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PubMed2005

Pretransplant lung function, respiratory failure, and mortality after stem cell transplantation.

RATIONALE: The role of pulmonary function before stem cell transplant as a potential risk factor for the development of early post-transplant respiratory failure and mortality is controversial. METHODS: We conducted a retrospective analysis of the pretransplant pulmonary function of 2,852 patients who received their transplant between 1990 and 2001. MEASUREMENTS: Pretransplant FEV(1), FVC, total lung capacity (TLC), diffusing capacity of carbon monoxide (DL(CO)), and the alveolar-arterial oxygen tension difference P(A-a)O(2) were measured and assessed for association with development of early respiratory failure and mortality in Cox proportional hazard logistic models. MAIN RESULTS: In multivariate analyses, progressive decrease of all lung function parameters was associated with a stepwise increase in risk of developing early respiratory failure and mortality when assessed in independent models. On the basis of a significant correlation between FEV(1) and FVC (r = 0.81), FEV(1) and TLC (r = 0.61), and FVC and TLC (r = 0.80), and a lack of correlation between FEV(1) and DL(CO), we developed a pretransplant lung function score based on pretransplant FEV(1) and DL(CO) to determine the extent of pulmonary compromise before transplant. Multivariate analysis indicated that higher pretransplant lung function scores are associated with a significant increased risk for developing early respiratory failure (category II hazard ratio [HR], 1.4; category III HR, 2.2; category IV HR, 3.1; p < 0.001) and death (category II HR, 1.2; category III HR, 2.2; category IV HR, 2.7; p < 0.005). CONCLUSIONS: These results suggest that not only does compromised pretransplant lung function contribute to the risk for development of early respiratory failure and mortality but this risk may be estimated before transplant by grading the extent of FEV(1) and DL(CO) compromise.

Adult↗

PubMed1990

[Stabilization of lung function in cystic fibrosis during long-term tube feeding via a percutaneous endoscopic gastrostomy].

To determine whether long-term enteral feedings can improve nutritional status and lung function parameters in patients with cystic fibrosis (CF), 11 patients (8 female, 3 male, age 7 to 23 years) received a percutaneous endoscopic gastrostomy (PEG) since February 1988. All patients were moderately to severely affected and extremely malnourished with a relative underweight of 15% or more. After 9 months of supplemental nocturnal feeding, mean body weight improved from 25.8 +/- 4.7 kg (mean, standard deviation) to 31.6 +/- 7.4 kg (p = 0.003); mean relative underweight decreased from 20.7 +/- 3.4% to 10.4 +/- 8.6% (p = 0.02). Lung function, which was measured either prior to or without any intravenous antibiotics, improved considerably: mean vital capacity increased from 39.5% of the predicted value to 46.8% after 9 months (p = 0.01), the mean peak flow rate improved from 39.5% to 50.8% (p = 0.01). This improvement in lung function is probably secondary to the increased muscle mass of the patients. Long-term nocturnal feedings via a percutaneous gastrostomy tube improve nutritional status and lung function severely in malnourished patients with CF.

Adolescent↗

PubMed1994

Ability of new lung function tests to assess methacholine-induced airway obstruction in infants.

We assessed the ability of innovative lung function tests to detect bronchial obstruction induced by methacholine bronchial challenge. Fifty-five recurrently wheezy infants (mean age 16 +/- 5.2 months) free of respiratory symptoms underwent baseline lung function tests. Forty-two completed the methacholine challenge. Maximal flow at functional residual capacity (VmaxFRC) was obtained using the squeeze technique; compliance and resistance of the respiratory system (Crs, Rrs) was measured with the passive expiatory flow volume technique; tidal volume breathing patterns were analyzed from recordings of respiratory rate (RR), tidal volume (VT), and inspiratory time divided by total cycle of duration (Ti/Ttot). Expiratory tidal flow volume (V/VT) curves were described with multiple indices such as the ratio of expiratory time necessary to reach peak tidal expiratory flow (Fpet) to expiratory time (Tme/Te). Transcutaneous oxygen tension (PtCO2) was measured as an indicator of response to methacholine challenge. Of 42 infants 41 responded to methacholine by a change > or = 2 standard deviations from baseline values. The mean SD unit changes were 9.8 in PtCO2, 3.7 for VmaxFRC, 2.8 for Crs, 2.09 for Rrs, 3.1 for RR, 1.6 for Ti/Ttot, 2.2 for Tme/Te 3.9 for PFVt. We conclude that these noninvasive lung function tests, especially VmaxFRC and Fpet, can be used to detect minor or moderate airway obstruction. Further studies are needed to determine the value of the tests in assessing bronchial disease and effects of its treatment.

Airway Obstruction↗

PubMed2002

[Lung function in preadolescents after pertussis infection. Results of the epidemiologic study in Krakow].

The main goal of the study was to check the hypothesis that pertussis infection may cause a lung function deterioration in children. Cross sectional study was carried out in 1997 among 992 schoolchildren attending the fourth form of elementary schools in Krakow. In the course of the study the epidemiologic interviews on respiratory health of children and spirometric testing were performed. Spirometric indices (FVC, FEV1 and FEF25-75%) were inversely correlated with allergic diseases, wheezing symptoms and tobacco smoking of mother in pregnancy, however, the effect of the latter variable was of border significance. Socio-economic status of the family and number of infections in lower respiratory tract in children reported over the last year were not related to the lung function level. Children who reported pertussis infection in the past showed significantly lower values of FEV1 and FEF25-75%. The results obtained suggest that pertussis infection may have a detrimental effect on the lung function of preadolescent children. Since these children may be more susceptible to environmental hazards and development of obstructive lung disease, therefore, it is justified to postulate a monitoring of lung function in children after pertussis infection throughout a longer period to detect early lung obstruction and setting up proper prophylactic measures.

Catchment Area, Health↗

PubMed1980

Effect of regional chest wall restriction on regional lung function.

The effect of impeding regional chest wall excursion on regional lung function was assessed. Fourteen subjects were studied while seated in a volume-displacement plethysmography. The lower rib cage and epigastrium were restricted with an inextensible binder. Because such restriction increases lung recoil and diminishes functional residual capacity (FRC), all measurements were made at the unstrapped FRC (FRCus). Regional excursion of the chest wall was measured with magnetometers placed anteroposteriorly at the sternomanubrial angle, the xyphoid, and umbilicus and transversely at the level of the xyphoid at the midaxillary line. Regional lung function was assessed by measuring the distribution of inspired boluses and washout of 133Xe with scintillation detectors positioned against the subject's back at the apical, middle, and basal regions. Restriction of the lower chest wall impeded expansion of the lower rib cage and diminished the distribution of inspired gas to and washout of the lung bases. The upper rib cage expanded normally and was associated with an increased distribution of inspired gas and normal distribution of washout to the apices. These results suggest that regional lung function was dependent on regional rib cage excursion.

Adult↗

PubMed1994

Lung function by tidal breathing in awake healthy newborn infants.

The increasing availability of appliances for measuring lung function in infants may allow clinical and epidemiological applications. The aim of the present study was to establish reference values for tidal breathing lung function in awake newborn infants and to investigate potential sources of variability. Tidal flow-volume loops were measured in 803 awake, healthy infants (427 males and 376 females) and passive respiratory mechanics (single-breath occlusion technique) in 664. Mean postnatal age was 2.7 +/- 0.9 (sd) days, gestational age 39.8 +/- 1.4 weeks and birthweight 3.59 +/- 0.49 kg. Tidal expiratory volume (Vt), peak tidal expiratory flow (PEF), and mid-expiratory flow increased significantly with increasing birthweight. Flow ratios: ratio of time to PEF to total expiratory time (Tpef/Te), ratio of volume to PEF to total expiratory volume (Vpef/Ve); and ratio of tidal flow at 25% remaining expiration to PEF (TEF25/PEF), were highest in 1 day old infants (medians 0.39, 0.46 and 0.81 respectively), decreasing to a minimum in 4-5 day old infants, but were not influenced by birthweight. Tidal flows and flow ratios were higher in males versus females, even after weight adjustment. Respiratory rates correlated significantly with tidal flows (r = 0.66), inversely with Vt (r = 0.40), but not with flow ratios. Mean compliance of the respiratory system was 1.18 ml.cmH2O-1.kg birthweight (95% confidence interval (95% CI) 1.15-1.21) and mean resistance 0.051 cmH2O.ml-1.s (95% CI 0.049-0.054). These results demonstrate that lung function in awake healthy infants varies according to weight, gender and postnatal age.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗

PubMed1986

Independent influence of reversibility of air-flow obstruction and nonspecific hyperreactivity on the long-term course of lung function in chronic air-flow obstruction.

We evaluated factors that might influence the course of lung function after 2 to 21 yr of follow-up in 81 nonallergic patients with chronic air-flow obstruction (CAO) and considerable lung function impairment (initial forced expiratory volume in one second as a percentage of inspiratory slow vital capacity (FEV1 % VC) ranging from 40 to 55% and increasing less than 15% after the administration of the anticholinergic bronchodilator thiazinamium). A more favorable rate of change in FEV1 was associated with less pack-years of smoking, less nonspecific hyperreactivity, and a higher degree of reversibility of air-flow obstruction, when expressed as the increase in FEV1 as a percentage of the predicted minus prebronchodilator FEV1 value. Nonspecific hyperreactivity and reversibility of air-flow obstruction appeared to influence the decline in FEV1 independently of baseline value of FEV1, both in smokers and ex-smokers. The hypothesis is put forward that regular bronchodilating therapy may be able to prevent deterioration of lung function. However, the possibility that interval therapy may ultimately produce the same results cannot be excluded. It seems to be important to stop smoking, both for the sake of its negative influence on the course of FEV1 and for the fact that a beneficial influence of bronchodilating therapy may become even more apparent.

Adult↗

PubMed2002

Lung function values in healthy non-smoking urban adults in iran.

BACKGROUND: The values of lung function tests (LFTs) are dependent on height, age, and sex. In addition, there is evidence of LFT variation in different ethnic groups. OBJECTIVE: We have therefore derived prediction equations for LFTs from a healthy, non-smoking, urban adult population in the city of Mashhad (northeast Iran). METHODS: Predicted equations for normal lung function have been derived from 572 healthy, non-smoking subjects including 326 men (height 154-195 cm) and 246 women (height 144-174 cm) aged 18-65 years. The subjects underwent measurement of spirometric flow and volume. The following variables were measured: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), maximal mid-expiratory flow (MMEF), peak expiratory flow (PEF) and maximal expiratory flow at 75, 50 and 25% of the FVC (MEF(75), MEF(50), and MEF(25), respectively). Regression analysis using height and age as independent variables was applied to provide predicted values for both sexes. RESULTS: There was a negative correlation between each lung function and age. The largest negative correlations were found for FEV(1) and FVC in men and women, respectively. All parameters correlated positively with height; the largest positive correlation was observed for FVC in both sexes. Comparison of LFTs derived from the equations of the present study showed significant differences with those of several previous studies. CONCLUSION: In this study, a set of LFT reference values and prediction equations for both sexes have been derived using a relatively large, healthy, non-smoking Iranian, adult population which was different from several other prediction equations.

Adolescent↗

PubMed1996

[Can preoperative lung function diagnosis detect risk of intraoperative pulmonary gas exchange insufficiency in artificial hip replacement with polymethylmethacrylate cement?].

In a study of 90 patients in whom a hipjoint had been replaced for the first time using polymethylmetacrylate cement, the extent of intraoperative pulmonary gas exchange disorders was established. The effect of a preexisting disorder of lung function was determined. We checked whether an appraisal of the risk patients who are operated on can be assisted by a preoperative analysis of lung function. After preoperative diagnosis of lung function, the arterial blood gases were analysed at defined times during the operation. An intraoperative fall in the partial pressure of oxygen and an increase in carbon dioxide partial pressure in the arterial blood were found in all patients. There were pronounced interindividual differences in the extent of the disorder of pulmonary gas exchange. The degree of severity of the respective acute disorder of lung function did not show any correlation with the pre-existing disorder of pulmonary ventilation. Major hemodynamic changes were not observed. According to the present findings, a definitive statement with regard to the degree of severity of intraoperatively occurring disorders of pulmonary function cannot be expected from a preoperative analysis of pulmonary function.

Aged↗

PubMed1994

Dust- and endotoxin-related acute lung function changes and work-related symptoms in workers in the animal feed industry.

Reported respiratory and related symptoms during work were compared between 265 exposed animal feed workers and a control group consisting of 175 external controls and nonexposed workers in the animal feed industry. Symptoms indicating respiratory and nasal irritation were significantly increased in the animal feed workers. Prevalences ranged from 9% (cough) to 21% (sneezing). Reported cough after work was also significantly increased. In 119 workers, a total of 457 across-shift spirometric lung function changes were measured. Almost all lung function variables showed a decrease during the work shift, as could be expected since the circadian rhythm is in a downward phase during the measurement period (2 p.m.-10 p.m.). When the workers were grouped into dust and endotoxin exposure categories according to their job titles, and exposure-response trend was seen for maximum mid-expiratory flow (MMEF) and maximum expiratory flow rate at 50% of vital capacity (MEF50). The effect of endotoxin was stronger than that of dust, both in magnitude and significance. For the same lung function variables and for forced expiratory volume in 1 second (FEV1) and MEF25, a significant across-week change was also detected. The results of this study are in concordance with other studies that indicate acute effects on lung function and elevated prevalences of respiratory symptoms during work caused by exposure to grain dust.

Adult↗

PubMed1989

Respiratory symptoms and lung function in relation to passive smoking: a comparative study of American and French women.

Results are reported from a parallel analysis of the association of passive smoking with respiratory symptoms and lung function (FEV1, FVC and FEV1/FVC) in 2220 US and 3855 French women from the general population examined over the same time period using similar methods. Age, city, educational level, occupational exposure and height (for lung function) were taken into account. In the US survey, being a never smoker married to a current or former smoker was significantly associated only with wheezing compared to being a true never smoker. A borderline significant association between passive smoking and dyspnoea was observed among women older than 40 in the French survey. No association was observed with cough or phlegm production. Passive smoking was significantly related to lower FVC and FEV1 values among French women 40 years or more, even among those without a history of wheeze or asthma. However, even among US women older than 40 years of age, there was no significant association between passive smoking and level of lung function. Better housing conditions, higher divorce rates, more frequent exposure to passive smoking in childhood, and different selection factors for active smoking in the US compared to France might explain the lack of association of current spousal smoking habits with lower lung function in American women.

Adult↗

PubMed1984

Differential ethnic standards for lung functions, or one standard for all?

The multiple regression equation predicting lung function values for a study population of South African Blacks is compared with equations predicting normal values for Blacks elsewhere, and in almost all cases is found to predict higher values. This is so despite the study population's high prevalence of respiratory disease and long history of exposure to crocidolite asbestos dust. This anomalous finding is explored in terms of some problems with studies generating normal values. In particular, the confounding effect of social class status on ethnic determinants of lung function is considered. Low 'normal' values for Blacks reported from South Africa and elsewhere are examined. The disadvantages to workers of being evaluated in relation to low norms are discussed in terms of preventive medicine and workmen's compensation. The application of a universal standard for all is proposed.

Adult↗

PubMed2006

Video-assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function.

BACKGROUND: The aim of this study is to evaluate the early outcome of patients with poor lung function who underwent video-assisted thoracic surgery (VATS) pulmonary resection for primary non-small cell lung carcinoma. METHODS: We reviewed retrospectively the records of patients with lung cancer undergoing VATS lung resection over a period of 5 years. Twenty-five patients with preoperative poor lung function defined as forced expiratory volume in 1 second less than 0.8 L or the percentage predicted value for forced expiratory volume in 1 second less than 50% were identified. Thirteen patients underwent VATS lobectomies and 12 VATS wedge resections. Data were analyzed with respect to demographics, risk factors, and early postoperative outcome and survival. RESULTS: There were 8 cases of morbidities (29%) and no surgical mortality. Five of these 8 patients had respiratory-related complications after surgery. A deterioration in pulmonary performance as indicated by the Eastern Cooperative Oncology Group (ECOG) score was seen in 7 patients (28%), with only 1 patient having an ECOG score greater than 2. No patient required home oxygen supplementation beyond the third month postoperatively. After a median follow-up period of 15.1 months (range, 1 to 24), 5 patients died. Only 1 patient (4%) died of a respiratory complication (pneumonia 6 weeks after surgery). The other 4 deaths were due to recurrent or metastatic disease. The actuarial survival rates at 1 and 2 years were 80% and 69%, respectively. CONCLUSIONS: Video-assisted thoracic surgery pulmonary resection for cancer in patients with poor lung function can achieve acceptable functional and oncologic outcome.

Aged↗

PubMed1988

Childhood asthma and adult lung function.

An age-matched group of 247 subjects who had had asthma as children and 39 control subjects were studied with lung function and bronchial reactivity testing at the age of 28 years. Lung function of those who had ceased wheezing was essentially normal, but lung function was increasingly abnormal in those who continued to wheeze. Those with frequent wheezing at 28 demonstrated a greater decline in their respiratory function since the age of 7 years than the other groups. Methacholine provocation testing was performed in 91% of the group and was associated with frequency of wheezing and evidence of small airways obstruction. No association was found between reactivity and loss of ventilatory capacity since 21 years of age.

Adult↗

PubMed2005

Are ethnic differences in lung function explained by chest size?

BACKGROUND: Ethnic differences in lung function (LF) are recognised in adults and children. Most prediction equations for LF are derived from whites, so non-whites are at risk of erroneous assessment. It was hypothesised that differences in chest dimensions would explain differences in LF between Asian (Indian) and white schoolchildren. AIMS: To quantify the impact of chest dimensions on LF, which would inform our understanding of ethnic differences that have implications for health care. METHODS: Children aged 6-11 were studied in school. A questionnaire provided information on ethnicity and respiratory health. Spirometry was used to record FVC, FEV1, FEF25-75, and PEF. Weight, height, sitting height, and chest dimensions (chest height, circumference, antero-posterior and transverse diameters) were measured. RESULTS: Data were obtained from 294 healthy children. Standing height was the most important predictor of LF. Ethnicity was an independent predictor for all LF measures except PEF, where the effect was marginal. FVC in whites was 13.4% bigger than in Asians of the same height, and the FEV1 was 10.6% greater in whites. The influence of chest dimensions on lung function was trivial. Body mass index was smaller in Asians but did not explain differences in LF. CONCLUSIONS: Differences in chest dimensions did not explain the substantial effect of ethnicity on LF. Mechanisms whereby ethnicity exerts its influence may include differences in inspiratory muscle strength or lung compliance but remain speculative. Nevertheless it remains imperative that ethnic differences are recognised when interpreting LF tests.

Anthropometry↗

PubMed2003

Roles of genotypes of beta2-adrenergic receptor in the relationship between eosinophil counts and lung function in Taiwanese adolescents.

To examine the roles of genetic polymorphism of the beta2-adrenergic receptor (beta2AR) in the relationship between eosinophil (EOS) counts and eosinophil cationic protein (ECP) counts and lung function, we recruited a random sample from the 1996 nationwide survey of asthma prevalence in middle school children. A total of 149 subjects--42 asthmatic children, 38 asthmatics in remission (no reported attack for more than 12 months), and 69 nonasthmatics--completed a physical evaluation, pulmonary function test, and determination of EOS, ECP, and beta2AR genotypes at amino acids 16 and 27. Asthmatic children had higher EOS and ECP than did nonasthmatics. No association was found between asthma and beta2AR genotypes. Lung function was significantly and inversely correlated with EOS but not with ECP in asthmatic children. By genotype, an inverse correlation between lung function and EOS was found in asthmatic children with Arg16Arg or Gln27Glu. A nonsignificant but similar inverse correlation was found in asthmatic children with Arg16Gly or Gln27Gln. However, a nonsignificant but positive correlation was found in asthmatic children with Gly16Gly. In conclusion, we suggest that EOS is a better clinical indicator of airway inflammation than ECP when children are not having an asthma attack. The association between an increase of EOS and lower lung function can be differentiated by beta2AR genotypes at amino acid 16.

Adolescent↗

PubMed1995

Lung function in Duchenne muscular dystrophy.

Over 90% of patients with Duchenne muscular dystrophy develop a scoliosis when they become wheelchair bound. The scoliosis is progressive and is associated with deteriorating lung function. The purpose of this study was firstly to assess whether a standing regimen, in patients who had gone off their feet, protected against the development of scoliosis and affected their lung function, and secondly to evaluate the effect of spinal stabilisation in patients who had developed a progressive scoliosis. The results of the first part of this study showed that a standing regimen significantly delayed the progression of scoliosis and that patients who complied with the standing regimen had a significantly better lung function, as measured by vital capacity and peak expiratory flow rate, than those patients who did not stand. Spinal stabilisation prevented deterioration in the scoliosis, whereas the deformity continued to progress relentlessly in patients who did not undergo surgery. The patients who underwent spinal stabilisation maintained a significantly better lung function and had an improved survival compared with the patients who refused surgery.

Child↗

PubMed2002

Lung function over six years among professional divers.

AIMS: To analyse longitudinal changes in pulmonary function in professional divers and their relation with cumulative diving exposure. METHODS: The study included 87 men at the start of their education as professional divers. At follow up one, three, and six years later, 83, 81, and 77 divers were reexamined. The median number of compressed air dives in the 77 divers over the follow up period was 196 (range 37-2000). A group of non-smoking policemen (n = 64) were subjected to follow up examinations in parallel with the divers. Assessment of lung function included dynamic lung volumes, maximal expiratory flow rates, and transfer factor for carbon monoxide (Tl(CO)). The individual rates of change of the lung function variables were calculated by fitting linear regression lines to the data, expressed as percent change per year. RESULTS: The annual reductions in forced vital capacity (FVC) and forced expired volume in one second (FEV(1)) were 0.91 (SD 1.22) and 0.84 (SD 1.28) per cent per year in divers, which were significantly higher than the reductions in the policemen of 0.24 (SD 1.04) and 0.16 (SD 1.07) per cent per year (p < 0.001). The annual reduction in the maximal expiratory flow rates at 25% and 75% of FVC expired (FEF(25%) and FEF(75%)) were related to the log(10) transformed cumulative number of dives in a multiple regression analysis (p < 0.05). The annual reductions in Tl(CO) were 1.33 (SD 1.85) and 0.43 (SD 1.53) per cent per year in divers and policemen (p < 0.05). CONCLUSIONS: FVC, FEV(1), maximal expiratory flow rates, and Tl(CO) were significantly reduced in divers over the follow up period when compared with policemen. The contrasts within and between groups suggest that diving has contributed to the reduction in lung function.

Accidents, Occupational↗