IMPULSE OSCILLOMETRY IDENTIFIES DISTINCT ASTHMA PHENOTYPES ON CLUSTER ANALYSIS

Reduced lung function has been shown to be a significant predictor of non-fatal ischaemic heart disease, and of mortality due to cardiovascular disease. Fewer studies have analysed the relationship between lung function and risk of fatal or non-fatal stroke. The present study presents results on the relation between forced expiratory volume in one second (FEV1) and risk of incident and fatal first-ever stroke. The analyses are based on prospective cohort data from 12 878 eligible men and women aged 45-84 years, who participated in the first health examination of the Copenhagen City Heart Study in 1976-1978. The subjects were followed from day of entry until 31 December 1993. During that period 808 first-ever strokes occurred of which 153 were fatal within 28 days. Risk of incident and fatal stroke was estimated by means of Cox hazard regression. The analyses included adjustment for potential confounders: sex, age, smoking, inhalation, body mass index, systolic blood pressure, triglycerides, physical activity in leisure time, education, diabetes mellitus, and antihypertensive treatment. We found an inverse association between FEV1 and risk of first-time stroke. For each 10% decrease in FEV1 in percentage of expected, the relative risk (RR) increased 1.05 (95% CI : 1.00-1.09, P = 0.03). This represents an approximately 30% higher risk of stroke in the group of people with the lowest lung function as compared to the group with the highest lung function. The association between lung function and risk of fatal stroke resembled that of risk of incident stroke (fatal and non-fatal). The RR was 1.11 (95% CI : 1.03-1.19) for each 10% decrease in FEV1 in percentage of expected. This represents approximately a doubling of the risk between the highest and lowest lung function groups. This study shows that reduced lung function measured in percentage of predicted FEV1 is a predictor of first-time stroke and fatal stroke independent of smoking and inhalation. The high risk of fatal first-ever stroke in the group of people with low lung function may be of significance in both the design and interpretation of clinical trials.

BackgroundPost-infectious bronchiolitis obliterans (PIBO) arises after lower respiratory tract infection during childhood and is marked by impaired lung function. Despite possible impacts on exercise capacity, cardiorespiratory fitness in PIBO patients remain largely unknown. This study aimed to examine cardiorespiratory fitness and identify possible demographic and clinical–functional associations.MethodsThe following variables were examined in a multicentre, cross-sectional study conducted in clinically stable PIBO patients aged 6–20 years: cardiorespiratory fitness (exercise testing), lung function (spirometry and impulse oscillometry), muscle strength (handgrip, upper and lower extremities), functional capacity (30-s sit-to-stand (STS) test), physical activity level (physical activity questionnaire adolescents and children; PAQ-A-C), body mass index (BMI), quality of life (Saint George's respiratory questionnaire; SGRQ) and dyspnoea perception (modified Medical Research Council scale).Results51 patients were enrolled (mean age 13.2±4.2 years, 49% female). BMI z-score was 0.06±1.20. Lung function tests indicated moderate-to-severe obstruction (forced expiratory volume in 1 s (FEV1) z-score −3.55±1.30) and elevated airway resistance (R5 Hz 165.8±53.64%). Peak oxygen consumption (V′O2peak) was 36.8±8.58 mL·kg−1·min−1 (47% ≤10 percentile) and breathing reserve 7.08±8.29%, indicating ventilatory limitation. Handgrip strength was 0.49±0.14 kg·kg−1. The 30-s STS test was 27.2±5.7 repetitions. PAQ-A/PAQ-C was 1.89±0.46 indicating a low physical activity level. SGRQ was 20.1±10.8%. There was no resting dyspnoea. Multivariate regression identified significant associations between V′O2peak and FEV1 (p<0.001), BMI (p<0.001), SGRQ (p=0.005), female sex (p=0.002) and age (p=0.033).ConclusionsIn these patients, cardiorespiratory fitness was impaired mainly due to ventilatory limitations. Lung function, upper and lower limb muscle strength, BMI, quality of life, sex and age were all associated with fitness level.

Background and aims: It has recently been documented that obesity is a global problem in all age groups, so that it affects about 250 million people in the world, accounting for 7% of the world’s population. Adipose tissue has an important role in inducing lung dysfunction through production and secretion of adipokines such as leptin. The aim of this study was to investigate the effect of a period of aerobic training on lung function indices and serum leptin levels in obese men. Methods: A total of 23 untrained obese men in Arak were recruited voluntarily for the study and randomly assigned to obese aerobic training group (Ob-AT, n=12) (45.26±2.45 years, body mass index (BMI) of 31.81±0.77 kg/m2 ) and obese control group (Ob-Cnt, n=11) (47.03±3.36 years, BMI of 31.45±0.96 kg/m2). Another normal control group (No-Cnt, n = 9) was sampled from individuals with normal weight to compare at the base level (45.1±4.1 years, BMI of 24.63±0.45 kg/m2 ). The obese exercise group participated in 12 weeks of progressive aerobic training, 3 sessions a week, 1.5 hours per session. Body composition (CT scan), leptin levels and lung function were measured before and after exercise protocol. Results: The participants with normal weight had significantly lower leptin concentration (P=0.01) and a higher lung function (P=0.016) compared to the obese participants. Moreover, the results indicated that leptin and obesity had an inverse correlation with lung function indices (forced vital capacity [FVC] and forced expiratory volume in one second [FEV1 ]) (P≤0.05). After the aerobic activity, obesity (BMI, WHR, body fat) and lung function indices (FVC and FEV1 ) significantly decreased in the obese aerobic training group compared to the obese control group (P≤0.05). In contrast, leptin concentration significantly decreased after the aerobic exercise protocol (P=0.018). Conclusion: We found that leptin level decreased after 12 weeks of aerobic exercise in obese men and this decrease was associated with the increased lung function and profound changes in body fat. The obtained data suggest that 12-week aerobic exercise causes alterations in leptin level that plays a key role in improving lung function.

There is a paucity of data on lung physiology in late-preterm children, who may be exposed to a risk of decline in lung function during childhood. In this study, we evaluated lung function in preschool children born late preterm using impulse oscillometry (IOS), and compared the results with those obtained in healthy term-born children. Children between 3 and 7 years of age who were born late preterm and who were being followed up at the outpatient clinic were included as the late-preterm group. Age-matched healthy term-born children served as controls. A total of 90 late-preterm and 75 healthy children were included in the study. At 5-20 Hz, resistance (R5-R20), reactance (X5-X20), impedans (Z5) and resonant frequency were measured on IOS. Mean IOS R5 and R10 were significantly higher in the late-preterm group than in the control group (P < 0.05). Mean R5, R10 and Z5 were statistically higher in late-preterm children who had been hospitalized for pulmonary infection compared with the control group (P < 0.05). Mean R5, R10, R15, R20 and Z5 were significantly higher, and mean X10 and X15 significantly lower in late-preterm children with passive smoking compared with late-preterm children without passive smoking and controls (P < 0.05). Children born late preterm had signs of peripheral airway obstruction on IOS-based comparison with healthy term-born controls. Besides the inherent disadvantages of premature birth, hospitalization for pulmonary infection and passive smoking also seemed to adversely affect lung function in children born late preterm.

Air pollution is associated with adverse health effects, particularly on respiratory and cardiovascular systems. Smog, prevalent in Northern India, contains particulate matter (PM10, PM2.5) and gaseous pollutants that can impair pulmonary function. Ambient air pollution can be quantified by the air quality index (AQI). Understanding the acute effects of air quality on respiratory physiology and inflammation is essential. A pilot prospective longitudinal observational study evaluated healthy volunteers during high (HAQI, AQI >350) and low pollution (LAQI, AQI <150) phases. Spirometry and impulse oscillometry (IOS) assessed lung function; and biomarkers (interleukin-6, tumor necrosis factor alpha) were measured from exhaled breath condensate (EBC) and serum. Paired t-tests or Wilcoxon signed-rank tests were used for analysis. A total of 21 participants (mean age 25.4±7.4 years, female 33.3%, body mass index 23.9±3.5 kg/m2) completed measurement at both HAQI (395.7±43.8) and LAQI (85.4±9.7). Spirometry revealed significantly lower slow vital capacity (SVC%, 81.6±11.2 vs. 87.7±7.7%, P = 0.008) and forced vital capacity (FVC%, 86.2±9.8 vs. 90.9±9.4%, P = 0.0005) under HAQI compared to LAQI. Forced expiratory volume at 1 second (FEV1) was also reduced (P < 0.0001), while FEV1/FVC remained unchanged. IOS showed higher airway resistance (R5, R20) during HAQI (P < 0.0001). Inflammatory biomarkers in serum and EBC showed no statistical differences between HAQI and LAQI. Despite measurable differences, spirometry and IOS parameters remained within normal limits. Acute air pollution exposure impairs lung function and increases airway resistance in healthy adults. These findings underscore the need for larger longitudinal studies to clarify the mechanisms linking acute air pollution exposure to chronic health outcomes.

BackgroundSince the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups A–D were introduced, the lung function changes according to group have been evaluated rarely.ObjectiveWe investigated the rate of decline in annual lung function in patients categorized according to the 2014 GOLD guidelines.MethodsPatients with COPD included in the Korean Obstructive Lung Disease (KOLD) prospective study, who underwent yearly postbronchodilator spirometry at least three times, were included. The main outcome was the annual decline in postbronchodilator forced expiratory volume in 1 second (FEV1), which was analyzed by random-slope and random-intercept mixed linear regression.ResultsA total 175 participants were included. No significant postbronchodilator FEV1 decline was observed between the groups (−34.4±7.9 [group A]; −26.2±9.4 [group B]; −22.7±16.0 [group C]; and −24.0±8.7 mL/year [group D]) (P=0.79). The group with less symptoms (−32.3±7.2 vs −25.0±6.5 mL/year) (P=0.44) and the low risk group (−31.0±6.1 vs −23.6±7.7 mL/year) (P=0.44) at baseline showed a more rapid decline in the postbronchodilator FEV1, but the trends were not statistically significant. However, GOLD stages classified by FEV1 were significantly related to the annual lung function decline.ConclusionThere was no significant difference in lung function decline rates according to the GOLD groups. Prior classification using postbronchodilator FEV1 predicts decline in lung function better than does the new classification.

Mitochondrial dysfunction is closely linked to obesity and diabetes, with declining lung function in aging increasing diabetes risk, potentially due to elevated serum levels of dioxin-like mitochondria inhibitor substances (MIS) from prolonged exposure to environmental pollutants. However, the mechanisms connecting MIS, mitochondria, lung function, and metabolic disorder remain unclear. In this study, we analyzed data from 1371 adults aged 40–69 years in the 2008 Korean Genome Epidemiologic Study (KoGES) Ansung cohort. We indirectly estimated dioxin-like MIS levels by measuring intracellular ATP (MISATP) and reactive oxygen species (MISROS) in cultured cells treated with the serum of participants. Using correlation analysis and structural equation modeling (SEM), we explored the relationships among MIS, mitochondrial function, body mass index (BMI), and lung function (FEV1 and FVC). Our findings revealed that MISATP was associated with BMI in females and with FVC in males, while MISROS correlated with both BMI and FVC in males, not in females. Significant associations between BMI and FVC were found in the highest MIS subgroup in both sexes. SEM analyses demonstrated that MIS negatively influenced mitochondrial function, which in turn affected BMI and lung function. Age-related declines in lung function were also linked to mitochondrial dysfunction. This study underscores the potential of MIS assays as alternatives for assessing mitochondrial function and highlights the importance of mitochondrial health in metabolic disorders and lung function.

Pulmonary exacerbations in cystic fibrosis with negative bacterial cultures

Stone-crushing although an important industrial sector in India has continuously been associated with health and safety related issues. The exposures from the dust emanated by various mechanical process such as drilling, dressing and loading, can trigger health issues ranging from minor symptoms to severe diseases and even cancers if worsened. In this view, the present study aimed at assessment of respiratory distress and lung function profile of the workers (n=46; aged 44.47±1.18y). The interview method was used to collect the information from the workers regarding their demographic, lifestyle and health related concerns. The lung function was assessed using spirometer using standard methodology. The results of the study revealed that the majority of workers had complaints of cough, breathlessness, dust particles in sputum and wheezing. Blocked and stuffed nose, loss -of- appetite and tiredness and joint pains were the other health complaints reported by the workers. The lung function stratified according to activities revealed a significant decline in lung function in those employed in drilling followed by the dressers and loaders. The workers were also categorized as having moderate (n=24), severe (n=14) and very severe COPD according to the lung function parameters as per the GOLD guidelines. Body Mass Index, years of smoking, Brinkmann index, duration of work and work schedule emerged as significant predictors of decline in lung function the present study is a risk assessment in regard to safeguarding the health of workers employed in such units. The results of this study can help in implementation of surveillance and establishing precautionary approaches for making such workplaces to be better and safer in terms of health of those employed.

Background Obstructive airway diseases, including asthma and chronic obstructive pulmonary disease (COPD), significantly impact respiratory function, making accurate diagnosis and differentiation essential for proper management. While spirometry is the gold standard for assessing lung function, impulse oscillometry (IOS) has emerged as a complementary tool, especially when spirometry results are inconclusive. This study aimed to compare the diagnostic utility of IOS with spirometry in patients with obstructive airway diseases and evaluate the correlation between these two methods. Methods A comparative observational study was conducted over 18 months at a tertiary care hospital in central India, including 130 patients (65 with asthma and 65 with COPD). Diagnostic evaluations using spirometry and IOS were performed before and after bronchodilator administration. Spirometry parameters assessed were forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio, while IOS parameters evaluated included resistance at 5 Hz (R5), resistance at20Hz (R20), resonant frequency(Fres), reactance at 5 Hz (X5), and the area under the reactance curve (AX). Statistical analysis was conducted using IBM SPSS version 27.0 (IBM Corp., Armonk, USA) and GraphPad Prism version 7.0 (Dotmatics, Boston, USA). Results Significant differences were observed in spirometry parameters between asthma and COPD groups, with asthma patients showing better lung function (FEV1, FVC, and FEV1/FVC; p<0.05). No significant differences were found in IOS parameters between the groupsexcept for a correlation between FEV1 (%) and IOS measurements in the asthma group. Spirometry demonstrated superior sensitivity in identifying airway obstruction compared to IOS. However, IOS was more effective in detecting peripheral airway obstruction in asthma patients, with 22 out of 65 (33.85%) asthma patients showing peripheral airway obstruction compared to six out of 65 (9.23%) COPD patients (p=0.001). Conclusion While spirometry remains the primary diagnostic tool for assessing obstructive airway diseases, IOS is a valuable adjunct, particularly for detecting peripheral airway involvement in asthma patients. Combining spirometry and IOS enhances diagnostic accuracy and provides a more comprehensive assessment of lung function in patients with asthma and COPD.

Plasma cysteine/cystine and glutathione/glutathione disulfide redox potentials in HIV and COPD patients

Introduction: Although occupational exposure is an important risk factor for development of chronic obstructive pulmonary disease (COPD), it has been little known about the effects of occupations exposures for progression of COPD. Aims and Objectives: To determine the effect of history for occupational exposures on lung function decline in men with COPD. Methods: Subjects were selected from a Korean COPD cohort, prospectively designed observational study and underwent yearly post bronchodilator spirometry. They were included if they underwent the spirometry at least three times. History of occupational exposures was evaluated for metal, asbestos, fiber, cereal, drugs, paper dust, and chemicals. History of occupational exposures was assessed by two blinded experts for each case. The annual decline of FEV1 was analyzed by random-slope and random-intercept mixed linear regression. Results: A total 222 patients with COPD were included, and patients with occupational exposures were 49. The mean age was 65.2 (standard deviation: 7.5) years, the mean smoking amount was 46.3 (28.1) pack-years. There were no significant differences in years of age, smoking amount, quality of life, and emphysema extent on CT, according to the presence of occupation exposures. The annual decline rates in FEV1 (ml per year) were significantly different for groups without occupational exposures of -32.9±21.9 compared to groups with occupational exposures of -25.5±19.9 (p = 0.038). Conclusions: Occupational exposures in men with COPD were associated with slower decline of lung function.

Foundry workers are occupationally exposed to a variety of inhalable chemical substances. Occupational exposure to vapors, gases, dusts, and fumes can lead to adverse health effects on the respiratory system and cause chronic respiratory diseases, such as interstitial lung diseases (ILDs), chronic obstructive lung disease (COPD), chronic bronchitis, and emphysema. Research on respiratory symptoms, diseases, and lung function in foundry workers over the past few decades has been limited. The aim of this cross-sectional study was to assess the prevalence of respiratory symptoms and diseases and declined lung function of current foundry workers, ex-foundry workers, and unexposed controls. We assessed respiratory symptoms, diseases, and lung function among 335 current foundry workers, 64 ex-foundry workers, and 161 unexposed controls. The cumulative dust exposure (mg-y) of each participant was calculated, and the median cumulative dust exposure according to the main places of exposure was determined. A higher prevalence of chronic bronchitis, as reported in a questionnaire, was found among current and ex-foundry workers compared to unexposed controls, even after adjusting for pack-years of smoking (p = 0.009). Additionally, cough and wheezing in adulthood without respiratory infection, and chronic rhinitis symptoms were more common among current and ex-foundry workers compared to unexposed controls. These differences remained significant even after adjusting for pack-years of smoking and body mass index (BMI) (p = 0.007 and p < 0.001, respectively). Impaired lung function was more prevalent among both ex-foundry workers (29.7%) and current foundry workers (15.5%) compared to the unexposed controls (8.7%), with the difference remaining significant even after adjusting for the pack-years of smoking and BMI (p = 0.009). According to the questionnaire, the number of physician-diagnosed cases of chronic obstructive pulmonary disease (COPD) or chronic bronchitis was unexpectedly low compared to the indications from the symptom questionnaire and lung function test results, suggesting a potential underdiagnosis. The prevalence of silicosis was low (0.8%) among current and ex-foundry workers. Respiratory symptoms are common among foundry workers. Current and ex-foundry workers exhibited lower lung function in spirometry compared to unexposed controls. There is a potential underdiagnosis of COPD and chronic bronchitis among foundry workers.

Background The association between impaired lung function and cardiovascular disease is well known. However, it is not fully understood how a decline in lung function affects the development of cardiovascular disease including heart failure (HF). Purpose We aimed to investigate the association between declining lung function and changes in cardiac structure and function. Furthermore, we investigated the association between a decline in lung function and the risk of HF. Methods The study included 2,995 participants from a general population study. All participants had two examinations with spirometry performed 10 years apart. Participants were free of valvular heart disease and HF. A subsample (n=1,164) was also examined with echocardiography at both timepoints. The decline in the forced expiratory volume in one second (dFEV1) from the first visit to the second visit, was calculated. The change in cardiac structure and function between the two visits, was calculated as the decline in left ventricular ejection fraction (dLVEF), global longitudinal strain (dGLS), left ventricular mass index (dLVMi) and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (dE/e’). Linear regression models were adjusted for the baseline FEV1 and echocardiographic value to account for regression to the mean. Outcome was incident HF. Results The entire sample consisted of 57% women, and the mean age was 62 ± 14 years. A total of 59% had hypertension, 8% had ischemic heart disease (IHD), 6% had diabetes, and 18% were active smokers. Mean FEV1 at baseline was 2.8 ± 0.95 liters (95 ± 19% as percentage of the predicted value). The mean decline in FEV1 between visits (median 10.8 years, IQR: 10.3-11.2) was 309 ± 362 mL. In the subsample examined with echocardiography, decreasing dLVEF was significantly associated with decreasing dFEV1 (p=0.030) in multivariable linear regression analysis, whereas dGLS, dLVMi, and dE/e’ were not. In the total study sample, 105 participants developed incident heart failure following the second visit during a median follow-up of 5.4 years (IQR: 4.5-6.3). Participants in the lowest quartile of dFEV1 (no change or increase) had an incidence rate of 2.48 per 1,000 person years (95%CI 1.33-4.60) versus participants in the highest quartile of dFEV1 (largest decline) with an incidence rate of 13.9 per 1,000 person years (95%CI 10.6-18.3), p&amp;lt;0.001. In multivariable Cox regression analysis, dFEV1 was an independent predictor of HF with a hazard ratio of 3.37 per 1 liter decline (95%CI 1.53-7.43, p=0.003). Conclusion We found a strong association between a decline in FEV1 and a decline in LVEF over a decade. Decreasing FEV1 was independently associated with incident HF. The incidence was highest for those with the largest decline in FEV1.A) Linear association B) Hist. of dLVEFA) Incidence rate B) Cumulative inc.

Reference equation for the incremental shuttle walk test in Portuguese children and adolescents