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PubMed2003

Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma.

BACKGROUND: Respiratory function and airway inflammation can be evaluated in preschool children with special techniques, but their relative power in identifying young children with asthma has not been studied. This study was undertaken to compare the value of exhaled nitric oxide (FE(NO)), baseline lung function, and bronchodilator responsiveness in identifying children with newly detected probable asthma. METHODS: Ninety six preschool children (age 3.8-7.5 years) with asthmatic symptoms or history and 62 age matched healthy non-atopic controls were studied. FE(NO) was measured with the standard online single exhalation technique, and baseline lung function and bronchodilator responsiveness were measured using impulse oscillometry (IOS). RESULTS: Children with probable asthma (n=21), characterised by recent recurrent wheeze, had a significantly higher mean (SE) concentration of FE(NO) than controls (22.1 (3.4) ppb v 5.3 (0.4) ppb; mean difference 16.8 ppb, 95% CI 12.0 to 21.5) and also had higher baseline respiratory resistance, lower reactance, and larger bronchodilator responses expressed as the change in resistance after inhalation of salbutamol. Children with chronic cough only (n=46) also had significantly raised mean FE(NO) (9.2 (1.5) ppb; mean difference 3.9 ppb, 95% CI 0.8 to 7.0) but their lung function was not significantly reduced. Children on inhaled steroids due to previously diagnosed asthma (n=29) differed from the controls only in their baseline lung function. The analysis of receiver operating characteristics (ROC) showed that FE(NO) provided the best power for discriminating between children with probable asthma and healthy controls, with a sensitivity of 86% and specificity of 92% at the cut off level of 1.5 SD above predicted. CONCLUSIONS: FE(NO) is superior to baseline respiratory function and bronchodilator responsiveness in identifying preschool children with probable asthma. The results emphasise the presence of airway inflammation in the early stages of asthma, even in young children.

Airway Resistance↗

PubMed2000

Effect of early ambroxol treatment on lung functions in mechanically ventilated preterm newborns who subsequently developed a bronchopulmonary dysplasia (BPD).

In a randomized trial in 102 preterm newborns with respiratory distress syndrome (RDS) it has been shown that early Ambroxol treatment (30 mg kg(-1) over the first 5 days) significantly reduces the incidence of RDS-associated complications [bronchopulmonary dysplasia (BPD), intraventricular haemorrhage, post-natal acquired pneumonia]. The aim of the present analysis was to investigate the effect of Ambroxol treatment on lung function in newborns who developed BPD. Respiratory function testing (RFT) was performed immediately after extubation and at day 28. Tidal volume (VT) and respiratory frequency (f) were measured during tidal breathing using the deadspace free flow-through technique. The lung mechanic parameter VT/maxPes was determined by measuring the maximal oesophageal pressure changes, maxPes, with a catheter tip pressure transducer. In the placebo group 36/50 infants were extubated within the first 28 days of life and 13/36 (36%) developed BPD. In the Ambroxol group 44/52 were extubated and 9/44 (20%) developed BPD. After extubation, RFT showed (i) no statistically significant difference in the ventilatory parameters of either treatment group, (ii) improved (P<0.05) lung mechanics (VT/maxPes) in Ambroxol group compared to controls (94+/-27 ml kPa(-1) vs. 8.1+/-2.6 ml kPa(-1)) and (iii) no statistically significant difference in lung function between infants with and without BPD. At day 28 we found (i) no effect of early Ambroxol treatment on lung functions, (ii) significantly (P < 0.05) higher f (58.5+/-11.7 min(-1) vs. 49.7+/-10.1 min(-1)) and significantly (P<0.01) lower V(T) (9.6+/-1.9 ml vs. 12.3+/-2.7 ml) and V(T)/maxPes (8.9+/-2.6 ml kPa(-1)] vs. 12.0+/-2.9 ml kPa(-1)) in infants with BPD compared to infants without and (iii) these differences are not influenced by early Ambroxol treatment. If the process of BPD development is induced, early Ambroxol treatment has no influence on impaired lung function at day 28.

Ambroxol↗

PubMed1990

[The effect of radio- and chemotherapy on lung function in children with malignant diseases].

Treatment of malignant diseases in children has become more an more aggressive during the last 15-20 years. In order to detect unwanted side-effects on the lung we investigated several parameters of lung function in 78 children with different malignancies. 1.5-15 years after termination of therapy, 43 patients (55.1%) showed a disturbed lung function. In 33.3% we found a restriction; 22 of 64 patients (34.9%) had a drop of PaO2 during exercise as an expression of disturbed diffusion. The number of patients with pathological pulmonary function raised with the intensity of irradiation of the lung. But also in 10 of 25 children who had only received a chemotherapy we could detect a disturbed lung function. Check-up at different times after completion of therapy (5, 8 and 11 years) revealed nearly the same percentage of patients without normal pulmonary function. Younger children (at the time of therapy) were more concerned (66.7%) than older ones (33.7%).

Adolescent↗

PubMed2003

Effects of passive smoking on lung function in children.

BACKGROUND: Passive smoking can have significant effects on lung function with reductions in forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and forced mid-expiratory flow rate (FEF25-75%) of between 5 and 10%. METHODS: Fifty non-smoking children aged 6-15 years, who had no history of asthma or atopy and no parental history of atopy, were assessed with respect to their lung functions (FEV1, FEV1/FVC, FEF25-75%). RESULTS: Thirty-three of these children were being exposed to environmental tobacco smoke inside their homes, while 17 children were not exposed. In the 'passive smoker' group the FEV1, FEV1/FVC and FEF25-75% values were found to be significantly lower than the non-smoker control group's values (P = 0.0080, 0.0228 and 0.0003, respectively). The decrease in FEF25-75% was significantly correlated inversely with the number of cigarettes smoked per day (P = 0.0261). CONCLUSION: There is sufficient evidence to support the notion that environmental tobacco smoke is a serious health burden for children. Considering that recent studies suggest that up to 70% of children grow up in homes with at least one smoker, every effort should be made to reduce these children's exposure to environmental tobacco smoke and to give them a chance to grow up in a more healthy environment.

Child↗

PubMed1985

Lung function of workers exposed to antigens from a contaminated air-conditioning system.

Following the manifestation of humidifier fever in a number of workers in a carpet yarn texturing plant, a comparative study was begun of a group of workers exposed to fungi from the air-conditioning system and a control group not so exposed. For both group of workers anamnestic data were collected, intracutaneous skin tests were performed, certain lung function parameters were determined, and the presence of antibodies to a number of antigens from the system was tested for. It was found that the group of exposed workers had a significantly higher rate of positive intracutaneous skin test than non-exposed workers. Additionally, their serology was more often positive. Both positive skin test and positive serology were more frequent in non-smokers than in smokers. A positive immediate skin reaction among exposed workers was found to correlate with an FEF25-75 reduction during the working week. A positive delayed skin reaction among exposed workers correlated with a lower FVC prior to the start of the working week than recorded for non-exposed workers. A positive serology in exposed workers did not correlate with a difference in lung function compared with non-exposed workers, nor was there a correlation with a change in lung function in the course of the working week. When humidifier fever is diagnosed, steps should be taken to reduce exposure. It would also appear desirable to keep exposed workers under medical observation and to monitor the subsequent development of their lung function.

Adolescent↗

PubMed1992

Lung function in silicosis.

In order to assess the effect of silicosis on lung function, 61 gold miners with radiological silicosis were compared with 61 controls. Each pair was matched for age, dust exposure, and smoking habits. A full range of lung function tests was performed, and with two exceptions the results showed no significant differences between the two groups. The exceptions are the slope of the alveolar plateau (phase 3) and the closing volume, for which the silicotic cases had significantly higher values. The reason for the higher readings in the silicotic patients remains unexplained.

Blood Gas Analysis↗

PubMed1989

[Long-term follow-up of lung function and standing height following scoliosis surgery in children and adolescents].

Previous investigations have reported conflicting results on the development of lung function and body height after operative correction of scoliosis at young age. Partly the number of patients or the duration of observation were relatively small. 120 patients were followed for at least 10 years (10-14, average 12 years) after surgical correction of scoliosis at the age of 18.2 +/- 6.8 years. Standing height and vital capacity were measured 1, 2, 5 and 10 years after operation. Height was expressed as percentile for age and vital capacity as % expected for actual height. The primary diagnoses were idiopathic scoliosis (n = 84, average Cobb angle 90 degrees), congenital scoliosis (n = 20, 83 degrees), poliomyelitis (n = 10, 128 degrees), neurofibromatosis (n = 6, 101 degrees). We found an initial decrease in lung function after 1 year, which was probably due to post-operative immobilization and increased by the gain in body height achieved by the operation. During the rest of the observation period a significant (p less than 0.05) increase of vital capacity (% of expected for actual height) was observed. The gain was maximal for idiopathic scoliosis (+6%). In congenital scoliosis body height %ile and relative vital capacity appeared fixed at the preoperative level. Interestingly patients with an initial vital capacity below 50% expected (n = 29) or preoperative Cobb angle above 90 degrees showed the best results. They also lacked the initial deterioration of lung function in the first postoperative year and had a significant gain of vital capacity (+14%) over 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2003

Smoking and atopy as determinants of sputum eosinophilia and bronchial hyper-responsiveness in adults with normal lung function.

Data concerning the determinants of sputum eosinophilia and bronchial hyper-responsiveness (BHR) in large cohorts of individuals with normal lung function are limited. Here, we assessed the occurrence of sputum eosinophilia and BHR and identified the risk factors for these variables in two populations living in North Karelia, Finland, and in Pitkäranta, the Republic of Karelia, Russia. These areas are geographically adjacent, but differ, however, fundamentally in major cultural, socioeconomical and lifestyle aspects. The study population comprised 790 Finns and 387 Russian, aged 25-54 years, who were randomly enrolled from the population registers. A methacholine challenge test to measure BHR was successfully performed in 581 (74%) Finns and 307 (79%) Russians with virtually normal lung function (FEV1 > 70% of predicted). Of these, induced sputum samples were obtained from 41% of the Finns and from 67% of the Russians. The proportion of current smokers was 27% among the former and 42% among the latter. Sputum eosinophilia was assessed using a semi-quantitative method, and total concentrations of sputum eosinophilic cationic protein (ECP) and myeloperoxidase (MPO) were measured using an immunoassay. Risk factors for BHR and sputum eosinophilia were identified with a regression analysis. The prevalence of sputum eosinophilia was 22% among the Finns and 19% among the Russians, and the respective figures for BHR were 14% and 13%. The median ECP concentration in sputum was significantly higher among the Russians as compared with the Finns (P<0.001), whereas for MPO, the difference did not achieve significance. Current smoking was significantly associated with both sputum eosinophilia and BHR in Russia (OR 3.1, 95% CI 1.2-7.6 for sputum eosinophilia, 2.8, 1.3-6.1 for BHR) and with BHR in Finland (2.1, 1.3-3.7). Atopy showed a tendency to be another risk factor for BHR in Finland (1.6, 0.98-2.6). In conclusion, sputum eosinophilia and BHR occurred commonly among the Finns and the Russians with normal lung function. Current smoking was significantly associated with BHR in both countries and additionally with sputum eosinophilia in Russia. Atopy was identified as a risk factor, albeit of borderline significance, for BHR in Finland only, suggesting that there may be differences in the aetiology and nature of BHR between the two countries.

Adult↗

PubMed2004

Area deprivation predicts lung function independently of education and social class.

The cross-sectional association between socioeconomic status (at both the individual and area-based level) and lung function, as measured by forced expiratory volume in one second, in a large population-based cohort was investigated. The study population consisted of 22,675 males and females aged 39-79 yrs. They were recruited from the general community in Norfolk, UK using general practice age/sex registers, as part of the European Prospective Investigation into Cancer (EPIC-Norfolk). It was found that being in a manual occupational social class, having no educational qualifications and living in a deprived area all independently predicted significantly lower lung function, even after controlling for smoking habit. The influence of area-deprivation on lung function, independent of individual socioeconomic status and of individual smoking habit, suggests that apart from targeting individuals who are at high-risk, such as smokers, environmental determinants also need to be examined when considering measures to improve respiratory health.

Adult↗

PubMed1992

Lung function after vecuronium pretreatment in young, healthy patients.

Lung function and clinical evidence of muscle weakness were assessed in 12 ASA I patients who received vecuronium 0.01 mg kg-1 pretreatment as a part of their anaesthetic management, before and 3 min after pretreatment. Most patients demonstrated ptosis and diplopia, while five of the 12 were unable to raise the head for > 4 s and had difficulty in swallowing. Significant reductions occurred in forced vital capacity, forced expiratory volume in 1 s, and maximum mid-expiratory flow rate. Among static lung volumes, functional residual capacity and expiratory reserve volume decreased significantly. However, these changes were not serious enough to cause clinically significant impairment of coughing or a decrease in oxygen saturation in any patient.

Adult↗

PubMed2003

Longitudinal decline in lung function measurements among Saskatchewan grain workers.

OBJECTIVE: To evaluate the relationship between the long term effects of grain dust and decline in lung function among grain elevator workers in Saskatchewan, studied over a 15-year period. METHODS: The Grain Dust Medical Surveillance Program was started by Labour Canada in 1978 and longitudinally studied the respiratory health of Canadian grain elevator workers over a 15-year period (1978 to 1993). Data on respiratory symptoms and pulmonary function tests (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) were collected once every three years; each three-year interval was called a 'cycle'. Data from Saskatchewan were analyzed for this report. A transitional model using the generalized estimating equations approach was fitted using a SAS macro to predict the annual decline in FEV1 and FVC. RESULTS: Previous lung function, as one of the covariates in the transitional model, played an important role. Significant predictors of FEV1 were previous FEV1, base height, weight, years in the grain industry, current smoking status, cycle II, cycle III and cycle V. Significant predictors of FVC were previous FVC, base height, weight, years in the grain industry, cycle II, cycle III and cycle IV. CONCLUSIONS: The estimated annual decline in FEV1 and FVC increased according to length of time in the grain industry among nonsmoking, ex-smoking and smoking grain elevator workers. Lung function values improved after dust control, and yearly declines in FEV1 and FVC after dust control were smaller compared with yearly losses before dust control.

Adult↗

PubMed2003

Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women's Heart and Health Study.

AIMS/HYPOTHESIS: The aim of this study was to assess the associations of lung function with insulin resistance and Type 2 diabetes. METHODS: We did a cross-sectional study of 3911 women who were 60 to 79 years old from 23 British towns, assessing the association of measures of lung function with insulin resistance (based on fasting insulin and glucose concentrations) and Type 2 diabetes (World Health Organisation diagnostic criteria). RESULTS: Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were inversely associated with insulin resistance and prevalence of Type 2 diabetes. In age-adjusted analyses, the homeostasis model assessment (HOMA) score (insulin resistance) decreased by 5% (95% CI: 2-7%) for a one standard deviation increase in log FEV1 and by 8% (95% CI: 6-10%) for a one standard deviation increase in log FVC. With additional adjustment for height, smoking, BMI, waist-to-hip ratio, physical activity, white cell count, adult social class, childhood social class and respiratory medication, these associations attenuated to 3% (95% CI: 1 to 5%) and 5% (95% CI: 3 to 8%). The fully adjusted odds ratio for diabetes prevalence was 0.85 (95% CI: 0.74-0.98) for a one standard deviation increase in log FEV1 and 0.80 (95% CI: 0.70-0.92) for a one standard deviation increase in log FVC. Forced expiratory flow in the central period of FVC was not associated with insulin resistance or diabetes. CONCLUSIONS/INTERPRETATION: Lung function measures which predominantly reflect lung volume are inversely associated with insulin resistance and Type 2 diabetes. These associations could reflect childhood exposures which affect lung growth and also programme insulin resistance.

Aged↗

PubMedDate not supplied

Preservation of competent rabbit lung function after 30 hours of storage with a low-potassium dextran solution.

BACKGROUND: The goal of organ preservation is maintenance of physiologic functions during extended extracorporeal storage. METHODS: This study was designed to evaluate the efficacy of using low-potassium (4 mmol/L) dextran (1%) solution on lung function after 30 hours hypothermic (10 degrees C) storage and to compare this with lung function after no storage. With low-potassium dextran solution rabbit lungs were flushed (10 degrees C, 40 ml/kg, 60 cm H2O), excised, inflated (with room air), and either not stored (control; no preservation; n = 9) or stored in low-potassium dextran solution (10 degrees C) 30 hours (experimental group; n = 9). RESULTS: During the flush the infusion pressure and pulmonary vascular resistance for the two groups did not differ (17.56 +/- 1.3 versus 16.74 +/- 1.5 mm Hg/ml/sec). After either no preservation or after 30 hours of storage, the lungs were first reperfused with low-potassium dextran solution (37 degrees C) for 4 minutes and then with blood (37 degrees C) for 30 minutes at 100 ml/min. During the reperfusion period the mean pulmonary artery pressure and end-inspiratory airway pressure for the control and experimental groups did not differ. After reperfusion the wet and dry weights of the left lung were determined. The wet/dry ratio for the two groups did not differ (5.32 +/- 2.20 versus 4.70 +/- 2.70, respectively). CONCLUSIONS: These data suggest that cold flush, cold storage, and initial warm perfusion with low-potassium dextran solution crystalloid preserve lung function after 30 hours of storage.

Animals↗

PubMed1997

Surfactant improves lung function and mitigates bacterial growth in immature ventilated rabbits with experimentally induced neonatal group B streptococcal pneumonia.

AIMS: To study the influence of surfactant on lung function and bacterial proliferation in immature newborn rabbits with experimental group B streptococcal (GBS) pneumonia. METHODS: Preterm rabbit fetuses (gestational age 28 days) underwent tracheotomy and were mechanically ventilated in a warmed body plethysmograph that permitted measurement of lung-thorax compliance. Fifteen minutes after the onset of ventilation the animals received either GBS or saline intratracheally; at 30 minutes, a bolus of saline or 200 mg/kg of a porcine surfactant (Curosurf) was administered via the airway. Bacterial proliferation was evaluated in lung homogenate at the end of the experiments and the results expressed as mean log10 cfu/g lung (SD). Animals receiving only saline (n = 20) or saline and surfactant (n = 20) served as controls. RESULTS: The average survival time was about three hours in all groups. Infected animals receiving surfactant (n = 22) had significantly less bacterial growth (9.09 (0.45) vs 9.76 (0.91)) and improved lung function (compliance: 0.61 (0.14) vs 0.34 (0.19) ml/kg. cm H2O) than infected rabbits receiving saline at 30 minutes (n = 22). CONCLUSION: Surfactant improves lung function and mitigates bacterial growth in preterm rabbits infected with group B streptococci.

Animals↗

PubMed2005

[Correlation between bronchoalveolar lavage and lung function in patients with systemic sclerosis and rheumatoid arthritis].

Fibrous alveolitis (FA), or diffuse interstitial fibrosis, is used as a term for diseases in patients suffering from some kind of systemic connective tissue (SCT) disorder and lung fibrosis. FA is not unusual in clinical practice in patients with SS and rheumatoid arthritis (RA) and can be found in the definitive fibrosis phase of the disease; the early detection of FA is of great importance. The aim of this study was to determine whether there was a correlation between certain lung function parameters and cellular components of BAL in patients with SS and RA. Lung function (LF) and BAL examination was carried out in all 20 SS patients and 38 RA patients. LF was evaluated via spirometry, flow volume curves, the lung transfer factor for carbon monoxide (DLco), and the coefficient of transfer factor (K/DLco), as well as body plethysmography and blood gas analysis. A differential number of cells were taken in all BAL samples. Normal cellular components of lavage were found in 19 patients (50%). Ly-alveolitis was found in 10 patients (4 with SS and 6 with RA) (26%), and N-alveolitis in 9 patients (8 with SS and 1 with RA) (23.7%). An increased percentage of CD8+T lymphocytes in relation to CD4+T lymphocytes, and a decreased level of CD4+/CD8+ was found through BAL. Restrictive ventilation disorder was discovered in 6 patients (15.7%), TLC values were reduced in 6 patients (15.7%), and K/DLco was decreased in 5 patients. DLco was normal in 20 patients (53%) and reduced in 18 patients (47%). We discovered a significant correlation between DLco and cellular components (neutrophile or lymphocyte) present in BAL, but there was no significant correlation between other lung function parameters. Analysis of BAL and DLco examination can be considered to be suitable parameters of interstitial lung changes in SS and RA patients.

Adult↗

PubMed1990

Relationship between infant lung mechanics and childhood lung function in children of very low birthweight.

Twenty-seven children of very low birthweight (less than or equal to 1,500 g) whose lung function had been measured on several occasions during the first year were studied at the age of about 9 years. Fifteen of the children had received neonatal intermittent positive pressure ventilation, mostly for respiratory distress syndrome. Ten of the ventilated children were still oxygen dependent at 30 days of age. Compared to the remainder of the group, mechanically ventilated children had reduced lung compliance in early infancy and increased thoracic gas volume in the middle of their first year. These changes correlated with the level of neonatal respiratory therapy as indicated by the oxygen score. Lung compliance in early infancy, but not thoracic gas volume, correlated with forced expiratory volume at 1 second recorded at 9 years. On the other hand, reduced airway conductance showed no significant correlation with the neonatal oxygen score, but there was a strong correlation between airway conductance late in infancy and lung function at 9 years. This relationship was independent of neonatal mechanical ventilation. We conclude that perinatal factors, which may be associated with disturbed lung mechanics early in infancy, are only weak and indirect predictors of childhood lung function. Airway conductance late in infancy, determined by constitutional factors, prematurity itself or other undetermined factors, is a good predictor of airway function at 9 years.

Bronchopulmonary Dysplasia↗

PubMed1994

Respiratory symptoms and lung function in animal feed workers.

In a study among 194 male workers exposed to endotoxin-containing organic dust in animal feed mills, lung function was measured by flow volume curves and impedance measurements and respiratory symptoms were recorded by means of a validated questionnaire. The aims were to detect and localize airway obstruction caused by fodder dust and endotoxin, and to relate respiratory symptoms to both types of lung function measurements. Flow volume and impedance parameters were significantly related to present exposure. All impedance parameters, of the spirometric measures only FEF25, were significantly related to cumulative dust or endotoxin exposure. The changes in impedance parameters were for overall increasing resistance at 8 Hz and decreasing reactance at 8 Hz, reflecting an increase in peripheral airflow obstruction, with increasing exposure. The changes in all lung function parameters were more strongly related to (cumulative) endotoxin exposure than to inspirable dust exposure. All impedance parameters and FEV1 showed a good correlation with complaints of chronic bronchitis and breathlessness. Impedance measurement of the respiratory system proved to be a useful tool for objectively assessing (early) airflow obstruction in workers exposed to inspirable dust and endotoxin and in localizing airflow obstruction.

Adult↗

PubMed2002

Systemic sclerosis and interstitial lung disease: a pilot study using pulse intravenous methylprednisolone and cyclophosphamide to assess the effect on high resolution computed tomography scan and lung function.

OBJECTIVE: To document the effectiveness, including the longterm effect, of a course of intravenous (IV) pulses of methylprednisolone (MP) and cyclophosphamide (CYC) in patients with scleroderma (SSc) who had evidence of lung inflammation on high resolution computer tomographic (HRCT) scan of the chest. METHODS: Fourteen consecutive patients with SSc and lung involvement were treated with 6 pulses of IV MP (10 mg/kg) and IV CYC (15 mg/kg) given at 3-4 weekly intervals. HRCT scans and lung function tests were performed at baseline and after the 6th pulse. Further lung function tests were repeated at 12 months and annually thereafter. RESULTS: Modified Rodnan skin scores improved significantly by 35% from a median baseline score of 17 (IQR 14-26.5) to a posttreatment score of 13 (IQR 10.5-18.5; p = 0.0058). HRCT scan scores improved significantly (p = 0.04). Twelve of 13 patients experienced either improvement or stabilization of the HRCT score. Median DLCO and lung volumes remained stable during the first 12 months. After a median followup of 26 months (IQR 19-43), 67% of patients experienced deterioration in DLCO. Median deterioration was 23% (IQR 44-0.6), with the median rate of deterioration of the predicted value of the DLCO/month being 0.87% (IQR 1.24-0.02). The treatment was safe and well tolerated. CONCLUSION: This IV regimen stabilized lung disease in patients with SSc. When treatment was stopped, or reduced in intensity, a deterioration in lung function occurred in the majority of patients. Rate of deterioration of DLCO may be a useful marker for determining the intensity of treatment. These findings have implications for treating lung disease and designing clinical trials in patients with SSc.

Adult↗