How to interpret parameters of routine lung function tests in 2023?

The diagnosis and management of the most prevalent chronic respiratory diseases partially rely on parameters obtained from pulmonary functional tests (PFTs), including spirometry, plethysmography, and carbon monoxide diffusion capacity (DLCO) measurement. In practice, the interpretation of PFTs' parameters is based on international recommendations issued by renowned scientific societies such as the American Thoracic Society (ATS) and the European Respiratory Society (ERS). The interpretation standards for PFTs established by ATS/ERS in 2005 were updated in 2022. According to the ATS/ERS-2022 standards, the interpretation of PFTs can be summarized in five steps. The first step involves comparing the determined parameters with those observed in a reference population of healthy individuals. This step helps determine whether the determined parameters are low, normal, or elevated. The second step aims to identify potential ventilatory impairments, such as obstructive and/or restrictive ventilatory impairments, which can be observed in certain chronic respiratory or extrarespiratory diseases. The third step involves assessing the severity of the identified ventilatory impairment or the decrease in DLCO. The fourth step entails evaluating the response to bronchodilator testing, if performed. Finally, if previous PFTs results are available, it is important to identify significant changes in certain PFTs parameters over time by comparing current and previous results. This clinical practice guide provides a comprehensive synthesis of the different steps in PFTs interpretation, taking into account the recommendations from ATS/ERS-2022.

Impact of cardiorespiratory rehabilitation program on submaximal exercise capacity of Tunisian male patients with post-COVID19: A pilot study.

Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients' hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points (p < 0.001), forced expiratory volume in one second by 110 ± 180 ml (p = 0.04), 6-min walk distance by 35 ± 42 m (p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg (p = 0.048), resting heart-rate by 7 ± 9 bpm (p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg (p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work.

Impact of a pulmonary rehabilitation program on social disadvantage and physical activity data of postCOVID19 patients: A North-African pilot study.

Background In addition to the cardiorespiratory, muscular, and neurological manifestations, coronavirus disease 2019 (COVID-19) alters patients' health-related quality of life (HRQoL), induces a large variety of psychiatric manifestations, and reduces mobility and motor activity. Several studies have raised the impact of a pulmonary rehabilitation program (PRP) on social disadvantage ( e.g., HRQoL, anxiety, depression) and physical activity of COVID-19 patients, but very few have been performed in low-income countries. This study aimed to investigate the impact of a PRP on post-COVID-19 HRQoL, hospital anxiety and depression (HAD), and physical activity in Tunisian post-COVID19-patients. Methods This was a cross-sectional study in an outpatient care setting. Patients with post-COVID-19 were included. They completed an interview (including three questionnaires) before and after a PRP (three sessions/week for four weeks, each session was 70 minutes in duration, PRP items: aerobic cycle endurance, strength training, and education). The VQ11 questionnaire assessed functional dimension, psychological dimension, relational dimension, and total score; HAD appraised depression and anxiety; and Voorrips physical activity assessed daily activity, physical activity, leisure activity, and total scores. Data were expressed as mean±standard deviation in PRP change (PRP change=after-PRP values - before-PRP values). Results In total, 14 moderate to severe post-COVID-19 patients (61±4 years) were included. The PRP significantly improved the i) functional, psychological, and relational dimensions, and the VQ11 total score by 1.79±1.58 (p=0.0033), 2.00±2.15 (p=0.0108), 1.57±1.50 (p=0.0077), and 5.36±3.97 (p=0.0015), respectively; ii) HAD anxiety and depression scores by 2.07±2.40 (p=0.0076), and 2.57±3.08 (p=0.0058); and iii) physical activity and total scores by 1.75±2.44 (p=0.0251), and 1.78±2.65 (p=0.0341), respectively. Conclusion The PRP improved HRQoL, HAD, and physical activity of Tunisian post-COVID-19 patients.