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PubMed2005

[Lung function testing --the Official Guideline of the Japanese Respiratory Society].

This review article introduces the official guideline for the lung function testing firstly established by the Japanese Respiratory Society in November 2004. The members of the Japanese Society of Laboratory Medicine were also included in the working group to make the guideline. A central goal of the guideline is to standardize the skill of lung function testing and thus minimize its variability. The guideline includes the chapters for spirometry, flow-volume curve, and diffusing capacity of the lung, where principles and quality controls are introduced with reference values for each testing. Furthermore, the algorithm for differential diagnosis using the lung function testing is demonstrated in the last chapter. The lung function testing can bring a strong impact on patients' lifestyle and future treatment plan. We sincerely hope that this guideline will contribute to routine laboratory practice.

Humans↗

PubMed2003

Lung function and symptom perception in children with asthma and their parents.

A large proportion of children with asthma are managed without recourse to specialized care, and treatment decisions are based solely on symptoms as reported by the children and their parents. We investigated 90 school-age children with the diagnosis of asthma and their accompanying parent to evaluate whether we can obtain better information by using three different means of asking for asthma symptoms: a questionnaire for children (QSR(children)), "smilies," and a visual analogue scale for children (VAS(children)). Furthermore, we analyzed the relationship between these symptom reports and lung function results. Finally, we attempted to determine whether performing a lung function test contributes relevant information toward improving asthma management. Multiple linear regression adjusted for age and gender showed a significant relationship between VAS for children and forced expiratory volume in 1 sec (FEV(1)) (P = 0.047) and maximal expiratory flow at 50% of forced vital capacity (MEF(50)) (P = 0.037). Neither age, gender, QSR for children, "smilies for children" nor all the parents' scores showed a significant association with lung function measurement in the regression model. Subgroup analysis with Spearman's rank correlation coefficients by age group revealed significant correlation in children <10 years between VAS for children, QSR for parents, smilies for parents, and the lung function parameters FEV(1), and MEF(50). Above age 10 years there was no correlation at all, with the accuracy correlation ranging from -0.04 to +0.21. Our data demonstrate that reported symptoms do not reliably correlate with lung function results in asthmatic children and the childrens' parents, and correlation is dependent on the instrument used for symptom evaluation. In children, the VAS, and in parents, the QSR were the most valuable means of obtaining best information on asthma symptoms. This underlines the importance of supplementing information on asthma symptoms with lung function measurements to more reliably assess the severity of asthma.

Adolescent↗

PubMed1983

Pharmacokinetics and pharmacodynamics of a short- and long-acting theophylline medication (Theolair and Theolair retard) in normals and asthmatics. Part II: Lung function and side effects.

Six normals and six patients with chronic obstructive lung disease were treated with a short- and long-acting theophylline (Theolair and Theolair retard). During treatment the lung function data of the patients showed an improvement on day 1, but no further improvement on days 4 and 7, despite the higher theophylline plasma concentration on these last days. There was no close correlation between the improvement of lung function and the theophylline plasma concentration, nor was there any difference between Theolair and Theolair retard as regards improvement of lung function. Side effects were negligible, and the theophylline plasma concentration was rather low. It seems advisable to use a higher dosage of the theophyllines and perhaps it is even better to combine them with other bronchodilators.

Adult↗

PubMed1997

Longitudinal study of lung function in a cohort of primary ciliary dyskinesia.

Patients with primary ciliary dyskinesia (PCD) have pronounced stasis of their respiratory secretions and therefore recurrent lower airway infections, which raises concerns for the development of lung function. Twenty four patients with PCD have been studied prospectively with a standardized regime in our clinic for 2-16 yrs with clinic visits, including spirometry 2-4 times per year, daily physiotherapy and monthly sputum cultures with subsequent specific antibiotic treatment. Lung function was significantly lower in the 12 PCD patients entering the cohort as adults when compared to the PCD patients entering as children (forced vital capacity (FVC) 70 versus 85% predicted; forced expiratory volume in one second (FEV1) 59 versus 72% pred). The lung damage did not relate to the type of ciliary dyskinesia. During the subsequent surveillance of the groups for a median of 14 and 7 yrs, respectively, the lung function remained stable in most patients. It is concluded that primary ciliary dyskinesia is accompanied by a progressive deterioration in lung function if undertreated, but lung function can be maintained with appropriate antibiotic treatment and regular physiotherapy. This emphasizes the need for early diagnosis of primary ciliary dyskinesia.

Adolescent↗

PubMed2006

Contribution of alpha- and beta-defensins to lung function decline and infection in smokers: an association study.

BACKGROUND: Alpha-defensins, which are major constituents of neutrophil azurophilic granules, and beta-defensins, which are expressed in airway epithelial cells, could contribute to the pathogenesis of chronic obstructive pulmonary disease by amplifying cigarette smoke-induced and infection-induced inflammatory reactions leading to lung injury. In Japanese and Chinese populations, two different beta-defensin-1 polymorphisms have been associated with chronic obstructive pulmonary disease phenotypes. We conducted population-based association studies to test whether alpha-defensin and beta-defensin polymorphisms influenced smokers' susceptibility to lung function decline and susceptibility to lower respiratory infection in two groups of white participants in the Lung Health Study (275 = fast decline in lung function and 304 = no decline in lung function). METHODS: Subjects were genotyped for the alpha-defensin-1/alpha-defensin-3 copy number polymorphism and four beta-defensin-1 polymorphisms (G-20A, C-44G, G-52A and Val38Ile). RESULTS: There were no associations between individual polymorphisms or imputed haplotypes and rate of decline in lung function or susceptibility to infection. CONCLUSION: These findings suggest that, in a white population, the defensin polymorphisms tested may not be of importance in determining who develops abnormally rapid lung function decline or is susceptible to developing lower respiratory infections.

Adult↗

PubMed1998

Effects of flutter and PEP mask physiotherapy on symptoms and lung function in children with cystic fibrosis.

Recently, the flutter was introduced as a new device to improve sputum expectoration. Preliminary data suggested a significant improvement in expectoration and lung function during flutter treatment in patients with cystic fibrosis (CF). The aim of the present study was to compare the effects of the flutter and the positive expiratory pressure (PEP) mask on symptoms and lung function in children with CF. In a crossover randomized study 22 patients with CF (mean age 12 yrs, range 7-17 yrs) performed physiotherapy using either the flutter or the PEP mask twice a day during two treatment periods of 2 weeks, separated by a one week wash-out period, in a random sequence. Lung function parameters (peak expiratory flow, forced vital capacity (FVC), forced expiratory volume in one second, maximal midexpiratory flow, maximal expiratory flow at 25% of FVC, thoracic gas volume, total lung capacity, residual volume/total lung capacity, airway resistance and specific airway conductance) and changes in transcutaneous oxygen haemoglobin saturation were assessed before and after the first supervised session and at the end of each treatment period. Throughout the study peak flow was measured and symptoms were scored daily. No significant changes in any lung function parameter occurred after a single session or after 2 weeks of physiotherapy with either method. There was no difference in acceptability and subjective efficacy. In conclusion, any superiority of the flutter over the positive expiratory pressure mask technique for expectoration could not be confirmed during 2 weeks of daily treatment in children with cystic fibrosis. Both methods are well accepted by children and do not change lung function. Long-term comparison of both methods, including expectoration measurements, seems to be required for further evaluation of the potential success of physiotherapy in cystic fibrosis.

Adolescent↗

PubMed2005

Lung function status of workers exposed to wood dust in timber markets in Calabar, Nigeria.

The effect of chronic exposure to dust from local woods such as ebony, achi, and iroko on lung function of timber market workers in Calabar - Nigeria, was studied. Forced vital capacity (FVC), Forced Expiratory Volume in one second, (FEV1), Forced Expiratory Volume as a percentage of forced vital capacity (FEV1 %), and Peak Expiratory Flow Rate (PEFR) were measured in 221 workers (aged 20-25 years) exposed to wood dust to assess their lung function and compared with 200 age- and sex- matched control subjects who were not exposed to any known air pollutant. The concentration of respirable dust was significantly higher in the test (P<0.001) than in control site. The mean values of FVC, FEV1, FEV1% and PEFR of the timber workers were significantly lower (P<0.01) than in control subjects. Respiratory symptoms such as cough, chest pain and nasal irritation had higher prevalence in the test group than in the control group. Non-respiratory symptoms (skin and eye irritation) were prevalent in the test group but not found in the control group. Workers exposed to wood dust had restrictive pattern of ventilatory function impairment. The lung function indices of the timber workers decreased with their length of service. Chronic exposure to wood dust impairs lung function.

Adult↗

PubMedDate not supplied

Identifying population differences in lung function: results from the Allied Dunbar national fitness survey.

In order to identify valid population differences in lung function (e.g. occupational, ethnic), it is necessary to adjust for known confounding variables (e.g. age, body size). The present paper proposes appropriate methods for analysing forced expiratory volume (FEV1), forced vital capacity (FVC) and maximum oxygen uptake (VO2 max), recorded as part of the Allied Dunbar national fitness survey (ADNFS). The ADNFS randomly selected subjects from 30 regional sites throughout England. Measurements of FEV1, FVC and complete records of other relevant information were available on 2672 subjects. Traditional analyses of co-variance (ANCOVA) were found to be inappropriate to investigate population differences in FEV1 and FVC, due to a significant increase in error variance with age. However, by fitting a multiplicative model with allometric body size components to the FEV1 and FVC measurements using weighted log-linear regression, valid and plausible associations with body size, age, smoking, and physical activity, together with 'gender specific' regional differences in lung function were identified. Further insight was obtained when FEV1 and FVC were included into the multiplicative model to predict VO2 max. The apparent advantage of being taller when predicting VO2 max, was explained more accurately by the subjects' superior FVC. In summary, by fitting the multiplicative 'allometric' model using weighted log-linear regression, valid population differences in lung function were identified. Regions containing a higher proportion of working-class, unemployed or less affluent subjects were found to be associated with below average lung function performances.

Adolescent↗

PubMed1992

Mortality and decline in lung function in 213 adults with bronchial asthma: a ten-year follow up.

The purpose of this longitudinal study was to describe mortality and change in lung function in adults with bronchial asthma, and furthermore to investigate a potential difference in the prognosis for patients with intrinsic and extrinsic asthma. Out of 213 asthmatics admitted to our hospital, 170 (82%) participated in a 10-year follow-up examination; according to the tests for extrinsic asthma at the first examination, the patients were divided into 117 patients with intrinsic asthma and 53 subjects with extrinsic asthma. Twenty-seven (13%) patients, 23 with intrinsic and 4 with extrinsic asthma, died during the observation period, which was almost twice the number expected in both intrinsic and extrinsic asthmatics, but because of the small number of patients with extrinsic asthma, the findings were statistically significant for the intrinsic asthmatics only (p less than 0.05). Seventeen (8.2%) died of pulmonary diseases, of whom 9 (6 patients with intrinsic asthma) died in an acute attack of bronchial asthma. After a questionnaire concerning respiratory symptoms had been answered, a lung function test was performed in all subjects in both 1976-1979 and 1988. A histamine challenge test was performed at the examination in 1988. Of the 143 subjects who were re-examined in 1988, 96% still had respiratory symptoms. The first lung function test in 1976-1979 showed no difference in FEV1 (% predicted) between the two groups, whereas the annual mean loss of FEV1 during the observation period for the intrinsic and extrinsic asthmatics was 50 ml and 22.5 ml, respectively (p less than 0.0001). Decline in FEV1 was found to be independent of smoking habits in both patient groups. We found that the decline in lung function increased with increasing age in both intrinsic and extrinsic asthmatics (p less than 0.001 and p less than 0.05, respectively). The so-called "horse-racing effect" could be demonstrated for the patients with extrinsic asthma (p less than 0.003); whereas no significant relation was found between FEV1 at the time of enrollment and decline of FEV1 for the intrinsic asthmatics. We conclude that asthmatic subjects have an excess mortality and that the prognosis for intrinsic asthma is worse than that of extrinsic asthma with regard to rate of decline in lung function.

Adolescent↗

PubMed1998

Acute lung function changes and low endotoxin exposures in the potato processing industry.

Work-related respiratory symptoms, acute lung function changes and personal endotoxin exposure were studied in 61 workers from a potato processing plant. According to their job title mean endotoxin exposure level, workers were divided into low (AM = 21 EU/m3) and high (AM = 56 EU/m3) exposure categories. Shortness of breath and chest tightness during work were reported by 18% and 16% of the workers, respectively, mainly in the low endotoxin exposure category. A total of 148 across-shift lung function changes were measured during three consecutive afternoon shifts. The mean FEV1 and MMEF showed a decrease over the work shift, being largest on the first working day after a 3-day absence from work. Workers exposed to high endotoxin levels showed a larger across-shift decrease in lung function than workers exposed to low endotoxin exposures, the effect being most pronounced on the first day after a 3-day absence from work. At the start of the second work shift, FVC, FEV1 and MMEF were lower than at the start of the first work shift. This difference was larger for high exposed workers. High exposed workers with work-related respiratory symptoms showed an 8-10% across-shift change in FVC, FEV1 and MMEF We conclude that significant across-shift decreases in lung function of potato processing workers is related to endotoxin exposure levels above 53 EU/m3 over 8 hr.

Acute Disease↗

PubMed1995

The effect of inhaled adrenaline on lung function of recurrently wheezy infants less than 18 months old.

Inhaled bronchodilators have been shown not to improve lung function in infants with wheeze. This observation has led to the suggestion that airway wall edema may be more important than bronchoconstriction in infants with airway narrowing. Inhaled adrenaline is used to relieve upper airway edema in children with croup and has been demonstrated to improve clinical scores and lower pulmonary resistance in some infants with wheeze associated with bronchiolitis. The aim of the present study was to examine the effect of inhaled adrenaline on lung function in a group of infants with recurrent wheeze. Eleven infants aged 10 to 18 months with a history of recurrent wheeze were studied during an asymptomatic interval. Respiratory function was assessed (1) by measuring maximal expiratory flow at functional residual capacity (VmaxFRC) during a forced partial expiratory maneuver and (2) by measuring conductance of the respiratory system (Grs) using a single expiratory occlusion technique. Following baseline measurements, the infants received 0.5 mg/kg adrenaline by nebulizer and serial lung function tests were repeated at 5 min intervals. Ten infants had abnormal baseline lung function (median VmaxFRC 44.2% predicted; median Grs 34% predicted). Using a random effects model, VmaxFRC and Grs declined significantly at 10 and 5 min after adrenaline, respectively. No significant improvements from baseline were observed in either measurement for up to 30 min following adrenaline delivery. It is concluded that inhaled adrenaline did not relieve airways obstruction in this group of asymptomatic infants with recurrent wheeze.

Administration, Inhalation↗

PubMed2003

Impaired lung function and serum leptin in men and women with normal body weight: a population based study.

BACKGROUND: Impaired lung function is a risk factor for cardiovascular morbidity. Whether circulating factors are responsible for this association is unknown. A study was undertaken to determine whether leptin, a hormone that can promote atherothrombosis, is raised in individuals with impaired lung function. METHODS: Data from non-obese participants in the Third National Health, Nutrition, and Examination Survey (n=2808) were analysed to determine the relationship between circulating leptin levels and forced expiratory volume in 1 second (FEV(1)) values divided into quintiles (quintile 1, FEV(1) predicted < or =85.2%; quintile 2, 85.3-94.3%; quintile 3, 94.4-101.4%; quintile 4, 101.5-110.0%; and quintile 5, > or =110.1%). RESULTS: Serum leptin levels changed along the FEV(1) gradient. The highest leptin levels were found in quintile 1 (geometric mean (GM) 5.42; interquartile range (IQR) 3.00-9.60 fg/l) and the lowest in quintile 5 (GM 4.94; IQR 2.80-9.10 fg/l). Adjustments for age, body mass index, and other confounders strengthened this relationship. Compared with quintile 5, the odds of having an increased serum leptin level in quintiles 1, 2, 3, and 4 were 2.26 (95% confidence interval (CI) 1.54 to 3.31), 2.20 (95% CI 1.52 to 3.17), 1.46 (95% CI 1.01 to 2.09), and 1.28 (95% CI 0.90 to 1.83), respectively. CONCLUSION: Individuals with impaired lung function have raised serum leptin levels. Leptin may play a role in the pathogenesis of cardiovascular morbidity and mortality related to impaired lung function.

Adult↗

PubMed2000

Serum carotenoids, alpha-tocopherol, and lung function among Dutch elderly.

Antioxidant vitamins (provitamins) may protect against loss of lung function over time. We studied the association between serum carotenoids (alpha-carotene, beta-carotene, lycopene, beta-cryptoxanthin, zeaxanthin, and lutein), alpha-tocopherol, and lung function among noninstitutionalized Dutch elderly age 65 to 85 yr (n = 528). Multiple linear regression analysis was performed with FEV(1) or FVC as dependent variables and serum levels of antioxidants in quintiles as independent variables. We adjusted for age, gender, height, and pack-years of smoking. Subjects in the fifth quintile of serum beta-carotene had a 195 ml (95% confidence interval [95% CI]: 40 to 351 ml) higher and those in the fifth quintile of alpha-carotene had a 257 ml (95% CI: 99 to 414 ml) higher FEV(1) compared with subjects in the first quintile of these carotenoids. Significant (p < 0.05) positive trends were observed between alpha-carotene, beta-carotene, lycopene, and FEV(1) and between alpha-carotene, beta-carotene, and FVC. Subjects in the highest quintile of the other carotenoids or alpha-tocopherol did not have significantly higher FEV(1) or FVC compared with subjects in the first quintile of these antioxidants. In conclusion, this study shows that from the six major serum carotenoids and alpha-tocopherol studied, particularly alpha-carotene, beta-carotene, and lycopene were positively associated with lung function in the elderly and may be considered as candidates for further investigations.

Aged↗

PubMed1986

Tests of small airway dysfunction: their correlation with the "conventional" lung function tests.

"Sensitive" and "conventional" lung function tests were compared in a group of 114 males, aged 35-55 years, including healthy non-smokers, asymptomatic smokers with normal spirometry, and smokers with chronic bronchitis with or without mild airflow limitation. In non-smokers, with the exception of a MEF vs. FEV1 correlation, "sensitive" and "conventional" tests were independent of each other. In asymptomatic smokers the phase III slope and the closing volume were significantly related to FEV1, RV/TLC and CO transfer factor. In smokers with chronic bronchitis all the "sensitive" tests were related to the "conventional" tests (with the exception of the total lung capacity). Hyperinflation and CO transfer impairment suggest that early emphysema may accompany mucus hypersecretion in smokers.

Adult↗

PubMed1996

Lung function studies in some Nigerian bank workers.

Following complaints of cough and tightness in the chest by a group of treasury workers exposed to large quantities of old and dirty currency notes withdrawn from circulation as well as currency for circulation, lung function tests were performed to find the effects of this exposure on the ventilatory function status of the workers. Lung function tests were carried out on 72 treasury workers (62 male and 10 female) aged 35.11 +/- 0.62 years (mean +/- SEM); range: (21 to 58 years), height 1.68 +/- 0.17 m; (1.55 to 1.97 m) and body weight 60.61 +/- 0.65 kg; (48 to 86 kg). The values were compared with a control group of age, height, weight and sex-matched Nigerians from the same area that were not exposed to any known air pollutant. The mean measured lung function values of the female workers were not significantly different from their control values. However, the mean measured values of FVC, FEV1 and PEFR of the males were significantly lower than their control values (p < 0.01; 0.05 and 0.001 respectively) which is indicative of a general restrictive ventilatory defect. We conclude that chronic exposure to large quantities of old and dirty currency notes withdrawn from circulation as well as new ones may impair the lung function of treasury workers.

Adult↗

PubMed1999

Neonatal lung function in very immature infants with and without RDS.

Some infants, despite being born at low gestations (< 28 weeks gestational age) do not develop RDS and are not surfactant treated. The changes in lung function during the neonatal period in such infants have not been explored, hence it is unknown whether they are similar to those of surfactant treated infants with RDS of similar gestational age. Such data would facilitate assessment of the impact of surfactant administration on the lung function abnormalities of very immature infants with RDS. We, therefore, compared the results of neonatal lung function measurements from immature infants with RDS who received surfactant to those from infants with non-RDS respiratory distress not so treated and matched to the RDS infants for gestational age and within 10% of birthweight. Compliance and functional residual capacity (FRC) were measured daily for the first five days and then at 1, 2 and 4 weeks in 16 infants, median gestational age 27 weeks (range 25-27 weeks). Although exogenous surfactant administration to the immature infants with RDS was associated with improvements in lung function, the non RDS, non surfactant treated infants had both higher compliance (p < 0.05) and lung volumes (p < 0.01) throughout the perinatal period. These results demonstrate surfactant administration does not fully correct the perinatal lung function abnormalities of very immature infants with RDS.

Birth Weight↗

PubMed1989

Progression of asbestos effects: a prospective longitudinal study of chest radiographs and lung function.

From an original prospective cohort of 244 current and ex-workers in two asbestos cement plants, longitudinal radiographic data covering ten years were available for 165 and lung function data covering about six years for 150. Estimates of average and cumulative dust exposure were available for each participant, all men. Radiographic progression (onset or worsening) was assessed by comparing earliest and latest films side by side. Annual changes in lung function were computed by fitting regression lines to all the data points. Small opacities (ILO category 1/0 or higher) were found in 16% of initial films, and progression of small opacities occurred in 13% of film pairs. Average and cumulative dust exposure were each significant determinants of the initial presence of small opacities, and were determinants of the progression of both parenchymal and pleural abnormalities. There was greater likelihood of progression if an abnormality was initially present, and a greater likelihood of progression in the plant that had systematic use of some crocidolite. Initial levels of lung function were related to smoking, exposure to dust, and initial radiographic status. Mean annual declines in lung function were modest (FVC-0.017 l/y, FEV1-0.020 l/y) and were related to smoking but not exposure to dust, initial radiographic status, or radiographic progression. Both plants used mainly chrysotile asbestos and exposure levels declined severalfold after 1960. Our findings suggest a waning effect of the larger remote dust exposures on recent annual change in lung function. This accords with human and experimental pathology data showing the relatively low resistance of chrysotile fibres to chemical alteration and clearance.

Adult↗

PubMed1999

Lack of effects of moderate-high altitude upon lung function in healthy middle-aged volunteers.

This study investigates the effects of moderate-high altitude on lung function and exercise performance in 46 volunteers (19 females, 27 males), with a mean age of 42.4 +/- 1.4 years (+/- SEM) and varying smoking and exercise habits, who were not previously acclimatized. Measures obtained in the base camp (1140 m) and at altitude (2630 m), in random order, included forced spirometry, maximal voluntary ventilation, maximal inspiratory and expiratory pressures, arterial oxygen saturation and capillary lactate concentration after a standardized exercise test. The smoking history, Fagerström test and degree of habitual physical activity were also recorded for each participant. The percentage of smokers was similar in males (19%) and females (21%) (P = n.s.). Mean habitual physical activity index was 8.2 +/- 0.2 (range, 5.88-11.63). At the base camp, all lung function variables were within the normal range. Lactate concentration after exercise averaged 3.7 +/- 0.3 mm l-1. No significant change was observed at altitude, except for a higher heart rate and a lower arterial oxygen saturation (SaO2) (both at rest and after inspiratory manoeuvres). The smoking history and the degree of physical activity did not influence lung function or exercise performance at altitude. The results of this study show that in middle-aged, healthy, not particularly well-trained individuals, lung function is not significantly altered by moderate-high altitude, despite the absence of any acclimatization period and independent of their smoking history and previous exercise habits.

Altitude↗