Dibutyl Phthalate Augments Allergen-induced Lung Function Decline and Alters Human Airway Immunology. A Randomized Crossover Study.

Rationale: Phthalates are a group of chemicals used in common commercial products. Epidemiological studies suggest that phthalate exposure is associated with development or worsening of allergic diseases such as asthma. However, effects of dibutyl phthalate (DBP) or other phthalates found in high concentrations in indoor air have never been examined in allergic individuals in a controlled exposure setting.Objectives: To investigate the airway effects in humans caused by inhalation of a known concentration of a single phthalate, DBP.Methods: In a randomized crossover study, 16 allergen-sensitized participants were exposed to control air or DBP for 3 hours in an environmental chamber followed immediately by an allergen inhalation challenge. Bronchoalveolar wash and lavage were obtained 24 hours after exposure. Lung function, early allergic response, airway responsiveness, inflammation, immune mediators, and immune cell phenotypes were assessed after DBP exposure.Measurements and Main Results: DBP exposure increased the early allergic response (21.4% decline in FEV1 area under the curve, P = 0.03). Airway responsiveness was increased by 48.1% after DBP exposure in participants without baseline hyperresponsiveness (P = 0.01). DBP increased the recruitment of BAL total macrophages by 4.6% (P = 0.07), whereas the M2 macrophage phenotype increased by 46.9% (P = 0.04). Airway immune mediator levels were modestly affected by DBP.Conclusions: DBP exposure augmented allergen-induced lung function decline, particularly in those without baseline hyperresponsiveness, and exhibited immunomodulatory effects in the airways of allergic individuals. This is the first controlled human exposure study providing biological evidence for phthalate-induced effects in the airways.Clinical trial registered with www.clinicaltrials.gov (NCT02688478).

The effectiveness of Reslizumab in severe asthma treatment: a real-world experience.

BACKGROUND: Increased numbers of blood and sputum eosinophils are associated with higher exacerbation frequency and increased asthma severity. In clinical trials, targeting Interleukin-5 has been shown to be a useful therapeutic strategy for patients with severe eosinophilic asthma. METHODS: Twenty-six patients have been commenced on Reslizumab in our institution since early 2017. Safety and clinical efficacy parameters were recorded at regular intervals. RESULTS: Mean ACQ-6 score at the start of treatment was 3.5. The average number of exacerbations in the year preceding treatment was 8.3 per person. 30% of patients had been admitted to hospital at least once over the 12 months preceding therapy. 54% of our patients were on long term oral steroid. Our data showed sustained improvement of Asthma control (Mean improvement in ACQ-6 was 1.7 at 1 year, and 2.0 at 2 years, P = 0.0001). Of the patients who were on long term systemic steroids, 35.7% discontinued steroids completely, with a mean reduction of prednisolone dose of 5.2 mg at 1 year. There was a 79% reduction in the annual exacerbation frequency at 1 year, and 88% at 2 years (P = < 0.0001). Modest, albeit statistically significant increases in creatine kinase which seemed to plateau by 1 year were noted. CONCLUSIONS: Overall, Reslizumab was well tolerated with discontinuation of treatment due to side effects recorded in only one patient. Our data confirm the utility of anti-IL5 therapy in a carefully selected phenotype of severe asthma with evidence of eosinophilic airway inflammation.

Influence of mouthwashes on extended exhaled nitric oxide (FENO) analysis.

Fractional exhaled nitric oxide (FENO) is used to assess eosinophilic inflammation of the airways. FENO values are influenced by the expiratory flow rate and orally produced NO. We measured FENO at four different expiratory flow levels after two different mouthwashes: tap water and carbonated water. Further, we compared the alveolar NO concentration (CANO), maximum airway NO flux (J'awNO) and airway NO diffusion (DawNO) after these two mouthwashes. FENO was measured in 30 volunteers (healthy or asthmatic) with a chemiluminescence NO-analyser at flow rates of 30, 50, 100 and 300 mL/s. A mouthwash was performed before the measurement at every flow rate. The carbonated water mouthwash significantly reduced FENO compared to the tap water mouthwash at all expiratory flows: 50 mL/s (p < .001), 30 mL/s (p = .001), 100 mL/s (p < .001) and 300 mL/s (p = .004). J'awNO was also significantly reduced (p = .017), however, there were no significant differences in CANO and DawNO. In conclusion, a carbonated water mouthwash can significantly reduce oropharyngeal NO compared to a tap water mouthwash at expiratory flows of 30-300 mL/s without affecting the CANO and DawNO. Therefore, mouthwashes need to be taken into account when comparing FENO results.

Effect of nasally exhaling budesonide/formoterol dry powder inhaled at "fast" inspiratory flow on eosinophilic chronic rhinosinusitis
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BACKGROUND: Budesonide (BUD)/formoterol (FM) dry powder inhaler has a feature that the fine particle fraction output is dependent on users' inspiratory flow rate. The aim of this study was to assess the amount of nasally exhaled BUD/FM inhaled in the different inspiratory flow rate. We also examined the effect of nasal exhalation of BUD/FM dry powder inhaled on radiographic evidence of sinonasal inflammation in asthmatic patients with eosinophilic chronic rhinosinusitis (ECRS). MATERIALS AND METHODS: The quantitative amount of nasally exhaled BUD/FM was analyzed by high-performance liquid chromatography in 3 healthy subjects. We retrospectively evaluated the effect of nasal exhalation of BUD/FM dry powder inhaled at > 60 L/min on radiographic evidence of sinonasal inflammation, which was assessed according to the Lund-Mackay staging (LMS) system, in 7 consecutive patients with asthma and ECRS. RESULTS: The amount of nasally exhaled BUD in the setting of inhaling BUD/FM dry powder inhaler at 60 L/min (subject 1: 25.8 ng/mL; subject 2: 37.3 ng/mL; subject 3: 30.0 ng/mL) was high compared to at 30 L/min (subject 1: 9.3 ng/mL; subject 2: 4.1 ng/mL; subject 3: 9.2 ng/mL) in each healthy subject. Nasal exhalation of BUD/FM dry powder significantly reduced total (p = 0.018) and ethmoid LMS scores (p = 0.0077). CONCLUSION: Nasal exhalation technique of BUD/FM dry powder inhaled at "fast" inspiratory flow has a potential of simultaneously treating asthma and ECRS.
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Lung function response and side effects to rapamycin for lymphangioleiomyomatosis: a prospective national cohort study.

RATIONALE: Mechanistic target of rapamycin inhibitors reduce loss of lung function in lymphangioleiomyomatosis (LAM), although their benefit varies between individuals. We examined lung function response and side effects to rapamycin in a national cohort. METHODS: Subjects were receiving rapamycin for progressive lung disease. Clinical evaluation, detailed phenotyping, serial lung function, rapamycin and safety monitoring were performed according to a clinical protocol. Lung function change, measured as FEV1 slope (ΔFEV1), was reported for those treated for 1 year or longer. RESULTS: Rapamycin was associated with improved ΔFEV1 in 21 individuals where pretreatment data were available (p<0.0001). In 47 treated for a mean duration of 35.8 months, mean ΔFEV1 was +11 (SD 75) mL/year, although it varied from +254 to -148 mL/year. The quartile with the highest positive ΔFEV1 had greater pretreatment FEV1 (p=0.02) and shorter disease durations (p=0.02) than the lowest quartile. Serum rapamycin level was positively associated with side effects (p=0.02) but not ΔFEV1 over 1 year. Within the first month of therapy, apthous ulcers, nausea and diarrhoea were associated with higher rapamycin levels. Acne, oedema and menstrual irregularities tended to increase over the first year of therapy. At the end of observation, the prevalence of side effects was 5% or less. CONCLUSIONS: Rapamycin reduces lung function loss in LAM, although in some, ΔFEV1 continues to fall at an accelerated rate. Poor response to rapamycin was associated with lower pretreatment lung function and longer disease duration but not serum level. Early intervention with low-dose rapamycin may preserve lung function and reduce side effects.

Mannitol challenge testing for asthma in a community cohort of young adults.

BACKGROUND AND OBJECTIVE: Mannitol challenge testing is an established tool for clinical asthma diagnosis, and can be performed outside of specialized respiratory laboratories. Despite applicability in both clinical and non-clinical populations, with different pre-test asthma probabilities, differences in diagnostic properties have not been well explored. This study aimed to quantify the diagnostic utility of mannitol challenge testing for asthma in a community cohort and a symptomatic wheezing subset of this cohort. METHODS: During the 22-year follow-up of the Western Australian Pregnancy (Raine) Cohort, 772 participants (384 males) completed mannitol challenge and skin prick testing and respiratory health questionnaires, of whom 148 reporting wheeze in the past 12 months were included in a wheezing subset. RESULTS: Responsiveness to mannitol had low sensitivity (19%) and high specificity (97%) to identify current asthma in the complete cohort, with positive and negative predictive values (PPV and NPV) of 45% and 92%, respectively. Within the wheezing subset, sensitivity (19%) and specificity (94%) remained similar, but PPV increased to 79%, and NPV decreased to 52%. CONCLUSION: Our findings support previously reported high specificity and good PPV for mannitol challenge testing in symptomatic wheezing populations, and highlight the need for caution when interpreting mannitol test results in non-clinical populations.

Bronchodilator response in wheezing infants assessed by the raised volume rapid thoracic compression technique.

BACKGROUND: Bronchodilator response (BDR) analyzed by the raised volume rapid thoracic compression (RVRTC) in wheezing infants is not yet well described, although bronchodilators (BD) are routine in the treatment of this population. OBJECTIVE: To evaluate BDR by RVRTC technique in infants with recurrent wheezing and compare to control group. METHOD: Cross sectional study, 45 infants, age 56 weeks (38-67 weeks). Two groups: wheezing group (WG: history of recurrent wheezing) and control group (CG). RVRTC was evaluated, FVC, FEV0.5, FEF50, FEF75, FEF85, FEF25-75 were measured. Salbutamol was delivered to infants and RVRTC evaluated again. BDR was determined by the increase greater than two standard deviation from the mean change in the CG. RESULTS: In WG (n = 32) lung function was worse than in CG (n = 13): FEV0.5: 0.0(-0.9-0.9z score) vs 0.8(0.2-1.4z score); FEF50: 0.2(-0.3-1.1z score) vs 0.9(0.5-1.4z score); and FEF25-75: 0.2(-0.5-1.1z score) vs 1.1(0.6-1.6z score), respectively, p < 0.05. Both groups had similar increase after BD. In WG 11 patients (34%) were responder and these had worse lung function compared to nonresponder (n = 21) (p < 0.05). The increase in lung function after BD in responder was higher than in nonresponder: FEV0.5: 6.5(2.1-7.1%) vs -0.5(-2.5-0.7%), FEF50: 5.1(2.7-11.7%) vs 0.4(-1.1-2.8%), FEF75: 20.7(4.7-23.6%) vs -1.3(-6.4-3.9%), FEF25-75: 9.9(3.8-16.4%) vs 0.0(-1.5-1.0%), respectively, p < 0.05. CONCLUSION: 34% WG showed BDR measured by the RVRTC. The best variables to detect BDR were FEF75, FEF25-75 and FEV0.5. Patients with worse lung function showed better response to BD.

Indacaterol vs tiotropium in COPD patients classified as GOLD A and B.

INTRODUCTION: According to current GOLD strategy, patients with COPD classified as groups A and B may be treated with inhaled bronchodilators, either long-acting ß2-agonist (LABA) or long-acting muscarinic antagonist (LAMA). However, there is little guidance on which class of agent is preferred and a lack of prospective data to differentiate the two. METHODS: In this study, we performed post-hoc analyses of pooled data from two prospective, controlled clinical trials comparing the LABA indacaterol and LAMA tiotropium in 1422 patients with moderate airflow limitation and no history of exacerbations in the previous year. This population fits the definitions of GOLD A and B groups and could be further stratified by symptom severity using Baseline Dyspnea Index (i.e. modeling GOLD A or B) and inhaled corticosteroid (ICS) use at baseline. Outcomes measured after 12 weeks of treatment were lung function (forced expiratory volume in 1 s; FEV1), health status (St George's Respiratory Questionnaire; SGRQ), symptoms (Transition Dyspnea Index; TDI) and rescue medication use. RESULTS: In 'GOLD A' patients not receiving ICS, differences favored indacaterol versus tiotropium (trough FEV1 0.05 L; rescue medication use -0.41 puffs/day; TDI total score 0.94 points; SGRQ total score -3.13 units, all p < 0.01). In 'GOLD B, no ICS' patients, compared with tiotropium, indacaterol treatment increased trough FEV1 (0.055 L, p < 0.05) and permitted a larger reduction in rescue medication use (-0.81 puffs/day, p = 0.004). In all patients, and in patients not using ICS, differences favored indacaterol for all variables. CONCLUSIONS: Our findings suggest that patients in GOLD groups A and B may experience greater benefits with indacaterol than with tiotropium.

Population intervention models to estimate ambient NO2 health effects in children with asthma.

Health effects of ambient air pollution are most frequently expressed in individual studies as responses to a standardized unit of air pollution changes (e.g., an interquartile interval), which is thought to enable comparison of findings across studies. However, this approach does not necessarily convey health effects in terms of a real-world air pollution scenario. In the present study, we use population intervention modeling to estimate the effect of an air pollution intervention that makes explicit reference to the observed exposure data and is identifiable in those data. We calculate the association between ambient summertime nitrogen dioxide (NO2) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) in a cohort of children with asthma in Fresno, California. We scale the effect size to reflect NO2 abatement on a majority of summer days. The effect estimates were small, imprecise, and consistently indicated improved pulmonary function with decreased NO2. The effects ranged from -0.8% of mean FEF25-75 (95% confidence interval (CI): -3.4, 1.7) to -3.3% (95% CI: -7.5, 0.9). We conclude by discussing the nature and feasibility of the exposure change analyzed here given the observed air pollution profile, and we propose additional applications of population intervention models in environmental epidemiology.

Ambient polycyclic aromatic hydrocarbons and pulmonary function in children.

Few studies have examined the relationship between ambient polycyclic aromatic hydrocarbons (PAHs) and pulmonary function in children. Major sources include vehicular emissions, home heating, wildland fires, agricultural burning, and power plants. PAHs are an important component of fine particulate matter that has been linked to respiratory health. This cross-sectional study examines the relationship between estimated individual exposures to the sum of PAHs with 4, 5, or 6 rings (PAH456) and pulmonary function tests (forced expiratory volume in one second (FEV1) and forced expiratory flow between 25% and 75% of vital capacity) in asthmatic and non-asthmatic children. We applied land-use regression to estimate individual exposures to ambient PAHs for averaging periods ranging from 1 week to 1 year. We used linear regression to estimate the relationship between exposure to PAH456 with pre- and postbronchodilator pulmonary function tests in children in Fresno, California (N=297). Among non-asthmatics, there was a statistically significant association between PAH456 during the previous 3 months, 6 months, and 1 year and postbronchodilator FEV1. The magnitude of the association increased with the length of the averaging period ranging from 60 to 110 ml decrease in FEV1 for each 1 ng/m(3) increase in PAH456. There were no associations with PAH456 observed among asthmatic children. We identified an association between annual PAHs and chronic pulmonary function in children without asthma. Additional studies are needed to further explore the association between exposure to PAHs and pulmonary function, especially with regard to differential effects between asthmatic and non-asthmatic children.

[Autonomic regulation at emotional stress under hypoxic conditions in the elderly with physiological and accelerated aging: effect of hypoxic training].

The effect of hypoxic training on autonomic regulation in psycho-emotional stress conditions in hypoxic conditions in older people with physiological (25 people) and accelerated (28 people) aging respiratory system. It is shown that hypoxic training leads to an increase in vagal activity indicators (HF) and reduced simpatovagal index (LF/HF), have a normalizing effect on the autonomic balance during stress loads in older people with different types of aging respiratory system.

Efeito do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos / Bronchodilator effect on maximal breath-hold time in patients with obstructive lung disease

OBJETIVO: Identificar o papel do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVOs). MÉTODOS: Estudo caso-controle incluindo pacientes com DVOs e grupo controle. Foram realizadas espirometrias antes e após o uso de broncodilatador, assim como testes de apneia respiratória, utilizando-se um microprocessador eletrônico e um pneumotacógrafo como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil, e os tempos de apneia voluntária inspiratória e expiratória máximos (TAVIM e TAVEM, respectivamente) foram determinados a partir do sinal adquirido. RESULTADOS: Um total de 35 pacientes com DVOs e 16 controles foram incluídos no estudo. O TAVIM sem o uso de broncodilatador foi significativamente menor no grupo DVO que no grupo controle (22,27 ± 11,81 s vs. 31,45 ± 15,73; p = 0,025), mas essa diferença não foi significativa após o uso de broncodilatador (24,94 ± 12,89 s vs. 31,67 ± 17,53 s). Os valores de TAVEM foram significativamente menores no grupo DVO que no grupo controle antes (16,88 ± 6,58 s vs. 22,09 ± 7,95 s; p = 0,017) e após o uso de broncodilatador (21,22 ± 9,37 s vs. 28,53 ± 12,46 s; p = 0,024). CONCLUSÕES: Estes resultados fornecem uma evidência adicional da utilidade clínica do teste de apneia na avaliação da função pulmonar e do papel do broncodilatador nesse teste.

OBJECTIVE: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD). METHODS: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end-inspiratory volume and at end-expiratory volume (BHTmaxV EI and BHTmaxV EE, respectively) were determined from the acquired signal. RESULTS: A total of 35 patients with OLD and 16 controls were included. Prior to the use of a bronchodilator, the BHTmaxV EI was significantly lower in the OLD group than in the control group (22.27 ± 11.81 s vs. 31.45 ± 15.73 s; p = 0.025), although there was no significant difference between the two groups in terms of the post-bronchodilator values (24.94 ± 12.89 s vs. 31.67 ± 17.53 s). In contrast, BHTmaxV EE values were significantly lower in the OLD group than in the control group, in the pre- and post-bronchodilator tests (16.88 ± 6.58 s vs. 22.09 ± 7.95 s; p = 0.017; and 21.22 ± 9.37 s vs. 28.53 ± 12.46 s; p = 0.024, respectively). CONCLUSIONS: Our results provide additional evidence of the clinical usefulness of the breath-hold test in the assessment of pulmonary function and add to the existing knowledge regarding the role of the bronchodilator in this test.

Effect of albuterol on expiratory resistance in mechanically ventilated patients.

BACKGROUND: In mechanically ventilated patients with COPD, the response of the expiratory resistance of the respiratory system (expiratory R(RS)) to bronchodilators is virtually unknown. OBJECTIVE: To examine the effect of inhaled albuterol on expiratory R(RS), and the correlation of albuterol-induced changes in expiratory R(RS) with end-inspiratory resistance and the expiratory flow-volume relationship. METHODS: We studied 10 mechanically ventilated patients with COPD exacerbation, before and 30 min after administration of albuterol. We obtained flow-volume curves during passive expiration, divided the expired volume into 5 equal volume slices, and then calculated the time constant and dynamic effective deflation compliance of the respiratory system (effective deflation C(RS)) of each slice via regression analysis of the volume-flow and post-occlusion volume-tracheal pressure relationships, respectively. For each slice we calculated expiratory R(RS) as the time constant divided by the effective deflation C(RS). RESULTS: Albuterol significantly decreased the expiratory R(RS) (mean expiratory R(RS) 42.68 ± 17.8 cm H(2)O/L/s vs 38.08 ± 16.1 cm H(2)O/L/s) and increased the rate of lung emptying toward the end of expiration (mean time constant 2.51 ± 1.2 s vs 2.21 ± 1.2 s). No correlation was found between the albuterol-induced changes in expiratory R(RS) and that of end-inspiratory resistance. Only at the end of expiration did albuterol-induced changes in the expiratory flow-volume relationship correlate with changes in expiratory R(RS) in all patients. CONCLUSIONS: In patients with COPD, albuterol significantly decreases expiratory resistance at the end of expiration. In mechanically ventilated patients, neither inspiratory resistance nor the whole expiratory flow-volume curve may be used to evaluate the bronchodilator response of expiratory resistance.

Long-term safety and efficacy of indacaterol, a long-acting ß2-agonist, in subjects with COPD: a randomized, placebo-controlled study.

BACKGROUND: Indacaterol is an inhaled, long-acting ß(2)-agonist providing 24-h bronchodilation with once-daily dosing in patients with COPD. METHODS: Subjects with moderate to severe COPD who completed a 26-week, randomized, double-blind study were eligible for enrollment in an extension, during which treatment with double-blind indacaterol, 150 or 300 µg once daily, or placebo was continued for a further 26 weeks. The primary objective was to evaluate the long-term safety of indacaterol. Efficacy end points included trough (24 h postdose) FEV(1) at 52 weeks, exacerbations, and health status (St. George Respiratory Questionnaire [SGRQ]). RESULTS: Four hundred fifteen subjects participated in the extension. Adverse events, mostly mild or moderate, occurred in 76%, 77%, and 68% of subjects receiving indacaterol, 150 µg; indacaterol, 300 µg; and placebo, respectively. Serious adverse events occurred in 10.4%, 12.3%, and 10.5%, respectively. Indacaterol had no clinically significant effects on ECG findings (corrected QT interval) or on serum potassium or plasma glucose levels. Indacaterol increased trough FEV(1) relative to placebo throughout the study (difference of ≥ 170 mL at week 52). No tolerance to its bronchodilator effect was detected. Indacaterol treatment was accompanied by significant reductions in COPD exacerbations (rate ratios compared with placebo, 0.62-0.64; P < .05) and as-needed albuterol use (1.2-1.4 puffs/d decrease, P < .001 compared with placebo). Health status improved with indacaterol treatment, with decreases from baseline in mean total SGRQ score generally > 4 units. CONCLUSIONS: During 1 year of treatment, indacaterol was well tolerated and provided significant and well-maintained bronchodilation that was accompanied by improved clinical outcomes. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00677807; URL: www.clinicaltrials.gov.

Bronchodilator effect on maximal breath-hold time in patients with obstructive lung disease.

OBJECTIVE: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD). METHODS: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end-inspiratory volume and at end-expiratory volume (BHTmaxV EI and BHTmaxV EE, respectively) were determined from the acquired signal. RESULTS: A total of 35 patients with OLD and 16 controls were included. Prior to the use of a bronchodilator, the BHTmaxV EI was significantly lower in the OLD group than in the control group (22.27 ± 11.81 s vs. 31.45 ± 15.73 s; p = 0.025), although there was no significant difference between the two groups in terms of the post-bronchodilator values (24.94 ± 12.89 s vs. 31.67 ± 17.53 s). In contrast, BHTmaxV EE values were significantly lower in the OLD group than in the control group, in the pre- and post-bronchodilator tests (16.88 ± 6.58 s vs. 22.09 ± 7.95 s; p = 0.017; and 21.22 ± 9.37 s vs. 28.53 ± 12.46 s; p = 0.024, respectively). CONCLUSIONS: Our results provide additional evidence of the clinical usefulness of the breath-hold test in the assessment of pulmonary function and add to the existing knowledge regarding the role of the bronchodilator in this test.

Antioxidants and pulmonary function among police officers.

OBJECTIVE: To examine associations of dietary antioxidant intake and pulmonary function. METHODS: Antioxidant data (vitamins A, C, D, E, magnesium, and omega-3 fatty acids) were abstracted from food frequency questionnaires. Pulmonary function was measured using American Thoracic Society criteria. We used analysis of variance to investigate associations. RESULTS: Among 79 police officers (57% male), forced vital capacity was positively and significantly associated with vitamin A after adjustment for age, gender, height, race, smoking status, and pack-years of smoking, and with magnesium after adjustment for those risk factors plus total calories, all supplement use, and abdominal height. Among current/former smokers only, mean levels of all pulmonary function measures were significantly associated with vitamin E; smoking status significantly modified these relationships. CONCLUSIONS: Increased intake of vitamin A, vitamin E (among current/former smokers only), and magnesium was associated with better pulmonary function.

[The repeatability of forced expiratory manoeuvres in 4- to 6-year-old children with intermittent bronchial asthma in healthy and in exacerbated status]. / Reproduzierbarkeit der FEV1 bei Kindern von 4 bis 6 Jahren mit intermittierendem Asthma bronchiale im beschwerdefreien sowie im Beschwerdeintervall.

INTRODUCTION: The question about the repeatability of forced expiratory manoeuvres in childhood lung function testing is of scientific and clinical interest. The following study investigated to what extent children ≥ 4 to < 7 years of age with intermittent bronchial asthma are able to produce reproducible lung function measurements on the one hand in the healthy status and on the other hand in an exacerbated status. METHOD: 64 children at the age of ≥ 4 to < 7 years with intermittent preschool bronchial asthma performed lung function measurements in the healthy status and again in an exacerbated status. FEV (1) values from the measurements were analysed according to ATS/ERS guidelines concerning repeatability. RESULTS: According to the new ATS/ERS guidelines 74.6 % of the children could perform at least 2, and 59.3 % could perform 3 repeatable measurements in the healthy status. In the exacerbated status this was 87.5 % and 68.8 %, respectively. There were no significant differences between the healthy and the exacerbated status and between the age groups. Compared to former repeatability criteria, children of this age group can perform significantly more reproducible measurements (p < 0.0001). CONCLUSION: The ATS/ERS guidelines from 2007 simplify the repeatability of forced expiratory manoeuvres in children at ≥ 4 to < 7 years of age compared to the former criteria. Repeatability is not reduced in the exacerbated status. 74.6 % of children in this age group can produce repeatable lung function measurements.

Responses of FEV6, FVC, and FET to inhaled bronchodilator in the adult general population.

BACKGROUND: The assessment of bronchodilator-induced change in forced vital capacity (FVC) is dependent on forced expiratory time (FET) in subjects with airflow limitation. Limited information is available on the concurrent responses of FVC, forced expiratory volume in six seconds (FEV6), and FET in the bronchodilation test among patients with obstructive airways disease or in the general population. The aim of this study was to assess the changes in FEV6, FVC, and FET, and their relationships in a standardized bronchodilation test in the general population. METHODS: We studied bronchodilation response in a general adult population sample of 628 individuals (260 men, 368 women) with flow-volume spirometry. The largest FVC, the corresponding FET and the largest FEV6 both at the baseline and after 0.4 mg of inhaled salbutamol were selected for analysis. RESULTS: After administration of salbutamol FEV6 decreased on average -13.4 (95% CI -22.3 to -4.5) ml or -0.2% (-0.4% to 0.0%) from the baseline. The 95th percentile of change in FEV6 was 169.1 ml and 5.0%. FVC decreased on average -42.8 (-52.4 to -33.3) ml or -1.0% (-1.2% to -0.7%). Concurrently FET changed on average -0.2 (-0.4 to 0.0) seconds or 0.4% (-1.4% to 2.3%). There were four subjects with an increase of FVC over 12% and only one of these was associated with prolonged FET after salbutamol. Changes in FEV6 and FVC were more frequently positive in subjects with reduced FEV1/FVC in baseline spirometry. CONCLUSION: In general adult population, both FEV6 and FVC tended to decrease, but FET remained almost unchanged, in the bronchodilation test. However, those subjects with signs of airflow limitation at the baseline showed frequently some increase of FEV6 and FVC in the bronchodilation test without change in FET. We suggest that FEV6 could be used in assessment of bronchodilation response in lieu of FVC removing the need for regulation of FET during bronchodilation testing.

Pulmonary function abnormalities in never-smoking flight attendants exposed to secondhand tobacco smoke in the aircraft cabin.

OBJECTIVE: To determine whether the flight attendants who were exposed to secondhand tobacco smoke in the aircraft cabin have abnormal pulmonary function. METHODS: We administered questionnaires and performed pulmonary function testing in 61 never-smoking female flight attendants who worked in active air crews before the smoking ban on commercial aircraft (preban). RESULTS: Although the preban flight attendants had normal FVC, FEV1, and FEV1/FVC ratio, they had significantly decreased flow at mid- and low-lung volumes, curvilinear flow-volume curves, and evidence of air trapping. Furthermore, the flight attendants had significantly decreased diffusing capacity (77.5% +/- 11.2% predicted normal) with 51% having a diffusing capacity below their 95% normal prediction limit. CONCLUSIONS: This cohort of healthy never-smoking flight attendants who were exposed to secondhand tobacco smoke in the aircraft cabin showed pulmonary function abnormalities suggestive of airway obstruction and impaired diffusion.