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Environmental correlates of impaired lung function in non-smokers with severe alpha 1-antitrypsin deficiency (PiZZ).

BACKGROUND: Active smoking is the most important risk factor for pulmonary emphysema in subjects with severe alpha 1-antitrypsin (AAT) deficiency. The aim of this study was to analyse the effects of environmental risk factors other than active smoking on lung function and on respiratory symptoms in non-smoking PiZZ individuals. METHODS: Lifetime exposure to passive smoking, domiciliary use of a kerosene (paraffin) heater or gas cooker, and all occupations since leaving school were reported by 205 non-smoking PiZZ individuals (95 men and 110 women) included in the Swedish AAT deficiency register. Lung function test results and histories of respiratory symptoms (chronic bronchitis, recurrent wheezing, and exertional dyspnoea) were elicited from the AAT register records. RESULTS: After adjustment for age, agricultural employment and domiciliary kerosene heater usage, but not gas cooker usage or passive smoking, were both associated with significantly decreased lung function. Multiple linear regression analysis showed age, sex, kerosene heater usage, and agricultural employment to be independent determinants of lung function impairment. Age and passive smoking for 10 years or more, both at home and at the work place, were associated with the presence of chronic bronchitis. Age and agricultural employment for > or = 10 years were associated with recurrent wheezing and exertional dyspnoea. CONCLUSIONS: Domiciliary kerosene heater usage and an agricultural occupation therefore appear to be environmental factors associated with decreased lung function in non-smoking PiZZ individuals, and passive smoking is associated with an increased frequency of chronic bronchitis, but not with impaired lung function.

Adult↗

The adverse effect of low levels of ambient air pollutants on lung function growth in preadolescent children.

The main purpose of our study was to assess the effect of low concentrations of ambient air pollution on lung function growth in preadolescent children. We accounted for height velocity over the follow-up period and also for other possible confounders such as baseline anthropometric and physiologic characteristics of children. In addition to outdoor air pollution, we considered the possible effects of social class and exposure to indoor pollutants such as gas stove fumes or environmental tobacco smoke. The cohort prospective study was carried out in 1,001 preadolescent children from two areas of Krakow, Poland, that differed in ambient air pollutants. In the city center (higher pollution area), the mean annual level [+/- standard deviation (SD)] of suspended particulate matter was 52.6 +/- 53.98 microg/m(3) and that of SO(2) was 43.87 +/- 32.69 microg/m(3); the corresponding values in the control area were 33.23 +/- 35.99 microg/m(3) and 31.77 +/- 21.93 microg/m(3). Mean lung function growth rate adjusted to height velocity and lung function level at the study entry was significantly lower in boys and girls living in the more polluted areas. Also, the proportion of children with the slower lung function growth (SLFG) was higher in the children from the more polluted area of the city. The analysis completed in the group of children after the exclusion of asthmatic subjects and those with asthmalike symptoms confirmed that, in boys, odds ratios (ORs) for SLFG [forced vital capacity (FVC)] and air pollution after adjustment to baseline FVC, height, and growth rate was significant [OR = 2.15; 95% confidence interval (CI), 1.25-3. 69)]. The analysis also confirmed that for SLFG(FEV(1)) the OR was 1. 90 (CI, 1.12-3.25). The corresponding OR values in girls were insignificant (OR = 1.50; CI, 0.84-2.68 and OR = 1.39; CI, 0.78-2. 44). The association between ambient pollutants and poorer gain of pulmonary volumes in children living in more polluted areas suggests that air pollution in the residence area may be a part of the causal chain of reactions leading to retardation in pulmonary function growth during the preadolescent years.

Air Pollution↗

Proteome-wide Mendelian randomisation of lung function to identify potential therapeutic targets for respiratory disease.

BACKGROUND: Despite multiple clinical trials, disease-modifying treatments for COPD are currently limited. Since many drugs target proteins, identifying causality between proteins and lung function informs understanding of COPD pathophysiology and may suggest novel targets. We used Mendelian randomisation (MR) to prioritise proteins as potentially causal for imparied lung function. For prioritised proteins, we explored their potential suitability as drug targets by predicting their effects on a range of clinical outcomes. METHODS: We used genome-wide association study (GWAS) data on 2923 proteins (n=48&#x2009;195, UK Biobank) to identify single genetic variants (protein quantitative trait loci (cis-pQTLs)) associated with protein levels (p&#x2264;5&#xd7;10-9, variant &#x2264;100&#x2005;kb of a transcription start site). We performed cis-pQTL-MR analyses of four spirometric traits (n=149&#x2009;166, 36 independent cohorts). Sensitivity analyses included colocalisation and reverse direction MR. We report associations between cis-pQTLs for prioritised proteins and multiple clinical respiratory outcomes, and use phenome-wide analysis to explore potential adverse effects or drug repurposing opportunities. FINDINGS: 1841 proteins had a suitable cis-pQTL. We implicated 16 proteins as potentially causal for lung function (p<1.71&#xd7;10-5): seven proteins have not been implicated by previous lung function GWAS or MR (CCND2, DTD1, PILRA, PTPRK, TDRKH, GRHPR, NUDT5), and we provide corroborative evidence for 10 proteins. We add to the literature identifying surfactant protein D (SFTPD) as a candidate, yet predict that integrin subunit alpha V (ITGAV) inhibition could impair some lung function measures, mimicking adverse results from a recent trial. INTERPRETATION: Our approach identifies proteins (some novel) that are potentially therapeutic targets for respiratory disease, and which warrant follow-up for utility and safety.

Journal Article↗

Particulate matter and lung function growth in children: a 3-yr follow-up study in Austrian schoolchildren.

The effects of particulate matter <10 microm in diameter (PM10) and other air pollutants on lung function were assessed in 975 schoolchildren, from eight communities in Lower Austria between 1994-1997. In each community, air pollution data were collected. Spirometry was performed twice a year. PM10 concentration (mean concentration between two subsequent lung-function measures in spring and autumn (summer interval) or between autumn and spring (winter interval)) showed a mean value of 17.36 microg x m(-3) in the summer interval and 21.03 microg m(-3) in the winter interval. A slower increase in the forced expiratory volume in one second (FEV1) and midexpiratory flow between 25 and 75% of the forced vital capacity (MEF25-75) with age in children exposed to higher summer PM10 was observed in the 3-yr study period. After adjusting for potential confounders (sex, atopy, passive smoking, initial height, height difference, site, initial lung function) an increase of summer PM10 by 10 microg x m(-3) was associated with a decrease in FEV1 growth of 84 mL x yr(-1) and 329 mL x s(-1) x yr(-1) for MEF25-75. Nitrogen dioxide and ozone also showed a negative effect on lung-function growth, confirming previous work. The authors concluded that long-term exposure to particulate matter <10 microm in diameter had a significant negative effect on lung-function proxy for the development of large (forced expiratory volume in one second) and small (midexpiratory flow between 25 and 75% of the forced vital capacity) airways, respectively, with strong evidence for a further effect of ozone and nitrogen dioxide on the development of forced vital capacity and forced expiratory volume in one second.

Air Pollutants↗

Air pollution and lung function among susceptible adult subjects: a panel study.

BACKGROUND: Adverse health effects at relatively low levels of ambient air pollution have consistently been reported in the last years. We conducted a time-series panel study of subjects with chronic obstructive pulmonary disease (COPD), asthma, and ischemic heart disease (IHD) to evaluate whether daily levels of air pollutants have a measurable impact on the lung function of adult subjects with pre-existing lung or heart diseases. METHODS: Twenty-nine patients with COPD, asthma, or IHD underwent repeated lung function tests by supervised spirometry in two one-month surveys. Daily samples of coarse (PM10-2.5) and fine (PM2.5) particulate matter were collected by means of dichotomous samplers, and the dust was gravimetrically analyzed. The particulate content of selected metals (cadmium, chrome, iron, nickel, lead, platinum, vanadium, and zinc) was determined by atomic absorption spectrometry. Ambient concentrations of nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and sulphur dioxide (SO2) were obtained from the regional air-quality monitoring network. The relationships between concentrations of air pollutants and lung function parameters were analyzed by generalized estimating equations (GEE) for panel data. RESULTS: Decrements in lung function indices (FVC and/or FEV1) associated with increasing concentrations of PM2.5, NO2 and some metals (especially zinc and iron) were observed in COPD cases. Among the asthmatics, NO2 was associated with a decrease in FEV1. No association between average ambient concentrations of any air pollutant and lung function was observed among IHD cases. CONCLUSION: This study suggests that the short-term negative impact of exposure to air pollutants on respiratory volume and flow is limited to individuals with already impaired respiratory function. The fine fraction of ambient PM seems responsible for the observed effects among COPD cases, with zinc and iron having a potential role via oxidative stress. The respiratory function of the relatively young and mild asthmatics included in this study seems to worsen when ambient levels of NO2 increase.

Adult↗

Lung function changes after allogenic bone marrow transplantation.

The lung function of 21 patients with leukaemia (11 with acute myeloid leukaemia, six with acute lymphatic leukaemia, four with chronic myeloid leukaemia) and of five with severe aplastic anaemia was tested before and after allogenic bone marrow transplantation. Vital capacity (VC) was lowered in patients with leukaemia before transplantation. VC and FEV1 fell significantly after transplantation. Residual volume (RV) and RV as a percentage of total lung capacity (RV % TLC) were already increased and rose significantly after transplantation. Patients with severe aplastic anaemia had noticeably increased RV and RV % TLC, values that did not change after transplantation. In contrast to the patients with aplastic anaemia, the patients with leukaemia had significantly reduced VC, RV, RV % TLC, and FEV1 before and after transplantation. The specific airway resistance (sRaw) was raised significantly before and after transplantation in the leukaemic patients. In addition, transfer coefficient (Kco) fell significantly more after transplantation in the patients with leukaemia than in those with severe aplastic anaemia. In three patients with histologically established obstructive bronchiolitis in conjunction with chronic graft versus host disease after transplantation, VC, FEV1 and FEV1 % VC fell, while RV, RV % TLC, and sRaw rose; Kco was far below normal. On the basis of these findings it is concluded that in patients with leukaemia obstructive disorders of ventilation develop or, if they are already present, worsen. In patients with severe aplastic anaemia lung function was not impaired in the early phase after transplantation. These differences are probably due to the more intensive immunosuppressive and cytotoxic preparatory regimen before transplantation in the leukaemic patients. Obstructive bronchiolitis, a complication of graft versus host disease, first manifests itself in a typical rise in specific airway resistance and must be treated early.

Adolescent↗

Regional lung function following prosthetic hip replacement surgery.

With a Xenon133 radiospirometric technique the regional lung function was evaluated before and after prosthetic hip arthroplasty performed in the lateral decubitus position with either respirator-controlled neuroleptic anesthesia or epidural anesthesia with spontaneous breathing. Regional lung function measured in a supine position 1, 20 and 72-96 hours postoperatively revealed a reduction of the perfusion, ventilation and volume of ventilated alveoli on the dependant lung. The reduction was most pronounced immediately postoperatively, especially following respirator-controlled anesthesia. There was also an increase of pulmonary blood volume and a decrease of total lung volume in this group. The changes of lung function are probably caused by congestive atelectasis, secondary to impaired ventilation of the dependent lung. Peroperatively induced microembolism might have potentiated the effect.

Aged↗

The effect of D-penicillamine on lung function parameters (diffusion capacity) in rheumatoid arthritis.

Sequential lung function tests were performed on 28 rheumatoid arthritis (RA) patients who were treated with D-penicillamine (total of 101 treatment years) and on 42 control RA patients who were not treated or who were treated with NSAIDs, chloroquine, gold salts, corticosteroids, salazopyrine or methotrexate. A decline in lung function parameters was found in both groups, although it was only significant for the carbon monoxide diffusing capacity corrected for lung volume (DLCO/VL). This decrease in DLCO/VL was less pronounced in the D-penicillamine group (mean -6.9%) than in the control group (mean -11.3%). This difference could not be attributed to smoking, which was more frequent in the control group. When reviewing only the patients with an initial DLCO/VL < 80% of the predicted value and having, with some exceptions, chest X-ray abnormalities, we even observed an amelioration in the mean DLCO/VL in the D-penicillamine group, in contrast with a deterioration in the control group (+5.1% versus -5.6%).

Adult↗

Lung function, CT-scan and X-ray in upper airway obstruction due to thyroid goitre.

The purpose of this study was to assess the clinical reliability and to compare routine lung function tests (maximal flows and resistance) and radiological images (computed tomography (CT)-scan and X-ray) in upper airway obstruction. We, therefore, performed these examinations prospectively in 28 female patients (aged 68 +/- 13 yrs) with a goitre and without pulmonary disorders. Lung function measurements consisted of maximum expiratory and inspiratory flow-volume curves and of airway resistance. CT-scans and X-rays were performed during apnoea at functional residual capacity (FRC). Peak expiratory flow was 3.6 +/- 1.3 l.s-1 (i.e. 62 +/- 21% predicted); airway resistance was 0.38 +/- 0.14 kPa (i.e. 149 +/- 58% pred); and specific conductance was 1.0 +/- 0.3 kPa (i.e. 70 +/- 24% pred). Almost all lung function tests were significantly correlated with each other. On CT-scan the tracheal cross-sectional area at the zone of tracheal narrowing could be evaluated in 26 patients and was 58 +/- 17% (CT1/2) of the control area 2 cm above the carina (CT2). On X-ray the sagittal and coronal tracheal diameters at the zone of narrowing could only be measured in 16 subjects and were 60 +/- 17% (X-dia1/2) of the diameter at the control level. CT1/2 and X-dia1/2 were significantly correlated to each other. No correlation was found between the lung function tests and the radiological indices except airway resistance and CT2. Routine lung function and CT-scan do not provide comparable information on the degree of airway obstruction due to a goitre.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Study on lung function tests and prediction equations in Indian male children.

OBJECTIVE: The present study was carried out to evaluate lung functions and develop prediction equations in Indian boys. SUBJECTS: 1555 normal healthy schoolboys from Hyderabad city who were in the age group of 5 to 15 years were selected for the present study. DESIGN: The anthropometric parameters such as height, sitting height, weight, and chest circumference were measured and body surface area (BSA) and percent body fat (% Fat) were derived. The lung functions studied were FEV1, FVC, FEV1% and PEFR. RESULTS: The height, sitting height, weight, BSA, chest circumference, body fat as well as FEV1, FVC, FEV1 % and PEFR were comparable with Indian boys. The height for age, weight for age and weight for height were found to be lower than 50th percentile of NCHS standards in the subjects studied. Similarly the lung function values of the study population were found to be lower than the values of corresponding western population. CONCLUSION: Regression equations were derived to predict FEV1, FVC and PEFR using physical characteristics. Height, chest circumference and fat free mass were the best predictors for FEV1, FVC, and PEFR. Age, height, sitting height, weight, chest circumference and fat free mass showed significant association with lung functions.

Adolescent↗

[Relationship between lung function and nocturnal hypoxemia in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To explore the relationship between the changes of lung function resulted from position changes and obesity, and nocturnal hypoxemia in patients with obstructive sleep apnea syndrome. METHOD: 34 patients with obstructive sleep apnea syndrome were detected by polysomnography with lung function and blood gas analysis in sitting and supine positions during wake, and the relationship between results of lung function and blood gas analysis, IBW% to the AI, and < 90% T (percentage of the duration of SaO2 below 90% to total sleep time) was analyzed. RESULT: The mean age of the patients was 44 +/- 13 years. The AI was 36 +/- 22 time.hour-1. On changing from sitting to supine position, PaO2, VC%, ERV, FRC, FRC%, RV%, TLC% decreased significantly, especially ERV and FRC%, which decreased 47% and 29% respectively. AI had positive correlation with VC% (r = 0.477, P < 0.01) and TLC% (r = 0.443, P < 0.01) in supine position, < 90% T had negative correlation with PaO2(r = -0.479, P < 0.01) and ERV (r = -0.416, P < 0.05) in sitting position. The IBW% had negative correlation with VC% in sitting (r = -0.547, P < 0.01) and supine position (r = -0.491, P < 0.01). IBW% also had negative correlation with ERV in sitting (r = -0.523, P < 0.01) and supine (r = -0.413, P < 0.01) position and FRC (r = -0.402, P < 0.05) in sitting position. The IBW% had positive correlation with the < 90% T(r = 0.514, P < 0.01). CONCLUSION: These results suggest that positional changes and obesity have effects on lung function in patients with OSAS, and lead to the deterioration of hypoxemia during apnea.

Adult↗

Lung function decline and outcomes in an adult population.

RATIONALE: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality. OBJECTIVES: To determine risk factors for and outcomes of rapid lung function decline in a cohort of adults in the United States. METHODS: We analyzed data from 15,536 adults aged 44-66 yr in the Atherosclerosis Risk in Communities study. We used Cox proportional hazard models to determine the risk of rapid lung function decline at 3 yr on mortality and COPD hospitalizations over the subsequent 8 yr. MEASUREMENTS AND MAIN RESULTS: Of those in the baseline cohort, 13,756 (88.5%) had spirometry at the Year 3 visit. The strongest risk factors for not having a follow-up spirometry were as follows: having Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3 or 4 disease at baseline (adjusted odds ratio [OR] 2.8; 95% confidence interval [CI], 2.1-3.8), being black (adjusted OR, 2.4; 95% CI, 2.1-2.7), and being a current smoker (adjusted OR, 1.8; 95% CI, 1.5-2.0). Participants with GOLD stage 3 or 4 disease were also more likely to be in the most rapidly declining lung function quartile (adjusted OR, 3.7; 95% CI, 2.7-5.0). Overall, participants with the most rapidly declining lung function had a modestly increased risk of death (adjusted hazard ratio, 1.4; 95% CI, 1.2-1.7) and time to a COPD-related hospitalization (adjusted hazard ratio, 1.4; 95% CI, 1.2-1.8). CONCLUSION: Rapid lung function decline was independently associated with a modest increased risk of COPD hospitalizations and deaths.

Adult↗

Effect of single and double strap backpacks on lung function.

Carrying heavy and moderate military loads in backpacks or as body armour compresses the chest, causing a change in lung function that is typical of a restrictive ventilatory impairment. It is not known if a lighter backpack load of only 6 kg, such as is typical of loads carried by students, will have a similar effect on lung function. There have been no studies examining whether backpacks of different strapping styles have an effect on lung function. Several designs of student backpack have recently been introduced to the market. One of the most popular is a single-strap backpack. This study examined Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1.FVC( - 1)% and Peak Expiratory Flow (PEF) in 13 participants (4 males, 9 females) wearing each of two 6 kg backpacks, one with two shoulder straps (a Double Strap Backpack (DSB)) and the other with a single strap (a Single Strap Backpack (SSB)) worn across the shoulder and chest. In comparison with the control of no pack (N), SSB significantly reduced FVC (by 3.94%, p = 0.006) but there were no significant differences in FEV1, FEV1. FVC( - 1)% and PEF. The DSB also significantly reduced FVC (by 1.97%, p = 0.034) but no significant differences were found in FEV1, FEV1. FVC( - 1)% and PEF measures. In comparison with DSB, the SSB was associated with a significantly lower FVC (by 2.05%, p = 0.049) and FEV1 (by 1.88%, p = 0.029) but there were no significant changes in FEV1. FVC( - 1)% and PEF. It is concluded that a backpack load of 6 kg could produce a mild restrictive type of ventilatory impairment in lung function. This effect was greater for a single cross-chest strap than for a more conventional double strap harness.

Adolescent↗

Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma.

We investigated the effects of primary (< or = 24 h) intramedullary femoral nailing on lung function and pulmonary hemodynamics in patients with multiple trauma. Two groups were separated: the group with primary femoral nailing with reaming (group RFN) was submitted to femoral nailing after reaming of the medullary canal; in the group with unreamed femoral nailing (group UFN) a small-diameter solid nail was inserted without reaming. Lung function was assessed by oxygenation ratio (PaO2/FIO2), and pulmonary hemodynamics by intraoperative pulmonary artery catheter measurements. Central venous blood concentrations of elastase and the platelet count were determined during and 3 days after surgery. Lung function was stable in UFN patients (n = 14), but deteriorated in RFN patients (n = 17) from 353 +/- 24 (PaO2/FIO2 preoperatively) to 260 +/- 28 (PaO2/FIO2 postoperatively) (p < 0.05) and improved only after 48 hours. Pulmonary artery pressure (PAP) did not change during surgery in UFN patients; in RFN patients PAP increased from 27.2 +/- 3.1 mm Hg (preoperatively) to 36.3 +/- 4.1 mm Hg (p < 0.05) upon reaming and normalized 1 hour after insertion of the nail. Femoral nailing after reaming represents a potential risk with respect to lung function disturbances. This might trigger the development of adult respiratory distress syndrome (ARDS), especially in patients at extra risk of this complication (additional lung contusion, "borderline patient"). In these cases unreamed femoral nailing might offer an alternative by allowing primary intramedullary stabilization without the risk of adverse effects to the lung.

Adult↗

Glutathione S-transferase genotypes modify lung function decline in the general population: SAPALDIA cohort study.

BACKGROUND: Understanding the environmental and genetic risk factors of accelerated lung function decline in the general population is a first step in a prevention strategy against the worldwide increasing respiratory pathology of chronic obstructive pulmonary disease (COPD). Deficiency in antioxidative and detoxifying Glutathione S-transferase (GST) gene has been associated with poorer lung function in children, smokers and patients with respiratory diseases. In the present study, we assessed whether low activity variants in GST genes are also associated with accelerated lung function decline in the general adult population. METHODS: We examined with multiple regression analysis the association of polymorphisms in GSTM1, GSTT1 and GSTP1 genes with annual decline in FEV1, FVC, and FEF25-75 during 11 years of follow-up in 4686 subjects of the prospective SAPALDIA cohort representative of the Swiss general population. Effect modification by smoking, gender, bronchial hyperresponisveness and age was studied. RESULTS: The associations of GST genotypes with FEV1, FVC, and FEF25-75 were comparable in direction, but most consistent for FEV1. GSTT1 homozygous gene deletion alone or in combination with GSTM1 homozygous gene deletion was associated with excess decline in FEV1 in men, but not women, irrespective of smoking status. The additional mean annual decline in FEV1 in men with GSTT1 and concurrent GSTM1 gene deletion was -8.3 ml/yr (95% confidence interval: -12.6 to -3.9) relative to men without these gene deletions. The GSTT1 effect on the FEV1 decline comparable to the observed difference in FEV1 decline between never and persistent smoking men. Effect modification by gender was statistically significant. CONCLUSION: Our results suggest that genetic GSTT1 deficiency is a prevalent and strong determinant of accelerated lung function decline in the male general population.

Adult↗

[Prognostic analysis of lung function and chest X-ray changes of 258 patients with severe acute respiratory syndrome in rehabilitation after discharge].

OBJECTIVE: To analyze the clinical characteristics and prognostic changes of rehabilitating severe acute respiratory syndrome (SARS) patients through regular lung function tests and lung imaging studies after discharge and to retrospectively analyze the treatment data of these patients. METHODS: 258 discharged SARS patients received regular SARS-Co virus IgG test, lung function test and chest X-ray and/or high resolution computerized tomography (HRCT) examination at General Hospital of PLA two months after discharge, and the treatment data of these patients were retrospectively analyzed. RESULTS: 80.6% patients (208 of 258 patients) were positive for SARS-Co virus IgG. 21.3% patients (55 of 258 patients) showed lung diffusion abnormity (D(LCO) < 80%pred). Compared to 155 SARS-Co virus IgG positive patients without lung diffusion abnormity and 50 SARS-Co virus IgG negative patients, the 53 SARS-Co virus IgG positive patients with lung diffusion abnormity had longer fever course, higher dosages of glucocorticoid therapy, higher percentage of oxygen therapy and non-invasive ventilation. 51 of the 53 patients with lung diffusion abnormity received lung function test after one month, and the results of D(LCO) improved in 80.4% patients (41 of 51 patients). 40 of 51 patients with lung diffusion abnormity showed lung fibrosis, and the fibrosis decreased in 55% patients (22 of 40 patients) after one month. CONCLUSIONS: This finding suggests that lung fibrosis caused by SARS mostly occurs in severe patients, and it can resolve spontaneously. D(LCO) may be more sensitive than HRCT in evaluating the fibrotic changes.

Adolescent↗

Decortication in chronic pleural empyema - effect on lung function.

OBJECTIVE: The aim of the present study is to evaluate the lung function before and after the lung decortication in patients with chronic pleural empyema (CPE). METHODS: Twenty-six patients with diagnosis of CPE were evaluated in a prospective manner by lung perfusion scintigraphy, blood gas analysis and spirometry before and 35 weeks (+/-17) after the lung decortication. RESULTS: Preoperative scintigraphy showed reduction of lung perfusion on the affected side to 24.5% (+/-12.6%) in 11 right side empyemas (predicted value 55%) and to 18% (+/-8%) in 15 left side empyemas (predicted value 45%). The postoperative measurements showed improvement in perfusion to 45.2% (+/-7.7%) in patients with right side empyema and 34.1% (+/-8.5%) with the left side affection. The preoperative vital capacity (VC) was reduced to 62.3% (+/-13.8%) of the predicted value and forced expiratory volume in 1s (FEV1) to 50% (+/-15.5%) of the predicted value. Postoperatively, slight improvement was achieved to 79.8 % (+/-12.9%) for VC and 69.2% (+/-12.7%) for FEV1. Blood gas analysis showed decreased values in majority of the patients before operation and significant improvement in postoperative evaluation. CONCLUSIONS: Perfusion and spirometry improves significantly in patients with CPE after the lung decortication but function of the affected lung remains impaired. There was no influence of the age, gender, side of the disease, bacteriology or duration of the empyema before operation on lung function.

Adult↗

The influence of lower respiratory illness in infancy and childhood and subsequent cigarette smoking on lung function in Sydney schoolchildren.

A prospective study of respiratory illness history and lung function of 10,898 school children in Sydney was begun in 1971. At the first visit, a history of previous asthma and of bronchitis before and after the first 2 years of life was obtained from a parental questionnaire, and maximal expiratory flow-volume curves were recorded. These lung function studies were repeated yearly between 1972 and 1974, at which time a history of respiratory illness during the previous 12 months and a personal smoking history were recorded, Two groups of children from a random selection of primary and secondary schools in Sydney were studied. Their respective mean ages were 8.9 yr (primary group) and 12.6 yr (high school group) in 1971. Mean values for the maximal flow at 50 percent of the forced vital capacity were lower in children with a history of bronchitis and/or asthma than those in the control group. This was true in both age groups in both sexes. No differences were found in the 0.5-s forced expiratory volume or forced vital capacity. The differences in maximal flow at 50 per cent of the forced vital capacity were present again in 1974. In 1974, the data from smokers were compared with those from nonsmokers; small differences were found. The results suggest that bronchitis in infancy and childhood as well as asthma may affect lung function as children grow, that the abnormality may not be detected by the forced expiratory volume, that the abnormality persists, and that it is possible that the abnormality is further affected by smoking.

Adolescent↗