical indications (group I) and 46 for routine surveillance (group II). Results of 64 (83.1%) group I biopsies were positive for rejection or infection. Thirty-one of these biopsy specimens showed signs of rejection (29 in group I and two in group II), characterized by a perivascular mononuclear infiltrate, lymphocytic bronchiolitis, and occasionally alveolar septal mononuclear infiltrate. Forty-six serial pulmonary function tests were performed. The forced expiratory volume in 1 second (percent predicted), forced expiratory flow rate between 25% and 75% of the forced vital capacity (percent predicted), and arterial oxygen tension (millimeters of mercury) were significantly reduced from baseline values during rejection episodes: forced expiratory volume in 1 second, 75.7% +/- 20.1% versus 52.7% +/- 18.3% (p less than or equal to 0.05); forced expiratory flow rate between 25% and 75% of the forced vital capacity, 97.6% +/- 30.5% versus 49.8% +/- 22.3% (p less than or equal to 0.05); and arterial oxygen tension, 92.1 +/- 8.8 mm Hg versus 71.4 +/- 18.8 mm Hg (p less than or equal to 0.05). The fall in pulmonary function was reversible with pulse methylprednisolone. Asynchronous heart and lung rejection was documented. Of the 29 episodes of pulmonary rejection, 18 (62%) occurred asynchronously. Ten of the 16 (62%) heart-lung recipients had at least one episode of cardiac rejection. Thirteen of 16 (81%) had at least one episode of lung rejection. Serial transbronchial biopsies with lavage, as dictated by pulmonary function tests and clinical status, have guided early and more specific therapy directed against rejection and infection. With early detection, small airway dysfunction has been reversible.

Adult↗
PubMed1980

Calibration of time derivatives of forced vital capacity by explosive decompression.

A simple, portable, inexpensive device is described that simulates expiratory flow curves for calibration of spirometers. A 4-L metal cylinder filled with copper mesh is fitted with a precision manometer. The pressure is increased to twice atmospheric and released by explosive decompression through 4 easily interchangeable resistors. The ratio of forced expiratory volume in one second to forced vital capacity ranged from 0.80 to 0.25, thus encompassing the range from normal to severe obstruction. Accuracy was defined by 25 measurements of forced vital capacity that differed by no more than 0.5% from the actual cylinder volume. Repeatability was reflected by a standard deviation of at most 0.04 L/s for one-second forced expiratory volume, mid-expiratory flow, and instantaneous flows at 50 and 25% of the forced vital capacity. Peak flow was less reproducible. Calibrations of a water spirometer at increased altitude and at temperatures from 4 degrees to 37 degrees C revealed no significant changes in volume or flow rates. Standard values have remained unchanged for 2.5 yr. Three volume spirometers and 2 primary flow devices were tested extensively.

Altitude↗
PubMed1993

Effects of aerosol methacholine and histamine on airways and lung parenchyma in healthy humans.

To investigate whether histamine (His) and methacholine (MCh) have different effects on airways and lung parenchyma, 11 healthy subjects were given aerosol MCh until a response plateau was obtained and then two doses of His. At the plateau, forced expiratory volume in 1 s and forced expiratory flow at 40% of vital capacity from partial flow-volume curves were reduced by 19 +/- 3 (SE) and 80 +/- 4%, respectively. Aerosol His decreased forced expiratory volume in 1 s by an additional 12 +/- 1% but left partial forced expiratory flow unchanged. The bronchodilator effect of deep inhalation, as inferred from the ratio of forced expiratory flow from maximal to that from partial flow-volume curves, increased after MCh and plateaued but decreased after His. Quasi-static transpulmonary pressure-volume area determined in seven subjects was unchanged after MCh but was increased by 57 +/- 10% after His. We conclude that adding His after the response to MCh plateaued does not increase the maximal degree of bronchoconstriction but may increase parenchymal hysteresis, thus blunting the bronchodilator effect of deep inhalation. These results suggest that His and MCh have similar effects on airway smooth muscle but different effects on lung tissue properties.

Adolescent↗
PubMed1998

[Spirometry in workers in a wheat-processing industry].

In order to determine both clinical and spirometric changes due to high environmental concentrations of wheat dust at a wheat processing plant mill, 48 exposed men and 48 age and antroprometrically-matched, non-exposed apparently healthy men were studied. In both groups a medical and occupational history were taken, and spirometric measurements were carried out, that included Forced Vital Capacity (FVC), Forced Expiratory Volume at the first second (FEV1), Peak Flow Rate (PFR), Forced Percentual Expiratory Volume (FEV%), Forced Percentual Vital Capacity (FVC%), Forced Expiratory Flow at 25% (FEV25%), at 50% (FEV50%) and at 75% (FEV75%) of their Forced Vital Capacity, which were analyzed through Corzo's predictive equations and the lung deterioration's criteria by USA's Thoracic Association. The environmental wheat dust was determined by gravimetry and its concentration was higher than the legally admitted (3/5, 60%). There was a decrease in the PFR, FEV%, FEV25% and FEV75%. (p < 0.05). In addition, 4 restrictive and 1 obstructive syndrome were detected in the exposed workers and none in the control group. The spirometric values diminished in a positive correlation with the time of exposure and smoking habits. There was no correlation between the clinical findings and the dust concentration but it did exist with the spirometric values. It is concluded that in this plant, the wheat dust exposed workers have a diminished spirometric values.

Adult↗
PubMed1980

Shwachman's syndrome. A review of 21 cases.

21 patients (10 male, 11 female) aged between 11 months and 29 years with Shwachman's syndrome are reviewed. All patients had exocrine pancreatic insufficiency. Haematological features included neutropenia in 19 (95%), anaemia in 10 (50%), and thrombocytopenia in 14 (70%); one patient developed erythroleukaemia. Severe infections occurred in 17 (85%) from which 3 (15%) died. Only one child exceeded the 3rd centile for height, and growth retardation was particularly evident in the older patients. All had skeletal abnormalities or delayed skeletal maturation, or both. Metaphyseal dyschondroplasia affected 13 of the older patients and was associated with skeletal deformities. Eight of 9 children under 2 1/2 years had rib abnormalities. Respiratory function tests in children under 2 years demonstrated reduced thoracic gas volume and chest wall compliance. Older patients had reduced forced expiratory volume and forced vital capacity. Neurological assessment showed developmental retardation or reduced IQ assessments, or both, in 85% of patients studied. Other neurological abnormalities included hypotonia, deafness, and retinitis pigmentosa. Neonatal problems had been present in 16 (80%) of the patients and 5 were of low birthweights. Hepatomegaly with biochemical evidence of liver involvement occurred in the younger patients and resolved with age. Other associated features included dental abnormalities, renal dysfunction, an icthyotic maculopapular rash in 13 (65%), delayed puberty, diabetes mellitus, and various dysmorphic features. These findings stress the diverse manifestations of the syndrome and extend knowledge on a number of aspects. Sibship segregation ratios support an autosomal mode of inheritance and an hypothesis for the pathophysiological basis of this syndrome is advanced.

Adolescent↗
PubMed1991

[Lung function following sleeve bronchoplastic lobectomy for bronchogenic carcinoma].

Twenty-five patients who underwent upper sleeve lobectomy for lung cancer were studied by spirometric examination to evaluate postoperative pulmonary function, including Vital Capacity (VC), %Vital Capacity (%VC), Forced Expiratory Volume in one second (FEV1.0), and Forced Expiratory Volume in one second as a percentage of the forced vital capacity (FEV1.0%). The results of the patients with bronchoplasty were compared with those of patients with lobectomy alone and of patients with pneumonectomy. Lung function was periodically examined postoperatively following bronchoplasty. VC, %VC and FEV1.0 were decreased postoperatively in the patients with upper sleeve lobectomy, while FEV1.0% was increased. There were no differences in postoperative %VC or FEV1.0% between the patients with bronchoplasty and those with upper lobectomy alone. However, the postoperative %VC of the patients with pneumonectomy was significantly decreased compared with patients who underwent postoperative %VC of the patients with pneumonectomy was significantly decreased compared with patients who underwent bronchoplasty or lobectomy alone. %VC in the patients with bronchoplasty was decreased at 3 months after operation, but it to gradually returned to the preoperative value by 13 to 24 months after operation.

Adult↗
PubMed1998

Preoperative screening for lung volume reduction surgery: usefulness of combining thin-section CT with physiologic assessment.

OBJECTIVE: This study was performed to assess the usefulness of preoperative thin-section CT alone and in combination with physiologic measurements in emphysema patients being evaluated for lung volume reduction surgery. SUBJECTS AND METHODS: Six 1-mm collimation sections through the chest were obtained in 20 patients being evaluated for lung volume reduction surgery. Extent and severity of emphysema were assessed by visually scoring the images. CT scores ranged from 0 to 144. Inspiratory resistance was measured in 12 of 20 patients and was also used to discriminate between responders (change in forced expiratory volume in 1 sec, > or = 150 ml after surgery) and nonresponders (change in forced expiratory volume in 1 sec, < 150 ml after surgery). RESULTS: Four of 20 patients with mild emphysema as revealed by thin-section CT (scores of < 50) did not improve lung function after lung volume reduction surgery. Eight of the remaining 16 patients with moderate to severe emphysema as revealed by thin-section CT (scores of > 50) underwent inspiratory resistance measurement. Those seven patients whose inspiratory resistance measurement exceeded 8.5 cm H2O/l per second did not respond favorably to lung volume reduction surgery (change in forced expiratory volume in 1 sec, < 150 ml). The remaining five patients whose inspiratory resistance measurement was less than 8.5 cm H2O/l per second responded favorably to lung volume reduction surgery. Thus, only five of the 20 patients showed improvement in forced expiratory volume in 1 sec after surgery. CONCLUSION: Our data suggest that among patients with moderate to severe emphysema who are being examined for lung volume reduction surgery, the combination of radiologic and physiologic assessment is more accurate for predicting a favorable response to lung volume reduction surgery than radiologic assessment alone. However, in patients with chronic obstructive pulmonary disease by the American Thoracic Society criteria, mild emphysema as revealed on thin-section CT virtually precludes further workup because these patients are unlikely to respond favorably to lung volume reduction surgery.

Adult↗
PubMed2004

Early results of endoscopic lung volume reduction for emphysema.

BACKGROUND: We determined the feasibility, safety, and short-term efficacy of bronchoscopic placement of a one-way endobronchial valve in selected bronchopulmonary segments as an alternative to surgical lung volume reduction. METHODS: A total of 21 patients with incapacitating emphysema who underwent this procedure were studied. All patients had placement of the endobronchial valves into the most emphysematous lung segments. We recorded any major complications or deaths attributed to the procedure and analyzed (1) improvements in the spirometric and functional parameters and quality of life and (2) the radiologic changes compared with the baseline data at 30 and 90 days. RESULTS: A total of 20 patients had complete follow-up data. There was no mortality in the group studied. The forced expiratory volume at 1 second, forced expiratory volume at 1 second (percentage of predicted), forced vital capacity, and forced vital capacity (percentage of predicted) all improved significantly at 90 days (0.73 +/- 0.26 L vs 0.92 +/- 0.34 L [P =.009]; 33.3% +/- 11.9% vs 42.2% +/- 15.0% [P =.006]; 1.94 +/- 0.62 L vs 2.25 +/- 0.61 L [P =.015]; and 63.3% +/- 17.6% vs 73.9% +/- 17.1% [P =.012], respectively). The 6-minute walking distance improved at 30 and 90 days (251.6 +/- 100.2 m vs 306.3 +/- 112.3 m and 322.3 +/- 129.7 m; P =.012 and P =.003). The results of the 36-Item Short-Form Health Survey and the St George Respiratory Questionnaire showed significant improvements at 90 days. The Medical Research Council dyspnea grade also improved significantly at 30 and at 90 days (P =.006 and P =.003, respectively). CONCLUSIONS: Endobronchial valve placement is a safe procedure, with significant short-term improvements in functional status, quality of life, and relief of dyspnea in selected patients with emphysema. A larger study with long-term follow-up is therefore warranted.

Adult↗
PubMed1983

Sputum and blood eosinophils during corticosteroid treatment of acute exacerbations of asthma.

Eleven patients with chronic bronchial asthma were studied during a noninfectious exacerbation. Each patient received 80 mg of prednisone daily for three days. Spirometric values, total blood eosinophil counts, and 24-hour quantitation of sputum eosinophils were studied. Three patients had total blood eosinophil counts of less than 250 at the time of presentation. Statistical comparisons with findings on Day 0 showed significant improvements for the one-second forced expiratory volume, total blood eosinophil count, and sputum eosinophil number. On Day 7, the one-second forced expiratory volume maintained a statistically significant difference from that on Day 0, but the total blood eosinophil count did not. Analysis of correlation coefficients showed significant relation between the total blood eosinophil count and one-second forced expiratory volume, the sputum eosinophil count and one-second forced expiratory volume, and the sputum eosinophil and total blood eosinophil counts. The conclusions are (1) blood eosinophilia is not an invariable feature of acute exacerbations of asthma; (2) numbers of blood and sputum eosinophils reflect the response of an acute exacerbation of asthma to corticosteroids; (3) sputum eosinophils may be more meaningful for monitoring the stable postcorticosteroid state; (4) there is no support for the belief that eosinophils disappear from the sputum of asthmatic patients with clinically effective doses of corticosteroids.

Acute Disease↗
PubMed2002

Deep breaths, methacholine, and airway narrowing in healthy and mild asthmatic subjects.

Deep breaths taken before inhalation of methacholine attenuate the decrease in forced expiratory volume in 1 s and forced vital capacity in healthy but not in asthmatic subjects. We investigated whether this difference also exists by using measurements not preceded by full inflation, i.e., airway conductance, functional residual capacity, as well as flow and residual volume from partial forced expiration. We found that five deep breaths preceding a single dose of methacholine 1) transiently attenuated the decrements in forced expiratory volume in 1 s and forced vital capacity in healthy (n = 8) but not in mild asthmatic (n = 10) subjects and 2) increased the areas under the curve of changes in parameters not preceded by a full inflation over 40 min, during which further deep breaths were prohibited, without significant difference between healthy (n = 6) and mild asthmatic (n = 16) subjects. In conclusion, a series of deep breaths preceding methacholine inhalation significantly enhances bronchoconstrictor response similarly in mild asthmatic and healthy subjects but facilitates bronchodilatation on further full inflation in the latter.

Adult↗
PubMedDate not supplied

[Forced expiration indices of the healthy human being in simulated weightlessness].

Lung volumes and forced expiratory volumes during 3-hour water immersion as well as in the upright and supine positions were measured. Water immersion up to the neck decreased the functional residual capacity, peak and maximum velocities of air flows during inspiration and expiration with various lung volumes and increased the forced expiratory time and pulmonary time constant. These changes seem to be produced by a higher inelastic resistance as well as by additional hydrostatic pressure upon the chest and abdomen. During the transfer from the upright to the supine position these changes were identical but of smaller magnitude.

Adult↗
PubMed2001

Pulmonary function tests in beta thalassemia.

To study pulmonary function tests (PFT) in multiple transfusion recipient thalassemics, PFTs were done for 30 thalassemics and 20 matched controls. Confirmed cases of thalassemia on regular transfusion therapy were the subject of study. Apart from history and physical examination of the thalassemics, serum ferritin estimation and spirometry were done. Parameters studied included lung volumes--functional residual capacity (FRC), forced vital capacity (FVC), residual volume (RV) and total lung capacity (TLC); and flow rates--forced expiratory volume in one second (FEV1), forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), peak expiratory flow 25-75 (PEF 25-75%) and peak expiratory flow rate (PEFR). Single breath carbon monoxide diffusing capacity (DLco) and arterial blood gas (ABG) were also analysed. The mean height and weight of thalassemics were below that of age matched controls. A restrictive abnormality in PFT was found in 86.6% cases. These patients were found to have a decrease in all the lung volumes namely FVC, FRC, RV and TLC with a proportional decrease in the flow rates, FEV1, PEF 25-75% and PEF with a normal (> 0.75) FEV1/FVC ratio. DLco was decreased in all the patients with restrictive lung disease and fall in DLco showed a good correlation (r = 0.7, P < .001) with the severity of restrictive disease suggesting that some intrapulmonary pathology is likely to be responsible for the restrictive pattern. None of the cases had an obstructive or mixed pattern of pulmonary dysfunction. No correlation was found between severity of restrictive disease and the serum ferritin levels. A negative correlation with degree of hepatosplenomegaly was found. No correlation was found between severity of the defect and age, number of blood transfusions received and hemoglobin at the time of doing the test. To conclude, restrictive lung disease is the predominant abnormality in multi-transfused thalassemics, which is probably due to pulmonary parenchymal pathology. The abnormality of PFTs is not directly related to iron overload.

Adolescent↗
PubMed1976

Lung function changes in smokers with normal conventional spirometry.

The comparative ability to detect early abnormalities in smokers by commonly used lung function tests was studied. Sixty-five healthy male nonsmokers served as a reference group and provided standards for 1-sec forced expiratory volume, vital capacity, end-tidal spirometry, spirometric forced mid-and end-expiratory flows, single-breath diffusing capacity, static lung volumes (helium method), and single-breath N2 closing volume measurements, In the present series of 80 male smokers, the measurements of forced mid-expiratory flow and forced end-expiratory flow did not improve the ability of the more conventional indices, 1-sec forced expiratory volume and the ratio of 1-sec forced expiratory volume to vital capacity, to detect obstructive lung disease. In 71 smokers with normal 1-sec forced expiratory volume and ratio of 1-sec forced expiratory volume to vital capacity, the end-tidal spirometry, diffusing capacity, and residual volume indices revealed 14,20, and 21 per cent of abnormalities. respectively. The single-breath N2 closing volume test (Phase IV/vital capacity and slope of Phase III) detected the greatest number of subtle changes in lung function; this was abnormal in 32 per cent of smokers with normal conventional spirometry. In young or light smokers, Phase IV/vital capacity was more frequently increased than the slope of Phase III; an incerse trend was observed in older or heavier smokers. The single-breath N2 closing volume test also provided the greatest number of abnormal results when other indices were impaired in the same subjects.

Adult↗
PubMed2003

Bronchial fenestration improves expiratory flow in emphysematous human lungs.

BACKGROUND: The crippling effects of emphysema are due in part to dynamic hyperinflation, resulting in altered respiratory mechanics, an increased work of breathing, and a pervasive sense of dyspnea. Because of the extensive collateral ventilation present in emphysematous lungs, we hypothesize that placement of stents between pulmonary parenchyma and large airways could effectively improve expiratory flow, thus reducing dynamic hyperinflation. METHODS: Twelve human emphysematous lungs, removed at the time of lung transplantation, were placed in an airtight ventilation chamber with the bronchus attached to a tube traversing the chamber wall, and attached to a pneumotachometer. The chamber was evacuated to -10 cm H2O pressure for lung inflation. A forced expiratory maneuver was simulated by rapidly pressurizing the chamber to 20 cm H2O, while the expiratory volume was continuously recorded. A flexible bronchoscope was then inserted into the airway and a radiofrequency catheter (Broncus Technologies) was used to create a passage through the wall of three separate segmental bronchi into the adjacent lung parenchyma. An expandable stent, 1.5 cm in length and 3 mm in diameter, was then inserted through each passage. Expiratory volumes were then remeasured as above. In six experiments, two additional stents were then inserted and forced expiratory volumes again determined. RESULTS: The forced expiratory volume in 1 second (FEV1) increased from 245 +/- 107 mL at baseline to 447 +/- 199 mL after placement of three bronchopulmonary stents (p < 0.001). With two additional stents, the FEV1 increased to 666 +/- 284 mL (p < 0.001). CONCLUSIONS: Creation of extra-anatomic bronchopulmonary passages is a potential therapeutic option for emphysematous patients with marked hyperinflation and severe homogeneous pulmonary destruction.

Feasibility Studies↗
PubMed1998

Lung reduction operation and resection of pulmonary nodules in patients with severe emphysema.

BACKGROUND: Severe pulmonary dysfunction has been considered a relative contraindication to surgical resection in patients with solitary pulmonary nodules. We report our initial experience with the combined use of lung volume reduction operation and tumor resection in this patient population. METHODS AND PATIENTS: Between January 1995 and July 1996, 14 patients underwent combined lung volume reduction operation and pulmonary nodule resection. Ten (71%) patients were oxygen dependent, 5 (36%) had a room air partial pressure of carbon dioxide > or = 45, and 5 (36%) were steroid dependent preoperatively. Mean preoperative pulmonary function tests included a forced expiratory volume in 1 second of 680 +/- 98 mL (24% +/- 5% predicted), forced vital capacity of 54% +/- 5% predicted, and a forced expiratory volume in 1 second to vital capacity ratio of 37% +/- 2% predicted. RESULTS: Sixteen lesions were resected in the 14 patients and included 9 non-small cell carcinomas. There was one postoperative death. All other patients are alive and well through a mean follow-up of 22.6 +/- 2.3 months (12 to 35 months). At 6-month follow-up improvements were noted in dyspnea index, forced expiratory volume in 1 second forced vital capacity, and 6-minute walk distance. Mediastinal recurrence at 12-month follow-up developed in 1 patient with two separate bronchioalveolar carcinomas. CONCLUSIONS: Simultaneous lung volume reduction operation and tumor resection should be considered in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung function.

Aged↗
PubMedDate not supplied

Synergistic effects of air pollution and personal smoking on adult pulmonary function.

There is strong evidence that air pollution and cigarette smoking adversely affect respiratory health, but it remains uncertain whether the joint effects of air pollution and smoking are additive or synergistic. The authors investigated the hypothesized synergistic effects of air pollution and personal smoking on pulmonary function in a random sample of 3287 adults (40-69 y of age) who resided in residential, industrial, and suburban areas in Beijing. The authors used multiple linear regression and adjusted for age, sex, height, education, indoor use of coal stoves, crowding within a house, occupational exposures, and passive smoking. The annual mean total suspended particulates for the period 1981-1985 in residential, industrial, and suburban areas were 389 microg/m3, 449 microg/m3, and 261 microg/m3, respectively, and the annual mean sulfur dioxide levels were 128 microg/m3, 57 microg/m3, and 18 microg/m3, respectively. Compared with individuals in the suburban area, never smokers who resided in the industrial area had a 26-ml (standard error = 39) reduction in forced expiratory volume in 1 s and a 150-ml (standard error = 42) reduction in forced vital capacity; however, smokers in the same area suffered an additional 53-ml (standard error = 38) reduction in forced expiratory volume in 1 s and a 65-ml (standard error = 41) reduction in forced vital capacity. Similarly, never-smokers who resided in the residential area had a 72-ml (standard error = 35) reduction in forced expiratory volume in 1 s and a 274-ml (standard error = 38) reduction in forced vital capacity, and smokers in the same area suffered an additional 75-ml (standard error = 39) reduction in forced expiratory volume in 1 s and a 107-ml (standard error = 42) reduction in forced vital capacity. Long-term exposure to high levels of particulate and sulfur dioxide in Beijing was associated with significantly reduced pulmonary function in both never smokers and smokers. However, the associations were significantly greater among smokers than among never smokers, indicating a synergistic effect of air pollution and personal smoking on adult pulmonary function.

Adult↗