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PubMed2006

Parental smoking and lung function in children: an international study.

RATIONALE: Both prenatal and postnatal passive smoking have been linked with respiratory symptoms and asthma in childhood. Their differential contributions to lung function growth in the general children's population are less clear. OBJECTIVE: To study the relative impact of pre- and postnatal exposure on respiratory functions of primary school children in a wide range of geographic settings, we analyzed flow and volume data of more than 20,000 children (aged 6-12 yr) from nine countries in Europe and North America. METHODS: Exposure information had been obtained by comparable questionnaires, and spirometry followed a protocol of the American Thoracic Society/European Respiratory Society. Linear and logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results and mean effects were estimated using meta-analytic tools. MAIN RESULTS: Smoking during pregnancy was associated with decreases in lung function parameters between -1% (FEV1) and -6% maximal expiratory flow at 25% of vital capacity left (MEF25). A 4% lower maximal midexpiratory flow (MMEF) corresponded to a 40% increase in the risk of poor lung function (MMEF < 75% of expected). Associations with current passive smoking were weaker though still measurable, with effects ranging from -0.5% (FEV1) to -2% maximal expiratory flow (MEF50). CONCLUSIONS: Considering the high number of children exposed to maternal smoking in utero and the even higher number exposed to passive smoking after birth, this risk factor for reduced lung function growth remains a serious pediatric and public health issue.

Child↗
PubMed1989

Potential of early chest roentgen examination in ventilator treated newborn infants to predict future lung function and disease.

The potentially of early chest X-ray to predict the risk of lung function abnormalities was studied prospectively in 40 preterm ventilator treated infants in a 8-10-year follow-up investigation. According to the findings at chest X-ray 3 to 10 days after completed ventilator treatment the infants were divided into 3 groups considered to represent increasing risk and severity of lung damage: 1) normal findings, 2) interstitial parenchymal abnormalities exclusively or 3) in combination with local or general hyperinflation. Lung function tests and chest x-ray were performed at the age of 8 to 10 years. A correlation was found between the findings at the early chest roentgen examination and the risk of abnormal lung function at the follow-up. Occurrence of focal or general hyperinflation or both were associated with a greater risk of airway obstruction. Infants with only interstitial abnormalities were, however, at a higher risk than those with normal chest examination to develop general hyperinflation and increased air way obstruction.

Bronchopulmonary Dysplasia↗
PubMed1997

Repeated doses of the perfluorocarbon FC-100 improve lung function of preterm lambs.

Intratracheal administration of a single dose of the perfluorocarbon FC-100 improves lung function in surfactant-deficient animals. In this study we compared the response to repeated doses of FC-100 (3 mL/kg 3% solution, n = 5) with that observed after administration of Exosurf (5 mL/kg, n = 5) to mechanically ventilated preterm lambs of 125 d of gestation. The initial dose of FC-100 rapidly increased arterial PO2, decreased arterial PCO2, and improved arterial pH. Also dynamic lung compliance markedly improved with this agent. Administration of an additional dose of FC-100 resulted in relatively similar changes, albeit of lesser magnitude than those observed with the initial dose. In contrast, Exosurf did not improve these variables even after three doses. All lambs treated with FC-100 survived the 6-h study period, whereas one of the five Exosurf-treated lambs survived (p < 0.05). Mean arterial blood pressure and heart rate decreased in those lambs that received FC-100, but not in surviving lambs that received Exosurf. Our data demonstrate that repeated intratracheal administration of the perfluorocarbon FC-100 improves lung function and survival of surfactant-deficient lambs better than the synthetic surfactant Exosurf. We speculate that tensio-active agents with properties different from surfactant, such as FC-100, might improve lung function in preterm neonates with diseases due to surfactant deficiency.

Animals↗
PubMed1996

Asbestos-related bilateral diffuse pleural thickening: natural history of radiographic and lung function abnormalities.

Sixty-four subjects with asbestos-related diffuse pleural thickening attending the London Medical Boarding Centre for Respiratory Diseases (formerly, the Central Pneumoconiosis Panel) were studied to investigate symptomatology, lung function, and radiographic change over an average period of 8 to 9 yr. Chest pain was a common symptom, occurring in over half of the subjects. Approximately one-third of the subjects had a history of pleurisy or pleural effusion. Full long function, available in all cases, showed a highly significant decrement (p < 0.001) compared with predicted values in all variables except gas transfer coefficient (Kco) at initial presentation, consistent with a restrictive ventilatory defect. Longitudinal lung function, available over a mean period of 8.9 yr in 36 subjects, showed a significant decrement above that predicted in FEV1 and FVC only (p < 0.05). Decreases in other parameters were observed, although statistical significance was not achieved. Radiographic score increased with time but there was no correlation between change in lung function and increasing radiographic score, probably reflecting the initial severity of the disease in subjects studied. These observations confirm an initial decrement in lung function in diffuse pleural thickening which is followed by comparatively little change over time.

Aged↗
PubMed2001

Lung function testing in infants with cystic fibrosis: lessons from the past and future directions.

Despite the increasing awareness of the need to identify early pulmonary changes in cystic fibrosis (CF) noninvasively, the role of lung function testing in infancy and early childhood remains less clear than in older children with CF. The aim of this review is to summarize available data, discuss the information gained from these publications, and put this information into perspective with more recent developments of lung function testing in both infants and older children with CF. While some of the available data have been the foundation of the current level of understanding of respiratory physiology in CF, interpretation of other data has been hampered by differences between centers with regard to the methods and equipment used, patient selection, small number of subjects, and lack of appropriate reference data. A structured multicenter approach based on recently published recommendations for the measurement of lung function in infancy, together with pursuit of recent developments such as assessment of raised lung volume flow volume curves and ventilation inhomogeneity may help to more effectively utilize lung function tests in infants in the future.

Clinical Trials as Topic↗
PubMed2005

Sequential analysis of surfactant, lung function and inflammation in cystic fibrosis patients.

BACKGROUND: In a cross-sectional analysis of cystic fibrosis (CF) patients with mild lung disease, reduced surfactant activity was correlated to increased neutrophilic airway inflammation, but not to lung function. So far, longitudinal measurements of surfactant function in CF patients are lacking and it remains unclear how these alterations relate to the progression of airway inflammation as well as decline in pulmonary function over time. METHODS: As part of the BEAT trial, a longitudinal study to assess the course of airway inflammation in CF, we studied lung function, surfactant function and endobronchial inflammation using bronchoalveolar lavage fluid from 20 CF patients with normal pulmonary function (median FEV1 94% of predicted) at three times over a three year period. RESULTS: There was a progressive loss of surfactant function, assessed as minimal surface tension. The decline in surfactant function was negatively correlated to an increase in neutrophilic inflammation and a decrease in lung function, assessed by FEV1, MEF(75/25%VC), and MEF(25%VC). The concentrations of the surfactant specific proteins A, C and D did not change, whereas SP-B increased during this time period. CONCLUSION: Our findings suggest a link between loss of surfactant function driven by progressive airway inflammation and loss of small airway function in CF patients with limited lung disease.

Cross-Sectional Studies↗
PubMed1998

Effects of multiple attempts to quit smoking and relapses to smoking on pulmonary function. Lung Health Study Research Group.

The effect of intermittent smoking on pulmonary function was assessed among participants in the Lung Health Study, 5887 adult smokers with evidence of early chronic obstructive pulmonary disease (COPD), followed up for 5 years. The mean annual rate of loss in FEV1% of predicted after year 1 was smallest for those who quit at some point during the first year of the study and stayed quit (-0.33%/year, +/-0.05%), intermediate for those who smoked intermittently during the study (-0.58%/year, +/-0.05%) and greatest for those who continued to smoke throughout the study (-1.18%/year, +/-0.03%). Surprisingly, those who made several attempts to quit smoking had less loss of lung function at comparable cumulative doses of cigarettes than those who continued to smoke. Quitting smoking for an interval followed by relapse to smoking appeared to provide a measurable and lasting benefit in comparison to continuous smoking. In this early COPD population, not only quitting smoking but attempts to quit smoking can prevent some loss of lung function. These results provide some encouragement to exsmokers who relapse on their way to complete cessation.

Adult↗
PubMed1995

Lung function in Estonian children: effect of sitting height.

The present analysis formed part of the population study of Estonian school-children and was undertaken in order to examine the relationships between lung function variables, standing and sitting height. We measured forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow and forced expiratory flows when 50 and 75% of FVC had been exhaled, and anthropometric indices in 645 healthy schoolchildren, aged 6-18 years. The growth spurt in standing and sitting height occurred between the ages of 11 and 13 years in girls, and 13 and 15 years in boys. Growth spurts of lung parameters occurred during the same periods. FVC and FEV1 showed close correlations (r = 0.89-0.94) with all anthropometric parameters and age, whereas correlation coefficients for the flows were less close (r = 0.65-0.88). In boys, correlations between sitting height and lung function variables were greater than those with standing height. Using stepwise regression analysis, in boys sitting height was selected in all lung function parameters, and in girls sitting height was never selected. We conclude that there is a very close correlation between sitting height and lung function variables. The use of sitting height in parallel with standing height in predicted values for Estonian schoolchildren would make the values more exact.

Adolescent↗
PubMed2001

Eosinophils in induced sputum from asymptomatic smokers with normal lung function.

Cigarette smoking is the dominant risk factor for chronic obstructive pulmonary disease (COPD). However, only 10-15% of smokers develop the disease and early changes within the airways are poorly defined. We aimed to compare cell profiles in induced sputum (IS) from asymptomatic smokers to that from healthy subjects, and to ascertain whether or not inflammatory cells in IS are related to lung function and smoking habit. We recruited 34 heavy, non-allergic asymptomatic smokers with normal lung function and 15 healthy volunteers, who performed lung function tests and IS by hypertonic saline (3%) solution. In smokers, significantcorrelation between pack-years and FEF25-75 (rs = -0.43, P < 0.02) was found. In IS, smokers had higher counts of macrophages (P < 0.01) and eosinophils (P < 0.02), when compared to those of healthy subjects. Additionally, eosinophils were found in IS of 14 out of 34 smokers, with eosinophils had a higher pack-years (31 +/- 25 vs. 13 +/- 10, P = 0.02) and lower FEF 25-75% value (78% +/- 34 vs. 100% +/- 23. P < 0.04). when compared to smokers without eosinophils. Additionally, on the basis of regression equations by stepwise multiple regression analysis, eosinophils were predicted by pack-years (r2 = 0.41). Our results showed that asymptomatic smokers have evidence of inflammatory cells in IS samples. In addition, we found thatthe degree of eosinophilic inflammation is related to early changes of lung function and can be predicted by smoking habit.

Adult↗
PubMed1983

The alveolitis of pulmonary sarcoidosis. Evaluation of natural history and alveolitis-dependent changes in lung function.

Current concepts of the pathogenesis of pulmonary sarcoidosis suggest that a mononuclear cell alveolitis, comprised of activated T-lymphocytes and activated alveolar macrophages, precedes and modulates the formation of granuloma and fibrosis that characterize the disease. To evaluate the natural history of this alveolitis and determine the relationship it has to subsequent changes in lung function, 19 untreated patients with pulmonary sarcoidosis without extrapulmonary manifestations were studied at 6-month intervals over 10.1 +/- 1.6 months with bronchoalveolar lavage, 67Ga scanning, and pulmonary function tests to evaluate lung T-cells, lung alveolar macrophages, and lung function, respectively. In this group of patients with sarcoidosis, low intensity alveolitis (lung T-cells less than or equal to 28% of all lung effector cells and/or 67Ga scan negative) was much more common (80% of all observations) than high intensity alveolitis (lung T-cells greater than 28% and 67Ga scan positive, 20% of all observations). However, the alveolitis can be unstable; 75% of all episodes of high intensity alveolitis spontaneously reverted to low intensity, whereas 12% of all episodes of low intensity alveolitis spontaneously reverted to high intensity. Furthermore, conventional clinical, roentgenographic, or physiologic studies could not predict the alveolitis status; the low intensity and high intensity groups were indistinguishable by usual criteria (p greater than 0.3, all comparisons). Interestingly, of the 51 alveolitis evaluations in the 19 patients, there were 24 occurrences (47%) where the alveolitis was "split," i.e., 67Ga scans positive and T-cells low (39%) or 67Ga negative and T-cells high (8%). In fact, 79% of all patients had either a positive 67Ga scan and/or high lung T-cells at least once during the study period, suggesting that most untreated patients with sarcoidosis without extrapulmonary symptoms often have some inflammatory processes ongoing in their alveolar structures. Overall, whenever a high intensity alveolitis episode occurred, it was followed by deterioration over the next 6 months in at least one lung function parameter 87% of the time. In contrast, a low intensity alveolitis episode was followed by functional deterioration only 8% of the time. Strikingly, while the alveolitis parameters (lavage and 67Ga scanning) clearly predicted prognosis, clinical, roentgenographic, and physiologic tests could not distinguish those patients who would subsequently deteriorate functionally. These observations should prove useful in understanding the natural history of pulmonary sarcoidosis, in staging patients with this disease, and in making rational therapy decisions.

Adult↗
PubMed1980

Lung function among employees of a copper mine smelter: lack of effect of chronic sulfur dioxide exposure.

Lung function among 599 white male employees of a southeastern Tennessee copper mine/smelter operation was compared according to smoking history and occupational experience. The job categories compared included employees with work histories in low sulfur dioxide [SO2] environments (both underground mining and non-mining), in high SO2 exposure work areas, and in those with transient exposure to SO2. Miners with low SO2 exposure were found to have lower lung function indices (both FVC AND FEV1) than did employees in other job categories. Smoking history was strongly associated with low FEV1. After adjusting for smoking history, cumulative long-term exposure to SO2 was not demonstrated to contribute to decreased lung function.

Bronchitis↗
PubMed2003

Lung function impairment in relation to asbestos-induced pleural lesions with reference to the extent of the lesions and the initial parenchymal fibrosis.

OBJECTIVES: The study focused on the effect of pleural lesions on the lung function of asbestos-exposed workers. METHODS: A clinical check-up, chest radiography, high-resolution computed tomography (HRCT), and lung function testing were performed on 162 asbestos-exposed workers without any sign of parenchymal fibrosis on their chest radiographs. According to the HRCT scans, two subgroups were delineated, 97 subjects with pleural lesions and 65 referents without pleural lesions. Four categories of pleural lesions were specified according to the extent. Parenchymal changes, if identified on the HRCT scans, were recorded. RESULTS: The radiographic sensitivity and specificity for pleural lesion detection when compared with that of HRCT were 64.9% and 98.5%, respectively. The HRCT scans showed parenchymal abnormalities in 46.3% of the participants, more frequently in those with pleural lesions (67.0% versus 15.4%, P<0.0001). After the effect of parenchymal fibrosis was taken into account, pleural lesions were found to have a significant effect on the decrease in total lung capacity, forced vital capacity, and forced expiratory volume in 1 second, if being classified into category 2 or higher. CONCLUSIONS: Pleural lesions proved to have a negative effect on lung function, depending on their extent. The effect of the initial parenchymal fibrosis detectable in the HRCT scans only was also significant. A normal chest radiograph does not exclude the presence of pleural lesions or initial parenchymal fibrosis, with a possible negative effect on lung function.

Asbestosis↗
PubMed2001

Body mass, fat percentage, and fat free mass as reference variables for lung function: effects on terms for age and sex.

BACKGROUND: Sex specific cross sectional reference values for lung function indices usually employ a linear model with terms for age and stature. The effects of also matching for body mass index (BMI = mass/stature(2)) or its components, fat percentage of body mass (fat%) and fat free mass index (FFMI = fat free mass/stature(2)) were studied. METHODS: The subjects were 458 asymptomatic male and female non-smokers (383 men) and 22 female ex-smokers. Measurements were made of ventilatory capacity, lung volumes, transfer factor (diffusing capacity, single breath CO method), and body composition (skinfold method). Linear and proportional regression models were used. RESULTS: Terms for fat% and FFMI significantly improved the accuracy of reference values for all the primary lung function indices. The improvements in subjects with atypical physiques (fat% and FFMI at the ends of the distributions for the subjects) were in the range 0.3-2.3 SD compared with conventional regression equations. The new partial regression coefficients on age were independent of age related changes in body fat. The coefficient for total lung capacity (TLC) on age in men was now positive. Most differences between the sexes were eliminated. A term for BMI improved the descriptions of subdivisions of TLC but lacked the other advantages. CONCLUSION: Allowance for fat% and FFMI increases the accuracy of reference equations for lung function, particularly for subjects with a lot of fat and little muscle or vice versa. Allowance for BMI is less informative.

Adipose Tissue↗
PubMed1990

[Status of lung function in females of a North Rhine-Westphalia rural and urban-industrial area].

A comparative investigation of the pulmonary function status was carried out in women, aged between 52 and 56 years, from a rural and a municipal industrial area in North Rhine Westphalia. A questionnaire that the subjects had to complete themselves, provided us with information on personal medical history, smoking habits, the nature of domestic heating, and social status (education). The function tests were performed in a mobile pulmonary function laboratory (Jäger, Inc.). The airway resistance (Raw) and the intrathoracic gas volume (ITGV) were measured with the aid of a constant-volume body plethysmograph; a pneumotachographic system was employed to measure the ventilatory pulmonary function. All lung volumes were recalculated in terms of BTPS, and expressed as a percentage of the predicted values. Women from Leverkusen complained somewhat more frequently of hay fever, allergies of all kinds, and non-respiratory disturbances, than did women from Borken. In contrast, respiratory symptoms were indicated equally frequently in both areas. In the case of the Leverkusen group, a mean Raw of 0.323 +/- 0.183 kPa.1-1.s, was obtained, and in the case of the Borken group, a mean Raw of 0.258 +/- 0.182 kPa.1-1.s; this difference is statistically significant (p less than 0.05). On average, the women from Leverkusen also had a significantly higher SRaw (p less than 0.005) and ITGV (p less than 0.05) than did the women from Borken. These results argue in favour of a negative influence of air pollution on the pulmonary function.

Air Pollutants, Occupational↗
PubMed2005

Association of birth weight with adult lung function: findings from the British Women's Heart and Health Study and a meta-analysis.

BACKGROUND: The aim of this study was to examine the associations between birth weight and lung function in a cohort of women aged 60-79 years and to combine these results with those from other published studies in a systematic review and meta-analysis. METHODS: The associations of self-reported birth weight with adult lung function (forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and forced expiratory flow rate during mid expiration (FEF(25-75)), all measured using standard procedures, were assessed in a cross sectional study of 2257 British women aged 60-79 years. A detailed literature search was used to identify all published studies of the association, and meta-analysis was used to pool the results from our study and all published studies. RESULTS: There were positive linear associations between birth weight and all three measures of lung function in simple age and examining nurse adjusted regression models. However, with adjustment for height (squared), all three associations attenuated towards the null: adjusted (age, nurse, height2) change in FEV1 per 1 kg birth weight was 0.01 l (95% CI -0.02 to 0.04); in FVC was 0.02 l (95% CI -0.02 to 0.07), and in FEF(25-75) was 0.00 l (95% CI -0.04 to 0.04). Further adjustment for life course socioeconomic position, adult body mass index, and smoking did not alter these associations. The results were similar among life long non-smokers and those who had ever smoked. A meta-analysis of eight studies of adults suggested that there was a positive association between birth weight and FEV1: pooled increase in FEV1 per 1 kg in birth weight 0.048 l (95% CI 0.026 to 0.070) adjusted for age, smoking, and height (or height squared). There was no evidence of small study bias in this meta-analysis. CONCLUSIONS: There is a modest positive association between birth weight and lung function which indicates that intrauterine factors might have a role in lung development.

Aged↗
PubMed1994

Abnormal lung sounds in patients with asthma during episodes with normal lung function.

Even in patients with clinically stable asthma with normal lung function, the airways are characterized by inflammatory changes, including mucosal swelling. In order to investigate whether lung sounds can distinguish these subjects from normal subjects, we compared lung sound characteristics between eight normal and nine symptom-free subjects with mild asthma. All subjects underwent simultaneous recordings of airflow, lung volume changes, and lung sounds during standardized quiet breathing, and during forced maneuvers. Flow-dependent power spectra were computed using fast Fourier transform. For each spectrum we determined lung sound intensity (LSI), frequencies (Q25%, Q50%, Q75%) wheezing (W), and W%. The results were analyzed by ANOVA. During expiration, LSI was lower in patients with asthma than in healthy controls, in particular at relatively low airflow values. During quiet expiration, Q25% to Q75% were higher in asthmatics than in healthy controls, while the change of Q25% to Q75% with flow was greater in asthmatic than in normal subjects. The W and W% were not different between the subject groups. The results indicate that at given airflows, lung sounds are lower in intensity and higher in pitch in asthmatics as compared with controls. This suggests that the generation and/or transmission of lung sounds in symptom-free patients with stable asthma differ from that in normal subjects, even when lung function is within the normal range. Therefore, airflow standardized phonopneumography might reflect morphologic changes in airways of patients with asthma.

Adult↗
PubMed1986

Lung function of farmers in England and Wales.

A study was performed to compare respiratory symptoms and lung function measurements in a sample of male farmers and farmworkers in different regions of England and Wales with the results obtained in a similar number of control men working in industries in the same areas. A total of 428 farmers and farmworkers drawn from 146 farms were studied. The prevalence of symptoms of chronic bronchitis assessed by the Medical Research Council questionnaire did not differ between farmers and controls. Farmers were older, taller, and heavier than controls; were less likely to smoke; and had significantly higher forced vital capacity (FVC). When each of these factors was taken into account, together with social class and geographical region, in a multiple linear regression analysis farmers were found to have significantly lower forced expiratory volume in one second (FEV1) and forced mid expiratory flow rate (FEF25-75). Among the farmers, those doing dairy farming and silage work were the only groups on their own to have significantly reduced lung function. The results of this survey suggest the need for further exploration of the mechanism of an effect of farming occupations on lung function.

Adult↗