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1.
Curr Med Sci ; 40(4): 677-682, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32862378

RESUMO

Changes of maximum expiratory flow at 25% and 50% of vital capacity (MEF25 and MEF50, respectively), and predominant parameters indicating small airways function in asthmatics before and after bronchodilator (BD) reversibility test have been less interpreted. Our study aimed to investigate the clinical role of changes of MEF25 and MEF50 before and after BD reversibility test in diagnosing asthma. Forced expiratory volume in the first second (FEV1), MEF25, and MEF50 were measured before and after BD reversibility test in 207 asthmatic patients using standard process. Forty healthy individuals were enrolled as controls. Receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of reversibility of MEF25 and MEF50 before and after BD reversibility test (ΔMEF25% and ΔMEF50%, respectively) in diagnosing asthma. Among these functional criteria, ΔMEF25% and ΔMEF50% ≥ 25% performed the best diagnostic performance. The sensitivity, specificity, and accuracy of ΔMEF25% ≥ 25% as an objective diagnostic test for asthma were 63.29%, 87.50%, and 67.21%, and of ΔMEF50% ≥ 25% were 79.23%, 85.00%, and 80.16%, respectively. The area under the ROC curve of the indicators was 0.8203 and 0.9104, respectively. By contrast, an increase in FEV1 ≥ 12% and 200 mL demonstrated a sensitivity of 62.32%, specificity of 82.50%, and accuracy of 65.59% in diagnosing asthma. The changes of MEF25 and MEF50 before and after BD reversibility test may be of additional value in the clinical diagnosis of asthma, with cutoff values of 25% being the most.


Assuntos
Asma/diagnóstico , Adulto , Asma/fisiopatologia , Broncospirometria , Estudos de Casos e Controles , Estudos Transversais , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade , Capacidade Vital , Adulto Jovem
2.
J Heart Lung Transplant ; 36(9): 980-984, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28651906

RESUMO

BACKGROUND: The principal obstacle to long-term survival after lung transplant is chronic lung allograft dysfunction (CLAD), which primarily affects the small airways. After transplant, patients are monitored with spirometry, which is a generally insensitive detector of small airways obstruction. The lung clearance index (LCI) is a measure obtained during multiple breath washout (MBW) maneuvers. We hypothesized that among lung allograft recipients, LCI would detect small airways disease not detected with spirometry. METHODS: This study enrolled 15 patients, 5 of whom already had a diagnosis of CLAD. We added MBW as an additional index of peripheral airway function to the established post-transplant routine care protocol. RESULTS: Of trials, 87.9% yielded valid measurements, and single maneuvers were 2-8 minutes. LCI did not yield any false-negative findings-no patients were considered obstructed by forced expiratory volume in 1 second (FEV1) but normal by LCI. At enrollment, 6 patients without CLAD had an elevated LCI, and 4 progressed to CLAD. Only 2 of these 4 patients would have been identified by a decrease in FEV1. CONCLUSIONS: LCI identified lung allograft dysfunction in more patients than the use of standardized spirometric measures, including patients with abnormal FEV1. These data suggest that LCI from MBW may be a more sensitive means to detect allograft peripheral airway disease than standard methods for measurement of small airways function.


Assuntos
Bronquíolos/fisiopatologia , Broncospirometria/métodos , Volume Expiratório Forçado/fisiologia , Transplante de Pulmão/efeitos adversos , Transplantados , Adolescente , Aloenxertos , Criança , Pré-Escolar , Estudos de Coortes , Fibrose Cística/diagnóstico , Fibrose Cística/cirurgia , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/cirurgia , Modelos Lineares , Transplante de Pulmão/métodos , Masculino , Pediatria , Valor Preditivo dos Testes , Disfunção Primária do Enxerto/mortalidade , Disfunção Primária do Enxerto/fisiopatologia , Prognóstico , Estudos Prospectivos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
3.
Tunis Med ; 91(8-9): 521-6, 2013.
Artigo em Francês | MEDLINE | ID: mdl-24227510

RESUMO

BACKGROUND: Smoking represents an ever-increasing problem of public health in the world, the impact of which is actually rising. The majority of smokers wish to stop smoking one day. This fact is one of the major acts leading to a better health and wellbeing. In the eighties, the lung age was already mentioned by Morris and Temple, a further tool motivating tobacco cessation. AIM: To determine the lung age of a population of workers and to evaluate the impact of its announcement on the smoking behavior. METHODS: It is a prospective study realized during a year (November 2010-November 2011) in a wire enterprise LEONI in Sousse (Tunisia), during an intervention program. 35 adult smokers were concerned by our study. A measurement of the breathing function by "Néo6" and a calculation of the lung age were practiced on all smokers. RESULTS: 35 smoking men (mean ± SD age of 36 ± 7 years, 27 and 28 smokers have, respectively, a high socio-economic level and a high schooling level) were included. The number of daily cigarettes consumed was from 5 to 40. The measurement of the smokers' respiratory function by the "Neo 6" did not show a pulmonary function defect. The lung age was of 45 ±13 years, significantly higher than the chronological age. The evaluation of the announcement of the lung age, realized one year after, showed that 8 among the 35 workers have stopped smoking and 7 smokers have reduced their tobacco consumption. CONCLUSION: Communicating the lung age results is an additional tool motivating tobacco cessation.


Assuntos
Pulmão/fisiologia , Abandono do Hábito de Fumar/psicologia , Fumar/efeitos adversos , Tabagismo/psicologia , Revelação da Verdade , Adulto , Fatores Etários , Broncospirometria , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Motivação/fisiologia , Abandono do Hábito de Fumar/estatística & dados numéricos
4.
Respir Res ; 12: 150, 2011 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-22074289

RESUMO

BACKGROUND: Pulmonary hyperinflation has the potential for significant adverse effects on cardiovascular function in COPD. The aim of this study was to investigate the relationship between dynamic hyperinflation and cardiovascular response to maximal exercise in COPD patients. METHODS: We studied 48 patients (16F; age 68 yrs ± 8; BMI 26 ± 4) with COPD. All patients performed spirometry, plethysmography, lung diffusion capacity for carbon monoxide (TLco) measurement, and symptom-limited cardiopulmonary exercise test (CPET). The end-expiratory lung volume (EELV) was evaluated during the CPET. Cardiovascular response was assessed by change during exercise in oxygen pulse (ΔO2Pulse) and double product, i.e. the product of systolic blood pressure and heart rate (DP reserve), and by the oxygen uptake efficiency slope (OUES), i.e. the relation between oxygen uptake and ventilation. RESULTS: Patients with a peak exercise EELV (%TLC) ≥ 75% had a significantly lower resting FEV1/VC, FEF50/FIF50 ratio and IC/TLC ratio, when compared to patients with a peak exercise EELV (%TLC) < 75%. Dynamic hyperinflation was strictly associated to a poor cardiovascular response to exercise: EELV (%TLC) showed a negative correlation with ΔO2Pulse (r = - 0.476, p = 0.001), OUES (r = - 0.452, p = 0.001) and DP reserve (r = - 0.425, p = 0.004). Furthermore, according to the ROC curve method, ΔO2Pulse and DP reserve cut-off points which maximized sensitivity and specificity, with respect to a EELV (% TLC) value ≥ 75% as a threshold value, were ≤ 5.5 mL/bpm (0.640 sensitivity and 0.696 specificity) and ≤ 10,000 Hg · bpm (0.720 sensitivity and 0.783 specificity), respectively. CONCLUSION: The present study shows that COPD patients with dynamic hyperinflation have a poor cardiovascular response to exercise. This finding supports the view that in COPD patients, dynamic hyperinflation may affect exercise performance not only by affecting ventilation, but also cardiac function.


Assuntos
Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Broncospirometria/efeitos adversos , Teste de Esforço/efeitos adversos , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia/efeitos adversos , Capacidade de Difusão Pulmonar/fisiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/etiologia
5.
Respir Res ; 12: 127, 2011 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-21951550

RESUMO

BACKGROUND: The coexistence of COPD and asthma is widely recognized but has not been well described. This study characterizes clinical features, spirometry, and chest CT scans of smoking subjects with both COPD and asthma. METHODS: We performed a cross-sectional study comparing subjects with COPD and asthma to subjects with COPD alone in the COPDGene Study. RESULTS: 119 (13%) of 915 subjects with COPD reported a history of physician-diagnosed asthma. These subjects were younger (61.3 vs 64.7 years old, p=0.0001) with lower lifetime smoking intensity (43.7 vs 55.1 pack years, p=0.0001). More African-Americans reported a history of asthma (33.6% vs 15.6%, p<0.0001). Subjects with COPD and asthma demonstrated worse disease-related quality of life, were more likely to have had a severe COPD exacerbation in the past year, and were more likely to experience frequent exacerbations (OR 3.55 [2.19, 5.75], p<0.0001). Subjects with COPD and asthma demonstrated greater gas-trapping on chest CT. There were no differences in spirometry or CT measurements of emphysema or airway wall thickness. CONCLUSION: Subjects with COPD and asthma represent a relevant clinical population, with worse health-related quality of life. They experience more frequent and severe respiratory exacerbations despite younger age and reduced lifetime smoking history. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00608764.


Assuntos
Asma/diagnóstico , Asma/fisiopatologia , Progressão da Doença , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Asma/patologia , Broncospirometria , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/patologia , Fumar/efeitos adversos
6.
Clin Exp Allergy ; 41(12): 1719-28, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21729182

RESUMO

BACKGROUND: Acute exacerbations in allergic asthmatics may lead to impaired ability to clear mucus from the airways, a key factor in asthma morbidity. OBJECTIVE: The purpose of this study was to determine the effect of inhaled house dust mite challenge on the regional deposition of inhaled particles and mucociliary clearance (MCC) in allergic asthmatics. METHODS: We used gamma scintigraphy (inhalation of (99m) Tc -sulphur colloid particles) to measure the regional particle deposition and MCC in allergic asthmatics (n=12) 4 h following an inhaled dust mite allergen challenge (Dermatophagoides farinae extract; PD(max) =fall in forced expiratory volume in 1 s of 10%) for comparison with baseline non-challenge measures. RESULTS: In responders (n=9 PD(max) dose), lung function returned to pre-challenge values by 3 h but was significantly decreased at 6 and 24 h in three of the responders (i.e. late-phase response) and induced sputum eosinophils were increased at 24 h post-challenge (P<0.05). Responders showed enhanced bronchial airway deposition of inhaled particles (P<0.05) and slowed clearance from the central lung zone (P<0.01) at 4 h post-challenge compared with the baseline (no allergen challenge) that was predicted by the PD(max) allergen concentration (r=-0.70, P<0.05). The decline in lung function at 24 h post-challenge correlated with reduced MCC from the central lung zone (r=-0.78, P<0.02) and PD(max) . Non-responders (n=3) showed no change in lung function, regional deposition or MCC post-challenge vs. baseline. CONCLUSIONS AND CLINICAL RELEVANCE: These data suggest that regional deposition and clearance of inhaled particles may be sensitive for detecting mild airway obstruction associated with early- and late-phase allergen-induced effects on mucus secretions. The study was listed on clinicaltrials.gov (NCT00448851).


Assuntos
Antígenos de Dermatophagoides/imunologia , Asma/imunologia , Depuração Mucociliar/imunologia , Pyroglyphidae/imunologia , Administração por Inalação , Adulto , Animais , Antígenos de Dermatophagoides/administração & dosagem , Asma/fisiopatologia , Testes de Provocação Brônquica , Broncospirometria , Eosinófilos/imunologia , Feminino , Volume Expiratório Forçado , Humanos , Contagem de Leucócitos , Masculino , Neutrófilos/imunologia , Escarro/citologia , Escarro/imunologia , Adulto Jovem
7.
Heart Lung ; 40(5): 440-7, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21665276

RESUMO

OBJECTIVE: The use of incentive spirometry (IS) is reported to prevent and treat postoperative pulmonary complications. This study sought to use the theory of planned behavior to predict the use of IS in this population. METHODS: The study used a prospective design, with convenience sampling, to recruit a total of 116 postcardiac-surgery patients from 2 medical centers in Taipei, Taiwan, from November 2008 to May 2009. Data were collected through 2 instruments: a demographic questionnaire, and an IS questionnaire. Descriptive analysis, independent t test, one-way analysis of variance, binary regression, and liner regression were used to analyze the data. RESULTS: Perceived behavioral control, but not intention, was a predictor of the use of IS. CONCLUSION: Our findings provide partial support for the utility of the theory of planned behavior in explaining the use of IS behavior for cardiac surgery patients.


Assuntos
Broncospirometria/psicologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Teoria Psicológica , Análise de Variância , Broncospirometria/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Pesquisa Qualitativa , Inquéritos e Questionários , Taiwan , Resultado do Tratamento
8.
J Pak Med Assoc ; 61(12): 1172-5, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22355960

RESUMO

OBJECTIVES: To assess the Pre-bronchodilator criteria and the Post-bronchodilator criteria of FEV1/FVC ratio in diagnosing Airflow obstruction. METHODS: An observational study was conducted from 1988 to 2006 at the Aga Khan University Hospital Patients referred to the pulmonary function test laboratory for spirometry with bronchodilator reversibility at the hospital during the above said period were enrolled. Forced spirometry was performed according to ATS guidelines. All patients who had pre-bronchodilator criteria of airflow obstruction were analyzed and compared with the post bronchodilator criteria. RESULTS: A total of 4222 individuals underwent spirometry out of which 4072 individuals were studied. Using the pre bronchodilator criteria, 1375 (34%) patients had airflow obstruction. Applying the post bronchodilator criteria on the same patients, 1098 (27%) had evidence of airway obstruction. Out of these 1375 patients who had airflow obstruction by using pre-bronchodilator criteria, 277 (20%) patients had no airflow obstruction by using the post bronchodilator criteria. Out of these 277 patients, 52% had significant airways reversibility as evidenced by >12% increase in their FEV1 pre and post bronchodilator. CONCLUSION: Pre bronchodilator criteria for detection of airflow obstruction overestimate the diagnosis of airflow obstruction and by using post bronchodilator criteria for airway obstruction on spirometry, decreases this over diagnosis of the condition


Assuntos
Obstrução das Vias Respiratórias/diagnóstico , Broncodilatadores , Adolescente , Adulto , Idoso , Obstrução das Vias Respiratórias/fisiopatologia , Broncospirometria/métodos , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Capacidade Vital/efeitos dos fármacos , Capacidade Vital/fisiologia , Adulto Jovem
9.
Rev Med Chir Soc Med Nat Iasi ; 114(3): 625-32, 2010.
Artigo em Romano | MEDLINE | ID: mdl-21243785

RESUMO

The hepato-pulmonary syndrome (HPS) is a rare complication of liver cirrhosis, with poor outcome; the term includes liver disease, increased alveolo-arterial gradient and intrapulmonary vascular dilations, described by Fluckiger, Kennedy and Knudson. HPS impairs survival in cirrhotic patients and the posttransplant outcome is altered in correlation with severity of HPS. Combined determination of SaO2 in clino- and orthostatic position by a pulsoximeter is a simple test for HPS identification in patients with chronic liver disease or non-cirrhotic portal hypertension.


Assuntos
Síndrome Hepatopulmonar , Cirrose Hepática/complicações , Algoritmos , Gasometria , Broncospirometria , Síndrome Hepatopulmonar/sangue , Síndrome Hepatopulmonar/diagnóstico , Síndrome Hepatopulmonar/etiologia , Síndrome Hepatopulmonar/fisiopatologia , Humanos , Hipóxia/etiologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/fisiopatologia , Oximetria , Oxigênio/sangue , Postura , Prognóstico , Índice de Gravidade de Doença , Relação Ventilação-Perfusão
10.
J Am Coll Nutr ; 29(5): 494-502, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21504976

RESUMO

OBJECTIVE: Dairy products contain vitamin D and other nutrients that may be beneficial for lung function, but they are also high in fats that may have mixed effects on lung function. However, the overall associations of dairy intake with lung density and lung function have not been studied. METHODS: We examined the cross-sectional relationships between dairy intake and computed tomography (CT) lung density and lung function in the Multi-Ethnic Study of Atherosclerosis (MESA). Total, low-fat, and high-fat dairy intakes were quantified from food frequency questionnaire responses of men and women who were ages 45-84 years and free of clinical cardiovascular disease. The MESA-Lung Study assessed CT lung density from cardiac CT imaging and prebronchodilator spirometry among 3965 MESA participants. RESULTS: Total dairy intake was inversely associated with apical-basilar difference in percent emphysema and positively associated with forced vital capacity (FVC) (the multivariate-adjusted mean difference between the highest and lowest quintiles of total dairy intake was -0.92 [p for trend = 0.04] for apical-basilar difference in percent emphysema and 72.0 mL [p = 0.01] for FVC). Greater low-fat dairy intake was associated with higher alpha (higher alpha values indicate less emphysema) and lower apical-basilar difference in percent emphysema (corresponding differences in alpha and apical-basilar difference in percent emphysema were 0.04 [p = 0.02] and -0.98 [p = 0.01] for low-fat dairy intake, respectively). High-fat dairy intake was not associated with lung density measures. Greater low- or high-fat dairy intake was not associated with higher forced expiratory volume in 1 second (FEV(1)), FVC, and FEV(1)/FVC. CONCLUSIONS: Higher low-fat dairy intake but not high-fat dairy intake was associated with moderately improved CT lung density.


Assuntos
Laticínios , Gorduras na Dieta/farmacologia , Enfisema/prevenção & controle , Pneumopatias/prevenção & controle , Pulmão/fisiopatologia , Capacidade Vital/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Broncospirometria , Estudos Transversais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/patologia , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
11.
Physiol Meas ; 30(11): 1197-209, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19794236

RESUMO

A method to assess nasal airflow resistance is presented that provides a continuous resistance value and applies a novel minimally obtrusive measurement technique. Instead of calculating the resistance once for each breathing cycle conventionally, it is calculated for each signal sample at any sampling frequency. The continuous pressure recording is produced with a nasopharyngeal catheter inserted 8 cm deep along the floor of the other nasal cavity and the flow recording is produced with respiratory effort bands. A least-mean-square (LMS) extension for the resistance model of Broms is developed that dynamically adapts to the time-varying characteristics of the nasal functioning and produces the continuous resistance values. Experimental results are shown that demonstrate the uniqueness and applicability of the new technique in assessing quickly changing resistance in a histamine/xylometatsolin challenges, the differences between normal and symptomatic patients, and the effect of nasal treatment of patients.


Assuntos
Resistência das Vias Respiratórias/fisiologia , Monitorização Fisiológica/métodos , Cavidade Nasal/fisiologia , Ventilação Pulmonar/fisiologia , Adulto , Idoso , Broncospirometria/instrumentação , Broncospirometria/métodos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Feminino , Humanos , Inalação/fisiologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Nasofaringe/fisiologia , Rinite/diagnóstico , Rinite/fisiopatologia , Adulto Jovem
13.
Med Sci Sports Exerc ; 40(3): 405-12, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18379200

RESUMO

PURPOSE: Data from the general population suggest that habitual exercise decreases bronchial responsiveness, but the possible role of exercise in asthmatics is undefined. The leukotriene receptor antagonist montelukast decreases bronchial responsiveness and exercise-induced symptoms in asthmatic children. This randomized study in children with mild asthma evaluated the combined effects of aerobic training for 12 wk and montelukast or placebo on bronchial responsiveness (BHR) to methacholine, exercise-induced bronchoconstriction (EIB), inflammatory markers in exhaled breath condensate (EBC), and asthma exacerbations. METHODS: Fifty children (mean age +/- SD: 10.2 +/- 2.4 yr) with mild stable asthma were randomly assigned to placebo (N = 25) or montelukast (N = 25). Before and after training, we assessed BHR and EIB and markers of airway inflammation-that is, exhaled nitric oxide (eNO), pH, and cysteinyl-leukotriene concentration-in EBC. RESULTS: Training increased maximal workload and peak minute ventilation. After training, the methacholine dose causing a 20% fall in FEV1 (PD20) increased in both groups. A decreased slope of FEV1 decline at increasing methacholine dose was found only in montelukast-treated children. EIB prevalence halved after training in both groups (EIB + children, placebo group: 10 pretraining, 4 posttraining; EIB + children, montelukast group: 8 pretraining, 5 posttraining; P < 0.05 by chi on all children). Resting eNO was unaffected, whereas the pH of EBC decreased after training in both groups. Cysteinyl-leukotriene concentrations were low in most children at both times. During training, montelukast-treated children showed fewer asthma exacerbations compared with the same period of the previous year. CONCLUSIONS: In children with mild stable asthma, exercise training decreased bronchial responsiveness to methacholine. Montelukast also decreased bronchial reactivity (FEV1 slope) and protected against exacerbations, suggesting a beneficial synergistic action of these two interventions in mild asthma.


Assuntos
Acetatos/uso terapêutico , Antiasmáticos/uso terapêutico , Asma Induzida por Exercício/tratamento farmacológico , Asma/tratamento farmacológico , Asma/fisiopatologia , Terapia por Exercício , Quinolinas/uso terapêutico , Acetatos/administração & dosagem , Acetatos/farmacologia , Antiasmáticos/administração & dosagem , Antiasmáticos/farmacologia , Asma Induzida por Exercício/fisiopatologia , Testes Respiratórios , Broncoconstrição/efeitos dos fármacos , Broncospirometria , Criança , Ciclopropanos , Teste de Esforço , Expiração/efeitos dos fármacos , Expiração/fisiologia , Feminino , Humanos , Itália , Masculino , Cloreto de Metacolina/administração & dosagem , Aptidão Física/fisiologia , Quinolinas/administração & dosagem , Quinolinas/farmacologia , Sulfetos
14.
Chest ; 131(5): 1486-93, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17494798

RESUMO

BACKGROUND: Current standards for spirometry require daily calibration checks to come within 3.5% of the inserted volume but do not require evaluation of trends over time. We examined the current guidelines and candidate quality control rules to determine the best method for identifying spirometers with suboptimal performance. METHODS: Daily calibration checks on seven volume spirometers recorded over 4 to 11 years were reviewed. Current guidelines and candidate quality control rules were applied to determine how well each detected suboptimal spirometer performance. RESULTS: Overall, 98% of 7,497 calibration checks were within 3.5%. However, based on visual inspection of calibration check data plots, spirometers 3 and 5 demonstrated systematic sources of error, drift, and bias. The +/- 3.5% criteria did not identify these spirometers. The application of +/- 2% criteria identified these spirometers (9% out-of control values in spirometers 3 and 5 vs < 5% in other spirometers). A rule stipulating out-of-control conditions when four consecutive checks exceeded 1% deviation identified suboptimal spirometers (14% and 20% out-of-control values) but maintained low error detection rates in other spirometers (< or = 2%). Other candidate rules were less effective or required longer times to error detection. CONCLUSIONS: The current recommendation that calibration checks come within +/- 3.5% of the inserted volume did not detect subtle errors. Alternative candidate rules were more effective in detecting errors and maintained low overall error-detection rates. Our findings emphasize the need for laboratories to systematically review calibration checks over time and suggest that more stringent guidelines for calibration checks may be warranted for volume spirometers. Although our general approach may also be appropriate for flow-type spirometers, the details are likely to differ since flow-type spirometers are a much more varied category of equipment.


Assuntos
Broncospirometria/instrumentação , Broncospirometria/normas , Calibragem/normas , Guias como Assunto , Humanos , Controle de Qualidade , Padrões de Referência
16.
Chest ; 131(5): 1494-9, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17400677

RESUMO

BACKGROUND: Peak forced expiratory flow (PEF) and FEV(1) are spirometry measures used in diagnosing and monitoring lung diseases. We tested the premise that within-test variability in PEF is associated with corresponding variability in FEV(1) during a single test session. METHODS: A total of 2,464 healthy adults from the Health, Aging, and Body Composition Study whose spirometry results met American Thoracic Society acceptability criteria were screened and analyzed. The three "best" test results (highest sum of FVC and FEV(1)) were selected for each subject. For those with acceptable spirometry results, two groups were created: group 1, normal FEV(1)/FVC ratio; group 2, reduced FEV(1)/FVC ratio. For each subject, the difference between the highest and lowest PEF (DeltaPEF) and the associated difference between the highest and lowest FEV(1) (DeltaFEV(1)) were calculated. Regression analysis was performed using the largest PEF and best FEV(1), and the percentage of DeltaPEF (%DeltaPEF) and percentage of DeltaFEV(1) (%DeltaFEV(1)) were calculated in both groups. RESULTS: Regression analysis for group 1 and group 2 showed an insignificant association between %DeltaPEF and %DeltaFEV(1) (r(2) = 0.0001, p = 0.59, and r(2) = 0.040, p = 0.15, respectively). For both groups, a 29% DeltaPEF was associated with a 1% DeltaFEV(1). CONCLUSION: Within a single spirometry test session, %DeltaPEF and %DeltaFEV(1) contain independent information. PEF has a higher degree of intrinsic variability than FEV(1). Changes in PEF do not have a significant effect on FEV(1). Spirometry maneuvers should not be excluded based on peak flow variability.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/fisiopatologia , Fatores Etários , Idoso , Broncospirometria , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pico do Fluxo Expiratório/fisiologia , Análise de Regressão , Reprodutibilidade dos Testes
17.
J Allergy Clin Immunol ; 119(3): 654-61, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17336615

RESUMO

BACKGROUND: Little is known about sensitization (defined as a positive IgE) to helminths and disease severity in patients with asthma. OBJECTIVES: To examine the relationship between sensitization (defined as a positive IgE) to Ascaris lumbricoides and measures of asthma morbidity and severity in a Costa Rican population with low prevalence of parasitic infection but high prevalence of parasitic exposure. METHODS: Cross-sectional study of 439 children (ages 6 to 14 years) with asthma. Linear regression and logistic regression were used for the multivariate statistical analysis. RESULTS: After adjustment for parental education and other covariates, sensitization to Ascaris lumbricoides was associated with having at least 1 positive skin test to allergens (odds ratio, 5.15; 95% CI, 2.36-11.21; P < .001), increased total serum IgE and eosinophils in peripheral blood, reductions in FEV(1) and FEV(1)/forced vital capacity, increased airway responsiveness and bronchodilator responsiveness, and hospitalizations for asthma in the previous year (odds ratio, 3.08; 95% CI, 1.23-7.68; P = .02). CONCLUSION: Sensitization to Ascaris lumbricoides is associated with increased severity and morbidity of asthma among children in Costa Rica. This association is likely mediated by an increased degree of atopy among children with asthma who are sensitized to Ascaris. CLINICAL IMPLICATIONS: In areas with a low prevalence of helminthiasis such as Costa Rica, Ascaris sensitization may be an important marker of severe atopy and disease morbidity in children with asthma.


Assuntos
Alérgenos/imunologia , Ascaris lumbricoides/imunologia , Asma/complicações , Asma/epidemiologia , Hipersensibilidade Imediata/complicações , Animais , Broncodilatadores/farmacologia , Broncospirometria , Criança , Costa Rica/epidemiologia , Eosinófilos/citologia , Feminino , Humanos , Hipersensibilidade Imediata/imunologia , Imunoglobulina E/sangue , Contagem de Leucócitos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Prevalência , Testes Cutâneos
18.
J Allergy Clin Immunol ; 119(3): 611-7, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17258304

RESUMO

BACKGROUND: Few studies have investigated the long-term association between inhaled corticosteroids (ICSs) and lung function decline in asthma. OBJECTIVE: To evaluate whether prolonged treatment with ICSs is associated with FEV(1) decline in adults with asthma. METHODS: An international cohort of 667 subjects with asthma (20-44 years old) was identified in the European Community Respiratory Health Survey (1991-1993) and followed up from 1999 to 2002. Spirometry was performed on both occasions. FEV(1) decline was analyzed according to age, sex, height, body mass index, total IgE, time of ICS use, and smoking, while adjusting for potential confounders. RESULTS: As ICS use increased, the decline in FEV(1) was lower (P trend = .025): on average, decline passed from 34 mL/y in nonusers (half of the sample) to 20 mL/y in subjects treated for 48 months or more (18%). When adjusting for all covariates, there was an interaction (P = .02) between ICS use and total IgE: in subjects with high (>100 kU/L) IgE, ICS use for 4 years or more was associated with a lower FEV(1) decline (23 mL/y; 95% CI, 8-38 compared with nonusers). This association was not seen in those with lower IgE. CONCLUSION: Although confirming a beneficial long-term association between ICSs and lung function in asthma, our study suggests that subjects with high IgE could maximally benefit from a prolonged ICS treatment. CLINICAL IMPLICATIONS: This study adds further evidence to the beneficial effect of inhaled steroids on lung function in asthma; future studies will clarify whether calibrating the corticosteroid dose according to the level of total IgE is a feasible approach in asthma management.


Assuntos
Corticosteroides/administração & dosagem , Asma/tratamento farmacológico , Imunoglobulina E/sangue , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Administração por Inalação , Adulto , Asma/imunologia , Broncospirometria , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Volume Expiratório Forçado , Humanos , Masculino
19.
J Allergy Clin Immunol ; 119(3): 583-90, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17204317

RESUMO

BACKGROUND: Air trapping reflects small airway obstruction in asthma and can be assessed quantitatively by high-resolution computed tomography (HRCT). Hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP) is deposited across all sizes of airways, including the small ones. However, its long-term effect on air trapping remains unknown in uncontrolled asthma. OBJECTIVES: To compare the effect of inhaled corticosteroids of different particle size - HFA-BDP and fluticasone propionate (FP) - on lung attenuation in mild-to-moderate uncontrolled asthma. METHODS: A randomized study was performed to analyze the effect of HFA-BDP (400 microg/d) or FP (500 microg/d) given over a period of 3 months to patients with uncontrolled mild-to-moderate asthma. HRCT was performed with spirometric gating, and lung attenuation was measured at residual volume and at pulmonary total capacity. The difference between inspiratory and expiratory attenuation was calculated as an air trapping index. RESULTS: Twenty-five out of 58 patients had abnormal air trapping and could be included in the study. Lung attenuation significantly diminished in the posterior zones of the lung after a 3-month treatment with HFA-BDP or FP, but the difference between the groups was not significant. Adjusted mean variations of the air trapping index from baseline to treatment completion were 34.3 (11.2, 57.3) and 27.3 (6.4, 48.2) for the HFA-BDP and FP groups, respectively. However, the reduction of air trapping area was more pronounced in the group treated with HFA-BDP. CONCLUSION: Inhaled corticosteroids decrease air trapping in uncontrolled asthma regardless of their particle size. CLINICAL IMPLICATIONS: In mild-to-moderate asthma, air trapping assessed by HRCT may be a new outcome related to the control of the disease.


Assuntos
Obstrução das Vias Respiratórias/tratamento farmacológico , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Beclometasona/análogos & derivados , Beclometasona/uso terapêutico , Administração por Inalação , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Obstrução das Vias Respiratórias/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Antiasmáticos/administração & dosagem , Asma/complicações , Asma/diagnóstico por imagem , Beclometasona/administração & dosagem , Broncospirometria , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Tamanho da Partícula , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
J Allergy Clin Immunol ; 119(3): 634-9, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17141852

RESUMO

BACKGROUND: Several studies have found obesity to be associated with an increased prevalence of asthma. For reasons that remain unclear, this association has often been reported to be stronger in women than in men. One possible explanation might be that these studies have used body mass index to identify adiposity, which might be a less reliable measure of body fat in men than in women. OBJECTIVE: We sought to explore the association between body fat percentage measured by means of bioelectrical impedance analysis and asthma, airflow obstruction, and airway inflammation in men and women. METHODS: Respiratory questionnaires, spirometry, bronchodilator response, exhaled nitric oxide level, and percentage of body fat were measured in a population-based cohort of approximately 1000 individuals at age 32 years. RESULTS: There was a significant association between the percentage of body fat and asthma in women (P = .043) but not in men (P = .75). Airflow obstruction was associated with percentage of body fat in women (P = .046), but there was an inverse association in men (P = .010). Bronchodilator responsiveness was also associated with lower body fat in men (P = .004). Airway inflammation, measured by means of exhaled nitric oxide, was not associated with body fat in either women (P = .17) or men (P = .25). CONCLUSION: Adiposity is associated with asthma and airflow obstruction in women. This does not appear to be mediated by airway inflammation. In men airflow obstruction and bronchodilator responsiveness are associated with a lower percentage of body fat. CLINICAL IMPLICATIONS: In women, but not in men, obesity is associated with asthma and airflow obstruction, but there was no association with airway inflammation.


Assuntos
Obstrução das Vias Respiratórias/epidemiologia , Asma/epidemiologia , Bronquite/epidemiologia , Obesidade/complicações , Tecido Adiposo , Adiposidade , Adulto , Índice de Massa Corporal , Brônquios/efeitos dos fármacos , Brônquios/fisiopatologia , Broncodilatadores/farmacologia , Broncospirometria , Feminino , Humanos , Masculino , Obesidade/diagnóstico , Inquéritos e Questionários
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