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PubMed1997

Lung function tests in patients with idiopathic pulmonary fibrosis. Are they helpful for predicting outcome?

STUDY OBJECTIVE: Idiopathic pulmonary fibrosis (IPF) varies widely in its course. To evaluate predictive parameters at presentation to the hospital, we investigated 99 patients with IPF (47 women), focusing on extensive lung function tests. METHODS: Standard tests of lung volumes, arterial oxygen tension, and gas exchange at rest and during bicycle exercise were performed. Survival rates in relation to functional parameters were calculated using the actuarial method. Differences in survival proportions were summarized as hazard ratios, and significance levels were determined by log-rank test. RESULTS: At presentation, most patients showed a reduced total lung capacity (TLC) of 79.2 +/- 21.1%, an arterial oxygen tension (PaO2) considered pathologic in 63%, when related to age, a significant decrease of PaO2 with 11.8 +/- 12.1 mm Hg and an increase of the alveolar-arterial oxygen pressure difference with 46.4 +/- 16.4 (12.2 to 76.8) mm Hg during bicycle exercise. Diminished survival was associated with an age older than 50 years, a reduced value to more than 2 SDs below the predicted values of both, TLC alone, or in combination with a reduced vital capacity. Factors not influencing survival were gender, parameters of gas exchange at rest, and PaO2 at rest and during bicycle exercise. CONCLUSIONS: We conclude that standard lung function tests make it possible to assess the prognosis of patients with IPF, while extensive tests like gas exchange measurements at rest and during bicycle exercise do not contribute additional information to make the prognostic estimations more precise.

Exercise Test↗

PubMedDate not supplied

Height and lung function in preadolescent children of Kuwaitis and European origin: a pilot survey on health effects of gas cooking in the Middle East.

Spirometric testing, including forced vital capacity (FVC), forced expiratory volume in .5 s (FEV0.5), FEF25-75%, and peak expiratory flow resistance (PEFR), was conducted among 130 10-y-old children (67 Kuwaitis, 63 Europeans) who lived with their parents in the same area in Kuwait city. Lung function of children who lived in houses with gas stoves were compared with those who lived in homes supplied with electric cookers. The FEV0.5 for children who lived in households with gas stoves was significantly lower (average difference, 94 ml; p = .05; corrected to height and sex). Other lung function indices, i.e., FVC, FEF25-75%, and PEFR, were also lower but, after accounting for confounders, were not statistically significant. Children from households that were equipped with gas cookers were approximately 3 cm shorter than children who lived in homes with electric cookers. These findings suggest that children who live in a very hot and dry climate--even with efficient air conditioning systems--are susceptible to the same environmental hazards to which children from other climatic zones are exposed. This susceptibility may be more pronounced before or at the onset of puberty.

Air Pollution, Indoor↗

PubMed1992

Atelectasis and lung function in the postoperative period.

Thirteen patients with healthy hearts and lungs, and with a mean age of 68 years, who were scheduled for lower abdominal surgery during isoflurane anaesthesia with muscular paralysis, were investigated with arterial blood gases, spirometry, pulmonary x-ray and computed tomography (CT) of the chest before and during anaesthesia, as well as during the first 4 postoperative days. Before anaesthesia, lung function and gas exchange were normal in all patients. Pulmonary x-ray and CT scans of the lungs were also normal. During anaesthesia, 6 of 13 patients developed atelectasis (mean 1.0% of intrathoracic transverse area in all patients). Two hours postoperatively, 11 of 13 patients had atelectasis and the mean atelectatic area was 1.8%. Pao2 was significantly reduced by 2.1 kPa to 9.8 kPa. On the first postoperative day, the mean atelectasis was unaltered (1.8%). None of the atelectasis found on CT scanning could be detected on standard pulmonary x-ray. Forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) were significantly decreased to 2/3 of preoperative level. Pao2 was significantly reduced to less than 80% of the preoperative level (mean 9.4 kPa). There were significant correlations between the atelectatic area and the impairment in FVC, FEV1, and Pao2. Spirometry and blood gases improved during the succeeding postoperative days, and atelectasis decreased. No patient suffered from pulmonary complications, as judged from clinical criteria and pulmonary x-ray, in contrast to the findings of atelectasis in 85% of the patients by computed tomography.

Abdomen↗

PubMed1988

[Lung function and symptoms in employees of poultry farms].

Environmental measurements were made in different types of poultry confinement buildings. Levels of total dust 1.6 meters above the ground averaged 5.0 mg/m3. Ammonia levels averaged about 13 ppm with peak values of about 50 ppm. To study possible respiratory problems of the people working in these confinement buildings, the ventilatory lung function was measured and an interrogation concerning respiratory symptoms was carried out by 26 (7 females, 19 males) poultry farmers. A very high prevalence (10 of 26) of obstructive ventilatory lung function changes was found. The FEV1 values of the exposed men were significantly lower than the predicted normal values (ECCS). An association between duration of exposure and pulmonary function exists.

Adult↗

PubMed2000

Effects of birthweight and oxygen supplementation on lung function in late childhood in children of very low birth weight.

Impaired respiratory function has been found frequently in ex-premature children, but it is unclear which specific factors influence this impairment the most. The aim of this study was to determine the importance of the contributions of birth weight, gestational age, neonatal respiratory disease, and its treatment on subsequent childhood lung function at age 11 years in a cohort of children of very low birth weight (VLBW; </=1,500 g). Detailed clinical histories were recorded, and lung function was measured in 60% (102 children) of surviving VLBW infants born 1981/1982, and compared with 82 matched control children (birth weight >2,000 g) of similar age. VLBW children were shorter and lighter than controls (P < 0.0001) at 11 years of age, and had reduced expiratory flows (P < 0.00001) and forced vital capacities (P < 0.001). The residual volume to total lung capacity ratio (RV/TLC ratio) was increased (P < 0.00001), while total lung capacity (TLC) remained unchanged. Those with bronchopulmonary dysplasia (BPD) had the lowest mean expiratory flows. Males had lower expiratory flows than females. On univariate analysis, gestational age by itself accounted for 8.8% of the explained variance in FEV(1) at 11 years of age, but birth weight accounted for 16% on its own; both together accounted for a further 0.2% (16.2%), suggesting that the latter was the dominant factor. On multivariate analysis, the contribution of birth weight and gestational age was small, and the best predictors at 11 years of age, which together explained 43.4% of the total variance in FEV(1), were log days of supplemental oxygen (9.6%) and a reported history of asthma (10.8%). For FEF(25-75), these predictors explained 7.2% and 13.4%, respectively, of the total explained variance of 40.6%. The relation between neonatal oxygen supplementation and childhood FEV(1) was such that up to 20 days of supplemental oxygen had little effect on subsequent FEV(1) at 11 years of age, but each additional week of supplemental oxygen after that time was associated with a progressive reduction in FEV(1) of 3%. These data confirm the significant role of supplemental oxygen in the neonatal period and a history of asthma on the subsequent reduction of expiratory flows in VLBW children. Birth weight was a more important prenatal factor than gestational age, but both were of lesser predictive significance than either supplemental oxygen or a reported history of asthma.

Asthma↗

PubMed2004

Effect of inhaled steroids on lung function in young children: a cohort study.

The objectives of the present study were to determine the use of inhaled corticosteroids (ICS) for treating recurrent bronchial obstruction (rBO) in young children up to 2 yrs of age and to assess possible modifying effects of ICS on lung function in young children with rBO. From an observational, noninterventional birth cohort of 3,754 newborn children (3,697 with complete questionnaire data by 2 yrs of age), 306 children with documented rBO by age 2 yrs (cases) were identified along with 306 matched controls. Two tidal flow/volume measurements were taken, one at presentation of disease (children were steroid naive) and one at 2 yrs of age (mean age 11.2 and 25.6 months, respectively), from: 21 cases who subsequently received ICS (ICS+); 33 who did not (ICS-); and in 15 controls. The mean +/- SD duration of ICS treatment was 10.3 +/- 6.5 months. The main outcomes were treatment with ICS and baseline ratio of time to peak expiratory flow/total expiratory time (tPTEF/tE). From the entire cohort, 77 children (2.1%) and 21% of children with rBO had received ICS by 2 yrs of age. Baseline tPTEF/tE was significantly lower at the first visit only in ICS+ as compared to ICS- subjects, as well as in ICS+ and ICS- as compared to controls. The mean difference in baseline tPTEF/tE from first to second visit was borderline statistically significant in the ICS+ group only and correlated significantly with duration of ICS treatment. The present observational cohort study demonstrated that one-fifth of young children with recurrent bronchial obstruction had received inhaled corticosteroids. Early inhaled corticosteroid treatment improved lung function by age 2 yrs, mostly in those with the longest duration of treatment.

Administration, Inhalation↗

PubMed1988

Irregularly shaped small shadows on chest radiographs, dust exposure, and lung function in coalworkers' pneumoconiosis.

The predominant shapes of small opacities on the chest radiographs of 895 British coalminers have been studied. The aims were to determine whether irregular (as distinct from rounded) small opacities can be identified reproducibly, whether their occurrence is related to dust exposure, and whether they are associated with excess prevalence of respiratory symptoms or impairments of lung function. Six of the doctors responsible for regular radiological surveys of all British coalminers each classified all 895 radiographs twice and independently, using the International Labour Organisation's 1980 classification system. The majority view was that 39 films showed predominantly irregular small opacities, 131 showed predominantly small rounded opacities, and 587 showed no small opacities. Readers' opinions varied about the presence and shapes of shadows on the other 138 films. In general, consistency between readers (and within readers on repeated viewings) was satisfactory. The occurrence and profusion of irregular shadows were related significantly both to the men's ages and additionally to their cumulative exposure to respirable coalmine dust as determined from 15 years' dust monitoring close to where the miners had worked. For any given level of exposure, the average level of profusion of the small irregular opacities was less than the corresponding profusion of small rounded opacities. The prevalence rates of chronic cough and phlegm, and of breathlessness, were higher in those with small irregular opacities than in those with no small opacities (category 0/0), but the differences were not statistically significant after adjustment for other factors including smoking habits. The presence of irregular (but not rounded) small shadows was associated with an impairment in respiratory function averaging about 190 ml deficits in both FEV1 and FVC. These deficits were not explicable in terms of the men's ages, body sizes, and smoking habits and they were in addition to the lung function losses attributable to the miners' dust exposure as such. It is concluded that the presence and profusion of small irregular opacities should be taken into consideration when assessing the severity of coalworkers' simple pneumoconiosis.

Age Factors↗

PubMed2004

Reducing attenuation in exposure-response relationships by exposure modeling and grouping: the relationship between wood dust exposure and lung function.

BACKGROUND: In a study of wood dust exposure and lung function, we tested the effect on the exposure-response relationship of six different exposure metrics using the mean measured exposure of each subject versus the mean exposure based on various methods of grouping subjects, including job-based groups and groups based on an empirical model of the determinants of exposure. METHODS: Multiple linear regression was used to examine the association between wood dust concentration and forced expiratory volume in 1s (FEV(1)), adjusting for age, sex, height, race, pediatric asthma, and smoking. RESULTS: Stronger point estimates of the exposure-response relationships were observed when exposures were based on increasing levels of aggregation, allowing the relationships to be found statistically significant in four of the six metrics. The strongest point estimates were found when exposures were based on the determinants of exposure model. CONCLUSIONS: Determinants of exposure modeling offers the potential for improvement in risk estimation equivalent to or beyond that from job-based exposure grouping.

Adolescent↗

PubMedDate not supplied

Reference values and modelling of lung function development as a transcendent function of age, body height and mass.

We present new lung function reference values based on an investigation of 1024 healthy subjects aged 6-81 years. The dependent variables, i.e. VC, FEV1, RV, FRC, TLC, PEF, MEF50 and MEF25 are expressed as transcendent functions of age, body height and mass. A single equation covers the age range from 6 to 81 years and reflects certain phenomena such as growth, maturation, ageing, sex differences and the undermass-overmass effect. This allows a more accurate determination of individualized reference values and normal limits.

Adolescent↗

PubMed2005

Disease-specific reference equations for lung function in patients with cystic fibrosis.

RATIONALE: Forced expiratory volume in one second (FEV1), an important measure of pulmonary disease severity in patients with cystic fibrosis (CF), is frequently expressed as a percentage of a predicted value derived from a healthy reference population. There are limitations to comparing the lung function of a patient with CF to that of healthy control subjects, and potential advantages to comparing it to that of other patients with CF. OBJECTIVE: To estimate CF-specific percentiles of FEV1 as functions of height, age, and sex. METHODS: We used 287,108 FEV1 observations among more than 21,000 patients with CF in the CF Foundation National Patient Registry between 1994 and 2001. The percentiles were estimated using quantile regression methods. RESULTS: FEV1 percentile "growth grids" are presented, allowing comparison of an individual's FEV1 to that of patients with CF of the same sex, age, and height. Their potential uses in clinical practice and research are illustrated. CONCLUSIONS: CF-specific reference equations allow individual patients' FEV1 to be placed in the context of the distribution of lung function of their peers with CF, and should improve generalizability of CF clinical trials by setting entry criteria that are equitable across sex and age ranges. They may serve as a useful adjunct to conventional reference equations.

Adolescent↗

PubMed1995

The effects of air pollution on ventilatory lung functions.

The prevalence of chronic bronchitis was studied among female subjects aged 18-63 years from three areas with different ambient air quality: Bakar and Krasica with SO2 concentrations above the WHO guideline and Viskovo where the SO2 concentrations were below the guideline. The subjects were examined and administered a questionnaire. Differences in their ventilatory lung functions were tested and related to air quality. The subjects from the two regions to air quality. The subjects from the two regions with a higher pollution level had lower FVC and FEV1 values than those from the Viskovo region. However, no statistically significant differences in the prevalence of chronic bronchitis between the subjects from regions with different ambient air quality were found. The same applies to the occurrence of pathological restrictive ventilation disturbances. In the Krasica region the occurrence of pathological obstructive ventilatory disturbances was significantly higher than in the Viskovo and Bakar regions; a correlation between the duration of residence and ventilatory lung function was also observed.

Adolescent↗

PubMed1999

Assessment of the sensitivity of the relation between current exposure to carbon black and lung function parameters when using different grouping schemes.

BACKGROUND: Equations using variance components in exposure data to predict attenuation and standard error of exposure--response slopes have been published recently. However, to date, no comparisons have been made between results of applying these equations to a real data set with the exposure-response relations estimated directly. METHODS: Data on lung function parameters and personal inhalable and respirable dust exposure levels from the European carbon black respiratory health study were used. The predicted attenuation and standard error of the relation between current inhalable and respirable dust levels and lung function parameters (FVC and FEV(1)) were calculated for various exposure grouping schemes. These results were compared with the observed exposure-response relations. Workers were grouped by Job Category, the combination of factory and Job Category and five a posteriori created Exposure Groups. In addition, the individual approach was also used, as exposure data were available for each worker. RESULTS: The rank orders of the coefficients from the regression analyses using the different grouping schemes were similar to those predicted by the equations, although the differences were larger than predicted. When using inhalable dust exposure, the predicted standard errors of the exposure-response slopes were slightly lower than those estimated directly; for respirable dust the predicted standard errors were about a factor two to three smaller than those from the regression analyses. When considering FVC, the predicted exposure-response relations were all statistically significant, whilst the observed relation was only significant when using the five a posteriori Exposure Groups. When reviewing the relations between dust exposure and level of FEV(1), all relations were statistically significant, with the exception of the (observed) relation between respirable dust and FEV(1), when the individual approach was used. CONCLUSIONS: Using different grouping schemes for estimating exposure can have large effects on the slope and standard error of the exposure-response relation. It is, therefore, important that the effect of the different grouping schemes on the level and precision of the exposure-response slope be estimated. Despite violation of most of the assumptions when applying the equations to predict attenuation and the standard error of the exposure-response slope, the similarities in predicted and observed exposure-response relations and standard errors are indicative of the robustness of these equations. Therefore, the equations appear to be a useful tool in establishing the most efficient way of utilizing exposure measurements.

Adult↗

PubMed2005

Growth and lung function in Asian patients with cystic fibrosis.

BACKGROUND: The incidence of cystic fibrosis (CF) in Asians is rare. How these patients fare in terms of morbidity and mortality in the UK compared to their non-Asian peers is not well documented. AIMS: To retrospectively study annual reviews of 31 Asian CF patients from three London paediatric CF centres. METHODS: Disease severity was assessed by lung function, age at first infection with Pseudomonas aeruginosa, and body mass index (BMI). The Asian children were compared with 143 matched non-Asian patients with CF. Matching criteria used were same sex and treatment centre as the Asian index patient. In addition, the controls were matched so that their date of birth, date of diagnosis, and date at annual review were within 12 months of the index patient. RESULTS: There was no significant difference in age at diagnosis or age at annual review between the Asian and non-Asian children. Mean Z-scores for FEV1 and FVC were significantly lower for the Asian girls. There was no significant difference in Z-scores for BMI between the Asian children and their controls. Age at first isolation of Pseudomonas aeruginosa in Asian girls was significantly later than for their controls (8.3 years compared to 5.6 years for non-Asian girls). CONCLUSIONS: While the Asian boys' lung function seems comparable with that of their non-Asian peers, the Asian girls emerge as a potentially vulnerable group and more work is required to discover why this is the case.

Adolescent↗

PubMed1993

Mortality of iron miners in Lorraine (France): relations between lung function and respiratory symptoms and subsequent mortality.

An increased mortality from lung and stomach cancer was found in previous studies on Lorraine iron miners. A detailed analysis, however, was not possible due to the lack of data for survivors. In this study the cohort included 1178 workers selected at random from all the 5300 working miners aged between 35 and 55 at the start of the follow up period, which ranged from 1975 to 1985. Occupational exposures and tobacco consumption, lung function tests, and respiratory symptoms were assessed for each subject in 1975, 1980, and 1985. This study confirmed the excess of lung cancer (standardised mortality ratio (SMR) = 389, p < 0.001) and of stomach cancer (SMR = 273, p < 0.05). There was no excess of lung cancer in non-smokers and moderate smokers (< 20 pack-years) or the miners who worked only at the surface or underground for less than 20 years. A significant excess (SMR = 349, p < 0.001) was found in moderate smokers when they worked underground for between 20 and 29 years. Heavy smokers (over 30 pack-years) or subjects who worked underground for more than 30 years experienced a high risk: SMR = 478 (p < 0.001) for moderate smokers who worked underground for over 30 years; 588 (p < 0.001) for heavy smokers who worked underground for between 20 and 29 years; and 877 (p < 0.001) for heavy smokers who worked underground for over 30 years. This showed an interaction between smoking and occupational exposure. The excess mortality from lung cancer was because there were some subjects who died young (from 45 years old). Comparison with the results of a previous study showed that additional hazards produced by diesel engines and explosives increased the mortality from lung cancer. The SMR was higher than 400 (p < 0.001) from 45 years old instead of from 56 years. A relation was found between a decrease in vital capacity (VC), forced expiratory volume in one second (FEV1) and of FEV1/VC and mortality from all causes and from lung cancer in heavy smokers or men who had worked underground for more than 20 years. Respiratory symptoms were related to mortality from lung cancer among smokers (moderate and heavy) who worked underground for more than 20 years. It is considered that the risk of lung cancer in the Lorraine iron miners was mainly due to dust, diesel engines, and explosives although the role of low exposure to radon daughters could not be totally excluded.

Adult↗

PubMed1997

One year follow-up study of endocrine and lung function of asthmatic children on inhaled budesonide.

Inhaled corticosteroids have become a mainstay in the management of chronic asthma. Their use had been considered safe, although some degree of adrenal suppression has been demonstrated after 2 and 4 weeks of treatment with either 400 microg x day(-1) of beclomethasone dipropionate or budesonide. To weigh the benefits and risks of long-term treatment, 12 children with moderately severe asthma were assessed in a follow-up study on budesonide 200 microg b.i.d. After 1 yr, the nocturnal cortisol production was significantly reduced by 19%, but no greater compared to 2 and 4 weeks of treatment. Growth and growth hormone levels were normal. Lung function tests were significantly better, not only versus baseline values but also versus 2 and 4 weeks of treatment. We conclude that systemic effects of inhaled corticosteroids in conventionally low doses do not accumulate with length of treatment, whilst lung function parameters will continue to improve. Therefore, inhaled corticosteroids once started in asthmatic children not controlled on other medications should be continued, but their use should be carefully considered and the minimal dose required to control the asthma employed.

Administration, Inhalation↗

PubMed1982

Annual decline of lung function in pulmonary emphysema: influence of radiological distribution.

Fifty-six male patients with pulmonary emphysema and normal serum alpha 1-antitrypsin were followed for a minimum period of three years (range 3-13 yr) to observe the effects of the radiological distribution of emphysema on the annual rate of change of lung function indices. The subjects were placed in three categories--upper zone (UZ), lower zone (LZ), and generalised (G). The influence of smoking was taken into account with subjects in each radiographic category being divided into ex-smokers (group EX-S) and continuing smokers (group S). The rate of decline of FEV1, VC, TCO, and KCO was greater in group S than EX-S in all three x-ray categories. In group S, FEV1, VC, TCO, and KCO declined significantly faster in UZ emphysema than in G emphysema. In group EX-S, FEV1, TCO, and PaO2 declined significantly faster in UZ than G emphysema but VC remained unaltered. KCO and PaCO2 did not change significantly in any radiographic category in either group S or EX-S. Patients with G and LZ emphysema underwent very similar physiological changes over the course of time. Those with UZ emphysema, however, complained of exertional dyspnoea at an earlier age; a number of their lung function indices deteriorated at a faster rate than in patients from the other two categories, suggesting that UZ emphysema is a different disease entity.

Adult↗

PubMed1986

Lung function and bronchial hyperreactivity following exposure to four different temperatures and relative humidities.

Seven asthmatic patients were exposed to four different climatic conditions in a climate chamber. The four conditions were: 15 degrees C/30% relative humidity (RH), 15 degrees C/70% RH, 30 degrees C/30% RH and 30 degrees C/70% RH and the exposure time was 4 hours. Before and after the exposure the following lung function parameters were measured: PEF, FEV1, RV and TLC. After each exposure a bronchial challenge with histamine was performed by the doubling-dose principle. The results indicated no difference in lung function after exposure to the "extreme" conditions in this study (i.e. 15 degrees C/30% RH and 30 degrees C/70% RH, water content 3.5 and 19 g/kg dry air, respectively), while a decrease in RV and TLC was seen after exposure to the "middle" conditions (i.e. 15 degrees C/70% RH and 30 degrees C/30% RH, water content 7.5 and 8 g/kg dry air, respectively). No change in ventilatory capacity was seen, and the bronchial hyperactivity also remained unchanged. During the 4 hours exposure, measurements of FEV1 and PEF also remained constant. It is concluded that this kind of exposure is without great effect on the asthmatics condition.

Adult↗

PubMed1993

[Cohort study on respiratory diseases and lung function in schoolchildren in southwest Germany. I. study design, prevalence and incidence of respiratory diseases].

A prospective cohort study on schoolchildren was conducted during the years 1977, 1979 and 1985 in Mannheim and the Black Forest county near Freiburg to investigate the regional differences in respiratory diseases and symptoms. Each survey included a lung function test and questions on respiratory symptoms. The response rates were high (84% averaged over the years and areas). A total of 8514 children participated in the study, 2066 children took part in two and 1486 in all three surveys. Prevalence and incidence rates of 11 respiratory and allergic diseases are reported in part 1 of the publication. In further parts, prevalence will be analysed using regression techniques and a comparison in the development of lung function between the different regions will follow. In general, prevalences of the respiratory and allergic diseases were higher for boys than girls at age 8-10. In contrast, 16 year old girls were equally affected and sometimes showed higher prevalences than boys except for asthma. 1977 and 1979 higher prevalences of respiratory symptoms were found in Mannheim compared to Freiburg. Allergic symptoms occurred more frequently in the area around Freiburg. No difference in prevalence and incidence could be demonstrated for the year 1985 between the two regions.

Adolescent↗