A study of vitamin C, superoxide dismutase and FEV1/FVC ratio in chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by incomplete reversible airflow limitation, which is associated with emphysema and chronic inflammation. Oxidative/antioxidant imbalance is one of the mechanisms of the current pathogenesis of COPD ECSOD is an antioxidant protein that scavenges superoxide free radicals from cigarette smoke and protects the lungs from free radical damage and chronic inflammation. Methods: Vitamin C was estimated by acid phosphotungustate on spectrometer at 660nm (Ayekygw 1978) method. SOD was estimated by Marklund S and Marklund G (1974) modified by Nandi and Chatterjee. FEV1/FEV ratio was done by spirometry technique. Results: The present study revealed that there was an increased oxidative stress in patients with COPD, when compared with controls and also decreased level of antioxidant activity in COPD patients, when compared with controls. In our studies significantly decreased sr. superoxide dismutase activity and FEV1/FVC ratio levels were found in subjects with COPD than healthy normal subjects. Conclusions: A significant decline in lung function may be associated with altered antioxidant enzyme activity due to the strong correlation between SOD and lung functions with COPD severity.

Alpha-1-antitrypsin level as a predictor of acute exacerbations in chronic obstructive pulmonary disease: a prospective observational study

Background: This prospective study investigated if alpha-1-antitrypsin (AAT) levels could predict chronic obstructive pulmonary disease (COPD) exacerbations needing hospitalization. Methods: 106 COPD subjects hospitalized for acute exacerbations were enrolled. Past 2-years� records were evaluated for prior exacerbation hospitalizations. AAT levels and post-stabilization FEV1 were assessed during current hospitalization. Exacerbation frequency correlated to current AAT levels and lung function. Results: Significant inverse association found between AAT levels and hospitalized exacerbations, indicating utility as a predictive biomarker for COPD patients prone to recurrent severe flares requiring admission. Patients with lower AAT levels also exhibited poorer lung function per lower FEV1 values. Conclusions: Monitoring AAT levels may promote timely interventions in high risk individuals susceptible to relapsing catastrophic exacerbations needing inpatient care. Further research warranted to validate findings and explore if supplementing deficient AAT reduces exacerbation frequency, thereby improving prognosis in this debilitating disease.

Study of pulmonary function tests in workers of rurally located flour mills

Background: Agro-based industrial works like flour milling are a significant component in the industrial arena of Kerala. In milling industry, dusts are produced in substantial quantities and inhalation of which can result in pulmonary impairment in workers. In such situations, spirometric evaluation can aid in the diagnosis and prognosis of pulmonary diseases. Aims and Objectives: The aims of this study were to assess the effect of flour dust on pulmonary function among flour mill workers and to study the variation in pulmonary function among workers according to duration of exposure and their working environment in the factory. Materials and Methods: A cross-sectional study was conducted in three wheat flour mills. Subjects were selected after proper exclusion and after getting informed consent. In the present study, 79 flour mill workers aged more than 20 years and employed for more than 1year, were considered and their FVC,FEV1,FEV1/FVC,PEFR and FEF25-75% values were assessed. The objective was to find out the effect of their duration of employment and exposure to dust on their spirometric parameters based on their type of job and age. These parameters were tested using a portable electronic spirometer in the factory premises. Results: The study showed no significant relation of these parameters with duration of employment and dust exposure. However, there was significant reduction in FVC and FEV1 with increasing age. Conclusion: Even though apparently normal PFT values are obtained in many subjects, these may be on the extremes of normal spectrum.

FEV1 (FORCED EXPIRATORY VOLUME IN THE 1ST SECOND) REVERSIBILITY AFTER NEBULISATION WITH SABA (SHORT ACTING BETA AGONIST) AS A MARKER OF CONTROL OF ASTHMA

INTRODUCTION: Variable expiratory air flow due to bronchoconstriction, airway wall thickening and increased mucus is an obvious feature in asthma. Variable air flow obstruction is evidenced by reversibility of FEV1 following a bronchodilator inhalation. PFT (Pulmonary Function Testing) using spirometry is often used for the estimation of FEV1. Reversibility is not uniform in all cases and vary with respect to severity and control of asthma. AIMS & OBJECTIVES: 1) To determine the control of asthma in 5-15-year-old children using GINA checklist and estimate FEV1 before and after SABA nebulisation. 2) To find out the association between FEV1 reversibility and control of asthma. MATERIALS & METHODS: This cross-sectional study included 90 consecutive 5-15-year-old-children with a clinical diagnosis of asthma attending the Paediatric OPD of a teaching hospital from October-May 2021. The symptoms, signs, comorbidities, treatment, compliance and assessment of control of asthma into 2 subgroups: Well-controlled and Partly-controlled/Uncontrolled asthma, as per GINA 2020 were recorded. All were subjected to spirometry for assessment of FEV1 before and 20 minutes after nebulisation with SABA. Depending upon FEV1, they were grouped as those with >12% reversibility and <12% reversibility. Data analysed using SPSS 20.0, Paired t test for comparison of means, Chi-square test for statistical difference in proportion, and post hoc tests. The RESULTS: M:F ratio was 1.2:1, 52.2% were 10-15 years and 47.8% 5-10 years. 68.9% had partly/uncontrolled, the rest well-controlled asthma (38.1%). The difference between mean FEV1 before (67.9±10.6) and after nebulisation (80.6±9.7) was statistically significant (p<0.00*). Among those with >12 reversibility, 64.5% were in partly/uncontrolled and 35.5% in well-controlled asthma and the difference was statistically significant (p -0.013*). The CONCLUSION: finding in the study that 68.9% had partly/uncontrolled asthma is an eye-opener to optimise protocol-based treatment among children. The statistically significant difference of >12% before and after nebulisation a marker of poor control was observed in 64.5% of partly/uncontrolled asthma compared to 35.5% of well controlled asthma. Hence, the persistence of a significant degree of bronchodilator response noted in those with partly/uncontrolled asthma is recommended as an objective surrogate of poor asthma control in children who can co-operate for a PFT in order to optimise protocol-based treatment.

Spirometry assessment of interstitial lung disease patients and correlation with its clinical and radiological profile

Background: Interstitial lung diseases (ILD) are a diverse set of lower respiratory tract illnesses that are defined by both abrupt and persistent inflammation as well as a largely irreversible and continuous progression of fibrosis in the interstitium and the walls of the alveoli. This study focuses on non-invasive techniques for clinically and radiographically confirmed situations. Since most patients refuse surgical or transbronchial lung biopsies and are in respiratory difficulty, an alternate method is preferable. Spirometry tests are often used as diagnostic aids. This study compares spirometry in ILD patients with their radiological and clinical features. Methods: In this prospective observational study, 50 ILD patients who were diagnosed on the clinical and radiological grounds included. A detailed history of illness was obtained and noted. All patients were examined clinically and underwent basic investigations. All patients were performed 6 MWT O2 saturation and spirometry. Correlation between spirometry findings and clinical and radiological profile was done. Results: The study group of 50 patients with ILD, idiopathic pulmonary fibrosis was the most common cause of ILD consists of 32 patients performing 64% of the study group. Average duration of symptoms in ILD patients in this study was 5.46±5.49 months. The mean age of the patients was 61.58±12.92 years ranging from 27 to 88 years with 27 (54%) male and 23 (46%) female. Cough and dyspnoea were the most common features at presentation in our study group, present in almost all the patients. Crepitations were present in 41 (82%) patients. Most common chest X-ray feature was reticular opacities which was present in 24 (48%) patients. Ground glass opacity in high-resolution computed tomography (HRCT) was seen in 33 (66%) patients. Most common spirometry pattern seen in our study was Restrictive pattern which was present in 42 patients. In ILD patients, mean values of FEV1% was 59.2±20.33, FVC% was 60.76±25.45, FEV1/FVC was 100.86±20.12. Conclusions: Idiopathic pulmonary fibrosis is the most common and chronic hypersensitivity pneumonitis along with cryptogenic organizing pneumonia are the second common ILD in our study. The underdiagnosis of interstitial lung disease is due to a lack of knowledge among doctors. Therefore, spirometry and 6MWT O2 saturation should be performed in all patients presented with complaints of chronic cough and breathlessness as screening tool and then HRCT chest and biopsy can be done for confirmation of diagnosis. So early diagnosis and treatment of ILD patients is possible with use of spirometry.

Assessment of pulmonary function test and its variability among different socio-demographic status of healthy school children of age group 9� years

Background: Pulmonary function test (PFT) is used to diagnose the underlying cause of respiratory symptoms in children and adolescents. It is also used to monitor the status of those with chronic lung diseases. In clinical practice, spirometry is the investigation of choice for the overall assessment of pulmonary function and is equated with the PFT in day to day practice the assessment of lung function. Aim and Objective: The aim of the study was to determine pulmonary function (as measured by FEV1 and FEV6) among school going children of age group 9� years and its variability with age, sex, height, and regional difference. Materials and Methods: This cross-sectional study was conducted among 703 normal healthy school children (335 boys and 368 girls) of Thiruvananthapuram city aged 9� years during 2015�16. The study group included both South Indian and North Indian children. Height, weight, and BMI were measured. All included children were tested in a sitting position with the head straight after taking written consent from parents. Spirometry was done using the instrument 揤italograph- COPD 6.� It displays FEV1 and FEV6. The FEV6 is used as a surrogate marker of FVC. Results: FEV1 and FEV6 were found to be statistically significant in the study group. Both FEV1 and FEV6 were higher in boys than girls. In both boys and girls, FEV1 and FEV6 values showed strong positive correlation with age, and height which was found to be statistically significant (P < 0.001). North Indian children have got higher FEV1 and FEV6 values than South Indian children. This was also found to be statistically significant (P < 0.001). Conclusion: Variables such as FEV1 and FEV6 values showed strong positive correlation with age and height in both sexes. By regression analysis, it was found that age, gender, and height were the significant predictors for both FEV1 and FEV6.

Comparison of the effect of recumbent body positions on dynamic lung function parameters in healthy adults

Background: Pulmonary function parameters can be altered with the change in body position. Therefore, physiological basis behind such consequent influence is essential to be understood. Pulmonary function tests are generally conducted in the erect sitting posture as it is more feasible and comfortable. However, bedridden patients are unable to do so and only few studies are found on recumbent postures. Thus, to comfort such patients in breathing, need arises to meet this requisite investigation to conclude the best recumbent body posture. Aim and Objectives: To compare and assess forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow of during 25�% expiration (FEF25�%, and peak expiratory flow rate (PEF) in the Supine, Crook-lying and Fowler抯 position. Materials and Methods: The present research was carried out on 128 healthy adults to measure FVC, FEV1, FEV1/FVC ratio, FEF25�% and PEF using a computer-based spirometer in the Supine, Crook-lying and Fowler抯 position. One-way Analysis of Variance with Tukey HSD post-hoc test was utilized between each body postures by evaluation of their mean values. Results: This study consisted of 128 subjects (males 57, females 71) with mean age of 21.62 � 1.75 years, mean weight 59.71 � 9.97 kg, mean height 164.68 � 9.30 cm and Body mass index 21.91 � 2.38 kg/m2. Fowler抯 posture showed significantly (P < 0.05) higher value in all spirometric parameters as compared to other two postures. Outcome of the study showed all spirometric parameters value- greater in the Fowler抯 posture than that of Supine or Crook-lying posture. Conclusion: The implication of this research is that it will meet the need of selection of the most suitable substitute posture for better pulmonary functioning in bedridden people.

Pulmonary function tests in subclinical hypothyroidism-a comparative cross-sectional study

Background: Subclinical hypothyroidism (SCH) reflects the earliest stage of thyroid dysfunction with subjects having normal free thyroid hormones T3, T4 with elevated Thyroid-stimulating hormone (TSH) values. Hypothyroidism may depress the central ventilator control and affects respiratory muscle strength which is linearly related to the thyroid hormone levels. In hypothyroidism, the impairment of pulmonary functions may be initiated at the subclinical stage of hypothyroidism. Aim and Objectives: The present study was designed to derive Forced Vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC, Peak expiratory flow rate and FEF 25–75 % in subclinical hypothyroid subjects and to compare the values with that of healthy controls. Materials and Methods: A cross-sectional comparative study was conducted in subjects aged between 25 and 60 years in which 85 subclinical hypothyroid cases were selected after proper exclusion and informed consent. 85 age and sex matched healthy controls were also studied. Statistical package for social sciences version 18 was used for statistical analysis. Results: All spirometric variables were found to be lower in subclinical hypothyroid subjects than in healthy controls and the abnormalities were of mixed pattern-both obstructive and restrictive. All values obtained were statistically significant (P < 0.05). Conclusion: Patients with SCH should be regularly screened with pulmonary function tests as respiratory derangement starts even at this stage. This will help for early diagnosis and treatment, and to prevent future complications.

Application and progress of pharmacodynamics study in bioequivalence evaluation of orally inhaled drug products / 中国临床药理学与治疗学

Orally inhaled drug products (OIDPs) play a great role in the pharmacological treatment of chronic obstructive pulmonary disease (COPD) and asthma. There is an unmet clinical need for OIDPs. Pharmacodynamics-Bioequivalence studies (PD-BE) are recommended by several national guidelines as important research methods for bioequivalence study of OIDPs. It can effectively bridge the gap between in vitro studies and PK-BE studies in evaluating the efficacy and safety consistency of generic drugs with the original drugs. There are two research methods for PD-BE, using a diastolic model or an excitation model. The different methods use different metrics to evaluate efficacy. The more commonly used metrics include Forced Expiratory Volume in the First Second (FEV1), Specific Airway Conductance (sGaw), Peripheral Airway Resistance (R5-20), and stimulant concentration/dose (PC20/PD20). PD-BE studies using FEV1 as an efficacy metric is also recommended by the FDA (Food and Drug Administration), EMA (European Medicines Agency) and NMPA (National Medical Products Administration) guidelines and is widely accepted by investigators. In such PD-BE studies, the trial protocols for different OIDPs drugs are relatively consistent in terms of trial design, trial data processing, and equivalence evaluation criteria, while there are detailed differences in terms of target population, single/multiple dosing, dose administration, and collection site design. This paper reviews the progress of PD-BE studies in the bioequivalence evaluation of OIDPs by combining national guidelines and PD-BE-related studies of OIDPs published in the last five years, with a view to providing important theoretical information for PD-BE studies of OIDPs.

Níveis de eosinófilos circulantes e declínio da função pulmonar em doença pulmonar obstrutiva crônica estável: um estudo longitudinal retrospectivo / Circulating eosinophil levels and lung function decline in stable chronic obstructive pulmonary disease: a retrospective longitudinal study

RESUMO Objetivo Discute-se se eosinófilos no sangue (EOS) na doença pulmonar obstrutiva crônica (DPOC) são associados à evolução da doença. O objetivo deste estudo foi avaliar se a contagem diferencial de células brancas do sangue (CBS), os sintomas e o tratamento podem prever o declínio da função pulmonar e as exacerbações em pacientes com DPOC. Métodos Foram retrospectivamente examinados pacientes com DPOC estável submetidos a um monitoramento mínimo de três anos em nossas clínicas ambulatoriais. Coletaram-se informações sobre volumes pulmonares (VEF1 e CVF), contagens total e diferencial de CBS, exacerbações agudas de DPOC (número nos 12 meses anteriores ao início do estudo = EA-DPOC-B; e durante o monitoramento = EA-DPOC-F), status tabagístico e tratamento. Os declínios de VEF1 e EA-DPOC-F foram descritos empregando modelo linear generalizado e regressão binomial negativa com interceptação aleatória de nível 2, respectivamente. Os modelos incluíram contagens de eosinófilo e neutrófilo como potenciais preditores e foram ajustados de acordo com sexo, idade, status tabagístico, EA-DPOC-B, tratamento com broncodilatadores e corticosteroides inalados (CSI). Resultados 68 pacientes foram considerados, dos quais 36 para EOS- (< 170 células/μL, valor da mediana) e 32 para EOS+ (≥ 170 células/μL). ∆VEF1 foi maior em EOS+ do que em EOS- (34,86 mL/ano vs 4,49 mL/ano, p = 0,029). Após o ajuste em relação aos potenciais confundidores, as contagens de eosinófilos (β = 19,4; CI 95% 2,8,36,1; p = 0,022) e CSI (β = -57,7; CI 95% -91,5,-23,9; p = 0,001) foram positivamente e negativamente associadas ao declínio da função pulmonar, respectivamente. Os EOS não foram associados ao número de EA-DPOC-F. Conclusão Em pacientes com DPOC estável, o maior nível de EOS (embora em um intervalo regular) prevê um maior declínio de VEF1, enquanto os CSIs são associados a uma evolução mais lenta da obstrução do fluxo aéreo.

ABSTRACT Objective Whether blood eosinophils (bEOS) in chronic obstructive pulmonary disease (COPD) are associated with disease progression is a topic of debate. We aimed to evaluate whether the differential white blood cell (WBC) count, symptoms and treatment may predict lung function decline and exacerbations in COPD patients. Methods We retrospectively examined stable COPD patients with a minimum follow-up of 3 years at our outpatients' clinic. We collected information about lung volumes (FEV1, FVC), the total and differential WBC count, acute exacerbations of COPD (number in the 12 months before the beginning of the study=AE-COPD-B, and during the follow-up=AE-COPD-F), smoking status and treatment. FEV1 decline and AE-COPD-F were described by using a generalized linear model and a 2-level random intercept negative binomial regression, respectively. The models included eosinophil and neutrophil counts as potential predictors and were adjusted by sex, age, smoking status, AE-COPD-B, treatment with bronchodilators and inhaled corticosteroids (ICS). Results Sixty-eight patients were considered, 36 bEOS- (<170 cells/μL, the median value) and 32 bEOS+ (≥170 cells/μL). ∆FEV1 was higher in bEOS+ than bEOS- (34.86 mL/yr vs 4.49 mL/yr, p=0.029). After adjusting for potential confounders, the eosinophil count was positively (β=19.4; CI 95% 2.8, 36.1; p=0.022) and ICS negatively (β=-57.7; CI 95% -91.5,-23.9; p=0.001) associated with lung function decline. bEOS were not found to be associated with the number of AE-COPD-F. Conclusion In stable COPD patients, a higher level of blood eosinophils (albeit in the normal range) predicts a greater FEV1 decline, while ICS are associated with a slower progression of airflow obstruction.

Evaluación de la respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos / Evaluation of the acute response to the bronchodilator in overweight and obese asthmatic patients

Introducción: La obesidad está asociada al uso frecuente de medicación de rescate y padecer asma de mayor gravedad. Los obesos asmáticos tienen menor reactividad bronquial, sin embargo, existe información limitada sobre la magnitud de la reversibilidad aguda al broncodilatador (RAB). Objetivo: Evaluar la magnitud de respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos. Métodos: Se realizó un estudio descriptivo transversal con 49 pacientes asmáticos sobrepesos y obesos atendidos en consulta externa del Hospital Neumológico Benéfico Jurídico (enero 2017˗ enero 2018) y se constató mediante espirometría la respuesta aguda al broncodilatador. Resultados: Predominó la edad (40-59 años), mayor asociación de padecer asma, poca mejoría con la aplicación del broncodilatador. El sexo femenino (20-59 años) presentó mayor número que el masculino y menor reversibilidad al broncodilatador. Los pacientes con antecedentes patológicos familiares de asma o atopia representaron 73,5 por ciento del total. El 76,5 por ciento de los obesos no presentó mejoría con la aplicación del broncodilatador. Predominó la categoría de gravedad persistente moderada. Conclusiones: El sexo femenino tiene más riesgo de padecer asma y no tener mejoría al aplicar el broncodilatador. Los obesos mayores de 40 años tienen mayor riesgo de no presentar reversibilidad aguda al broncodilatador. Los antecedentes patológicos familiares de asma o atopia y personales de otras enfermedades no predisponen a menor reversibilidad aguda al broncodilatador. La gravedad del asma no influye en la reversibilidad aguda al broncodilatador(AU)

Introduction: Obesity is associated with the frequent use of rescue medication and suffering from more severe asthma. Obese asthmatics have less bronchial reactivity, however, there is limited information on the magnitude of acute bronchodilator reversibility. Objective: To assess the magnitude of the acute response to the bronchodilator in overweight and obese asthmatic patients. Methods: A cross-sectional descriptive study was carried out in 49 overweight and obese asthmatic patients seen in the outpatient clinic at Benéfico Jurídico Pneumologic Hospital from January 2017 to January 2018, and the acute response to bronchodilator was verified by spirometry. Results: Age predominated (40-59 years), greater association of suffering from asthma, and little improvement with the use of bronchodilator. The female sex (20-59 years) showed greater number than the male and less reversibility to bronchodilator. Patients with family pathological history of asthma or atopy represented 73.5 percent of the total. 76.5 percent of the obese did not show improvement with the use of bronchodilator. The category of moderate persistent severity predominated. Conclusions: The female sex has greater risk of suffering from asthma and has no improvement when applying bronchodilator. Obese individuals over 40 years of age have higher risk of not having acute reversibility to the bronchodilator. Family pathological history of asthma or atopy and personal history of other diseases do not predispose to less acute reversibility of bronchodilator. The severity of asthma does not influence acute reversibility to bronchodilator(AU)

FEV1/FEV6 y FEV6 una alternativa para FEV1/FVC y FVC en la detección de obstrucción de vías respiratorias / FEV1/FEV6 and FEV6 an alternative for FEV1/FVC and FVC in the detection of airway obstruction

INTRODUCCIÓN: el objetivo de este estudio fue verificar si los puntos de corte fijos y el límite inferior de lo normal (LLN) para el volumen espiratorio forzado en un segundo (FEV1) y el volumen espiratorio forzado en 6 segundos (FEV6) FEV1/FEV6 y el FEV6 son una medida alternativa para el FEV1 y la capacidad vital forzada (FVC), FEV1/FVC y la FVC en la detección de la enfermedad pulmonar obstructiva crónica (EPOC), en una muestra de pacientes del oriente boliviano. MÉTODOS: se analizaron un total de 92 pruebas espirométricas, 66 varones y 26 mujeres con riesgo de EPOC. La población del estudio incluyó a residentes de la ciudad de Santa Cruz de la Sierra-Bolivia (ciudad cosmopolita) de 35 a 90 años de edad. RESULTADOS: la sensibilidad y la especificidad fueron del 97,0% y el 96,9%, respectivamente, cuando se compararon los valores de corte fijos de FEV1/FEV6 de 0,73 con los de FEV1/FVC < 0,7 como regla estándar, según las recomendaciones del global obstructive lung diseases (GOLD) para detectar la obstrucción de las vías respiratorias. La sensibilidad y la especificidad fueron de 93,4% y 81,2%, respectivamente, cuando el LLN de FEV1/FVC y FEV1/FEV6 fueron utilizados. CONCLUSIONES: en conclusión, el FEV6 es un sustituto válido de la CVF para detectar la obstrucción de las vías respiratorias, ya sea utilizando puntos de corte fijos o el LLN. Se necesitan más estudios para verificar estos resultados en una población más grande y para establecer los valores predictivos espirométricos locales.

INTRODUCTION: the aim of this study was to verify if fixed cut-off points and lower limit of normal (LLN) for forced expiratory volume in one second (FEV1)/FEV6 and FEV6 as an alternative for FEV1/forced vital capacity (FVC) and FVC are valid for the detection of obstructive lung disease in a sample of Bolivian subjects. METHODS: a total of 92 spirometric consecutive tests from subjects, 66 males and 26 females at risk for COPD were analyzed. The study population included residents of city Santa Cruz de la Sierra, (Bolivia) aged from 35 to 90 yrs., from various ethnical origins (cosmopolitan city). RESULTS: sensibility and specificity were 97.0% and 96.9%, respectively when fixed cut-off values of FEV1/FEV6 of 0.73 was compared to FEV1/FVC<0.7 as standard, according to GOLD recommendations to detect airway obstruction. Sensibility and specificity were 100% and 89.5%, respectively when LLN of FEV1/FVC and FEV1/FEV6 were used. CONCLUSIONS: in conclusion, FEV6 is a valid surrogate for FVC to detect airway obstruction, either using fixed cut-off points or LLN. Further study is needed to verify these results in a larger population and to establish local spirometric predicted values

Utility of Echocardiography in Cardiac Evaluation of COPD Patients and Its Relationship with Severity of Disease

COPD is a leading cause of death and disability worldwide as well as in India. It is a multisystem disorder among which cardiac manifestations are common. Echocardiography provides a rapid, non-invasive, portable, and accurate method to evaluate such changes. We wanted to assess the cardiac changes due to COPD by echocardiography, evaluate the correlation between echocardiographic findings and severity of COPD using GOLD guidelines (2011 updates).METHODSThis study was a hospital based cross sectional study conducted in M.L.B. Medical College, Jhansi (U.P.). The study included admitted COPD patients in Internal Medicine Department and T.B. Chest Department. The study was conducted after obtaining permission from the Institutional Ethics Committee and identity of the patients has not been revealed.RESULTSOut of 200 admitted patients, 98 patients had cor pulmonale and were further classified by using GOLD guidelines 2017. Upon comparing FEV1 with mPAP in each group we observed p value of 0.001 which is statistically significant. A positive correlation was also found between duration from onset of the disease and mPAP.CONCLUSIONSBy estimating PAP early in the disease process, even in those patients who are not able to perform lung function test correctly due to other co-morbidities, we can determine the progression of the disease and can achieve a better outcome by planning a more appropriate and intense line of management.

Application of a multiple linear regression model of FEV1 in pulmonary function test / 南方医科大学学报

OBJECTIVE@#To construct a multiple linear regression model of forced expiratory volume in 1 second (FEV1) for estimating FEV1 in special populations unable to receive or uncooperative in pulmonary ventilation function tests.@*METHODS@#The multiple linear regression model of FEV1 was constructed based on the data of 813 individuals undergoing pulmonary function tests in First Affiliated Hospital of Zhejiang Chinese Medical University between September, 2017 and September, 2019, and was validated using the data of another 94 individuals from the same hospital between January and July, 2020. FEV1 of the individuals was measured by pulmonary ventilation function test, and respiratory resistance (Rrs) was measured using forced oscillation technique (FOT). Pearson correlation analysis was used to assess the correlation between the factors, and the model equation was established by multiple stepwise regression analysis. The calculated FEV1 based on the model was compared with the measured FEV1 among both the individuals included for modeling and validation.@*RESULTS@#FEV1 was not significantly correlated with BMI (@*CONCLUSIONS@#The multiple linear regression model for calculating FEV1 constructed in this study is suitable for clinical application.

Chronic obstructive pulmonary disease patients and steroids: benefit or harm

Background: Corticosteroids are being widely used in conditions related to allergy and inflammation. There are great species differences in the responses to glucocorticoids that mean a “steroid resistant” species. Steroids have profound effect on inflammatory response by way of vasoconstriction, decreased chemotaxis and interference with macrophages. There still are enormous gaps in our knowledge of the action of glucocorticosteroids in patients of chronic obstructive lung disease (COPD).Methods: This study was done in the department of general medicine at SKIMS, Srinagar from December 2017 to December 2018 on patients of chronic obstructive pulmonary disease. A total number of 100 patients were enrolled for the study but 20 patients, 10 from each group lost their follow up. To see the effect of steroids on pulmonary function tests, patients were divided into case and control group. Patients in case group were given prednisolone 30 mg orally for two week (tapering dose). Patients in control group were given placebo for the same duration of two weeks. Steroid response was defined as 15% improvement in baseline forced expiratory volume (FEV).Results: Steroid response was defined as 15% increase in forced expiratory volume in one second/forced vital capacity (FEV1/FVC) after receiving tapering dose of prednisone 30 mg for 2 weeks, no patients in case group showed increase in FEV1/FVC of 15%. The change in pulmonary function tests was comparable in each group (p>0.5).Conclusions: The change in pulmonary function tests were comparable in each group (p>0.5). So, steroids in stable patients of COPD are best to be avoided.

A comparative study of lung function among sawmills workers in central India

Background: Many of the studies have put forth the hypothesis that sawdust deteriorates lung function, increases the incidence and prevalence of diseases of the respiratory system, and can predispose to cancer and deaths. Deterioration of lung function can be tested by pulmonary function tests. Several studies have shown respiratory disorders in sawmill workers, including the reduction of pulmonary function tests, but there is a paucity of such studies in Central India; hence, in this study, we tried to study comparative lung function among sawmill workers. Objective: The objective of this study was as follows: (i) To study the lung function of workers in sawmill industry, (ii) comparative assessment of lung function with those of controls, and (iii) to study the effect of occupational exposure to wood dust. Materials and Methods: The study was carried out in the sawmills in Nagpur city from September 2013 to December 2015. Sawmill workers were the study group and local government workers as comparison group. Each worker was examined in a separate room away from the workplace. Spirometry was done to assess the lung function using the UK’s Compact Vitalograph. Subjects in the control group were also examined with the spirometry. The lung function values of sawmill workers compared with the control and the difference in them was assessed both numerically and statistically. Results: Mean of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow25–75, and peak expiratory flow rate was significantly decreased among sawmill workers as compared to control group (P < 0.05), but FEV1/FVC ratio was significantly elevated among sawmill workers (P < 0.05). Conclusion: We have concluded that sawmill workers suffered from obstructive or restrictive type of pulmonary disorder, but the predominant type was restrictive lung disease.

Pulmonary function test in patients of type 2 diabetes mellitus

Background: We are today witnessing a pandemic of diabetes mellitus (DM), globally and nationally. DM and its complications have become the most important contemporary and challenging health problems. Diabetes is not associated with any specific pulmonary symptom and hence periodic screening for lung disease is not done in diabetic patients. However, an extensive microvascular circulation and an abundant connective tissue in the lung raise the possibility that the lung may also be a target organ in diabetic patients. The aim and objectives were to study the pulmonary function of individual with type 2 diabetes mellitus patients by performing spirometry.Methods: Study included non-smoker diabetic patients, who had no history of respiratory disease, were selected for this study and undergone pulmonary function test by spirometry. The study was conducted at department of General Medicine Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.Results: Present study, author found that there was significant derangement in the spirometric readings in the diabetic patients. The FEV1/FVC values further declines as the duration of diabetes increased.Conclusions: Spirometric values (FVC, FEV1, FEV1/FVC) were consistently lower in subjects with type 2 diabetes mellitus. The effect on FVC predicted % was found to be more pronounced in subjects whose duration of DM was more than 5 years.

Effectiveness Of Cervical Stabilization Exercises With Feedback On Respiratory Status In Chronic Neck Pain Patients With Forward Head Posture

Background: Chronic neck pain is observed to be commonly kindred with forward head posture (FHP). Rib cage mechanics is found to be altered that decreases thoracic mobility. This reduced mobility of thorax reduces the effectiveness of diaphragm, intercostals, and abdominal muscles in terms of ventilation. Therefore this study was done to evaluate the effectiveness of exercises meant for enhancing the stability of the neck with feedback on neck stabilization exercises with feedback in improving the respiratory status. Methods: This was an experimental study. Based on inclusion & exclusion criteria, 100 subjects (54 males and 46 females) enrolled for the study, which was further allotted into Experimental and Control groups. The experimental group was given Cervical Stabilization Exercise with feedback in addition to routine Physiotherapy treatment. Control group was given only regular Physiotherapy treatment for six weeks. The digital camera assessed the FHP by measuring of Craniovertebral Angle (CVA). Spirometry assessed pulmonary function (FEV1) and Micro RPM assessed inspiratory muscle strength (PImax). All measurements were taken on the day of study, on 3rd and 6th week Results: Significant reduction in forward head posture measured by improvement in Craniovertebral angle, improvement in Inspiratory muscle strength (PIMax) and pulmonary functions (FEV1) were found in the group that received cervical stabilization exercises with feedback along with the conventional Physiotherapy (p< 0.05). Therefore it is suggested that cervical stabilization exercises correct the head posture and helps to improve the biomechanics of respiratory muscles. Conclusion: Cervical stabilization exercise is an effective approach to correct the forward head posture, and it should be included in the intervention measures of patients with forward head posture.

Effects of a Swimming Training Session on Pulmonary Functions in Young Adult Beginners

Introduction: It is well documented that any sort of exercisedone regularly, is beneficial for health. Swimming is noexception and considered to be a very good exercise formaintaining proper health and also has a profound effect on thelung functions. Regular swimming practice gives a positiveeffect on the lungs by increasing the pulmonary capacity andthus improves the lung functions. The proposed study wascarried out with the above background, among swimmingbeginners undergoing a swimming training session to see howa course of swimming affect the lung function parameters.Material and Methods: The study was carried out on 32males and 12 females’ healthy young adults of either sex ofage group of 18-35 yrs. At the beginning of the swimmingsession recording of pulmonary functions tests was done foreach selected candidate (control group). Again procedureswere repeated at the end of three months and at the end of sixmonths for same candidates (case group).Results: In the present study, it is observed that there issignificant increase (p value <0.05) in FVC, FEV1, PEFR andMVV after three months and after six months of swimmingboth males and females separately.Conclusion: From the present study we concluded that evenafter short course of swimming training session there issignificant benefit in some parameters of lung function. Theimprove lungs function is thought to be duo to increase inrespiratory muscle mass. More elaborate and multi-centredstudies are needed to corroborate our findings

Study of Effects of Kerosene and LPG on Pulmonary Function Tests in Rural Women of Punjab

The unhealthy effects of indoor air pollution by cooking fuels is great concern for good respiratory health. Present study was conducted to study and compare the effects of two major fuels used in developing countries like India, Kerosene and Liquefied Petroleum Gas (LPG) in rural women of Amritsar, India. Methods: Study was conducted on 800 rural women out of which 400 using Kerosene as cooking fuel and rest 400 using LPG. Subjects of chronic and recent respiratory illness even if treated were excluded Ventilatory functions of lungs were done on computerized spirometer, MED-SPIRER. Results: There was statistically significant decline in FEV1 in Kerosene using women (0.98±0.47) when compared with LPG using women (1.86±0.37). Other parameters FEV3, PEFR, FEF 25-75%, FEF2-12, FEF 25%, FEF 50% FEF 75% and MVV showed similar significant decline in women using Kerosene as fuel. Conclusion: There is significant decline in ventilator function od lungs in women using Kerosene as cooking fuel, which is still used in developing country like India. Reduced values indicate small airway obstruction.