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.

Aging, tobacco use and lung damages.

The main two functions of the lung are the respiratory functions, dependent on ventilatory mechanics and gas exchange, and the nonrespiratory functions such as metabolic, immunological, and endocrine ones. Lung aging is secondary to the age-dependent impairment of one or more of these functions. Tobacco use accelerates lung aging and touches biological, structural and respiratory and non-respiratory functions. These changes contribute to the development of chronic pulmonary diseases and predispose to pulmonary infections in older individuals. The knowledge of these changes is very useful for better management of elderly. Lung health in aging can be improved by strategies that slow the age-related decline in lung function by acting on the environmental parameters. It is also possible to improve lung development in children and to strengthen the lungs' resistance to environmental challenges and thus to extrinsic lung aging.

The aging lung face to COVID-19.

Coronavirus disease 2019 (COVID-19) has so far killed many people; with the majority of deaths occurring in people over the age of 65 years. It has been noted that the severity and outcome of COVID-19 depends in part on the patient's age. The combination of three factors could explain this ascertainment: the first is linked the lung aging, the second is the associated comorbidities in elderly subjects and the third is the particularities of COVID-19. Here we emphasize the modifications linked to pulmonary aging and their role in worsening the COVID-19 disease.

Chemical characteristics and cancer risk assessment of smokeless tobacco used in Tunisia (neffa).

INTRODUCTION: neffa, a form of air-dried smokeless tobacco used in North Africa, is spuriously perceived as a lower risk alternative to smoking. The objective of this study was to provide information on some harmful constituents of neffa and to use them for cancer risk assessment. METHODS: a high-performance liquid chromatography method coupled with fluorescence detector was used to determine polycyclic aromatic hydrocarbons (PAHs) in one sample of neffa. An atomic absorption spectrometry was performed to determine the concentrations of lead and cadmium in three samples of neffa. The levels of toxicants found in neffa were used to assess for lifetime cancer risk as advocated by the US Environment Protection Agency. RESULTS: the determination of PAHs in neffa allowed the identification of phenanthrene and anthracene. However, the higher molecular weight PAHs such as Benzo(a)Pyrene B(a)P were not detected. The concentrations of cadmium and lead varied between 1.3 to 2.8µg/g and 1.7 to 4.6µg/g respectively. Cancer risk for cadmium and lead varied between 4.2E-03 to 9.3E-03 and 2.5E-06 to 6.4E-06 respectively. Cancer risk for Cd exceeded the range of 10E-04 to 10E-06 of an acceptable risk. CONCLUSION: neffa is not a healthy alternative for overcoming smoking addiction. It contains mineral and organic pulmonary toxicants. This study could serve as a scientific basis to inform consumers about the products´ toxicity and help them to quit smokeless tobacco (SLT) use.

The Ventilatory and Diffusion Dysfunctions in Obese Patients with and without Obstructive Sleep Apnea-Hypopnea Syndrome.

Objective: To analyze the ventilatory and alveolar-capillary diffusion dysfunctions in case of obesity with or without an OSAS. Methods: It is a cross-sectional study of 48 obese adults (23 OSAS and 25 controls). Anthropometric data (height, weight, and body mass index (BMI)) were collected. All adults responded to a medical questionnaire and underwent polysomnography or sleep polygraphy for apnea-hypopnea index (AHI) and percentage of desaturation measurements. The following lung function data were collected: pulmonary flows and volumes, lung transfer factor for carbon monoxide (DLCO), and fraction of exhaled nitric oxide (FeNO). Results: Obesity was confirmed for the two groups with a total sample mean value of BMI = 35.06 ± 4.68 kg/m2. A significant decrease in lung function was noted in patients with OSAS compared with controls. Indeed, when compared with the control group, the OSAS one had a severe restrictive ventilatory defect (total lung capacity: 93 ± 14 vs. 79 ± 12%), an abnormal DLCO (112 ± 20 vs. 93 ± 22%), and higher bronchial inflammation (18.40 ± 9.20 vs. 31.30 ± 13.60 ppb) (p < 0.05). Conclusion: Obesity when associated with OSAS increases the severity of pulmonary function and alveolar-capillary diffusion alteration. This can be explained in part by the alveolar inflammation.

Does Ramadan Fasting Affect Spirometric Data of Healthy Adolescents?

PURPOSE: Several studies raised the effects of Ramadan fasting on healthy adults spirometric data, but none was performed in children. The aim of this study was to compare the spirometric data of a group of faster adolescents (n = 26) with an age-matched non-faster one (n = 10). METHODS: This comparative quasi-experimental study, including 36 healthy males aged 12 to 15 years, was conducted during the summer 2015 (Ramadan: June 18 to July 16). Three sessions (Before-Ramadan [Before-R], Mid-Ramadan [Mid-R], After-Ramadan [After-R]) were selected for spirometry measurements. Spirometry was performed around 5.5 to 3.5 h before sunset and the spirometric data were expressed as percentages of local spirometric norms. RESULTS: The two groups of fasters and non-fasters had similar ages and weights (13.35 ± 0.79 vs 12.96 ± 0.45 years, 46.8 ± 9.2 vs 41.7 ± 12.6 kg, respectively). There was no effect of Ramadan fasting on forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow, and maximal mid-expiratory flow. For example, during the Before-R, Mid-R, and After-R sessions, there was no significant difference between the fasters and non-fasters mean FVC (101 ± 11 vs 99 ± 14, 101 ± 12 vs 102 ± 14, 103 ± 11 vs 104 ± 13, respectively) or FEV1 (101 ± 13 vs 96 ± 16, 98 ± 11 vs 97 ± 16, 101 ± 10 vs 98 ± 16, respectively). CONCLUSIONS: Ramadan fasting had no interaction effect with the spirometric data of Tunisian healthy male adolescents.

Biochemical Data and Metabolic Profiles of Male Exclusive Narghile Smokers (ENSs) Compared With Apparently Healthy Nonsmokers (AHNSs).

Studies evaluating the metabolic profiles of ENSs are scarce and presented controversial conclusions. This study aimed to compare the metabolic profiles of ENSs' and AHNSs' groups. Males aged 25-45 years and free from a known history of metabolic and/or cardiovascular diseases were included. According to the smoking status, two groups of ENSs and AHNSs were identified. Body mass index (BMI, kg/m2), waist circumference (WC, cm), systolic and diastolic blood pressures (SBP, DBP, mmHg), fasting blood data in mmol/L (blood glycemia [FBG], triglycerides [TG], total cholesterol [TC], high- and low- density lipoprotein cholesterol [HDL-C, LDL-C]) and obesity status were evaluated. The metabolic syndrome (MetS) was defined according to the 2006 International Diabetes Federation (IDF) recommendations. Data were expressed as mean ± standard deviation ( SD) or percentages. Compared to the AHNSs' group ( n = 29), the ENSs' one ( n = 29) had (a) higher values of BMI (26.5 ± 2.3 vs. 28.2 ± 3.6), WC (95 ± 7 vs. 100 ± 10), and TG (1.22 ± 0.40 vs. 1.87 ± 0.85); and (b) included a lower percentage of males having low HDL-C (82.7% vs. 62.0%), and higher percentages of males having obesity (6.9% vs. 37.9%) or hypertriglyceridemia (10.7% vs. 51.7%). Both the ENSs' and AHNSs' groups: (a) had similar values of FBG (5.38 ± 0.58 vs. 5.60 ± 0.37), TC (4.87 ± 1.16 vs. 4.36 ± 0.74), HDL-C (0.92 ± 0.30 vs. 0.82 ± 0.21), LDL-C (3.09 ± 0.98 vs. 2.92 ± 0.77), SBP (117 ± 9 vs. 115 ± 8), and DBP (76 ± 6 vs. 73 ± 7); and (b) included similar percentages of males having normal weight (17.2% vs. 31.0%); overweight (44.8% vs. 62.1%); android obesity (79.3% vs. 59.6%), hypertension (10.3% vs. 10.3%), hyperglycemia (37.9% vs. 48.2%), and MetS (51.7% vs. 34.5%). There is a need to monitor narghile use among male metabolic patients since it alters some components of the MetS.

The Effects of Aging on Exhaled Nitric Oxide (FeNO) in a North African Population.

OBJECTIVE: To determine and explain the effect of age on exhaled nitric oxide values in North African healthy subjects aged from 5 to 83 years. DESIGN: Prospective cross-sectional study. METHODS: Volunteer children adults and elderly healthy subjects were included. A medical questionnaire was used to assess several subject characteristics. The levels of exhaled fraction of nitric oxide (FeNO) were measured by Medisoft HypAir FeNO method. Spirometry function test was done after the FeNO measurement. The following parameters were measured: forced vital capacity (FVC, L); 1st second forced expiratory volume (FEV1, L); FEV1/FVC ratio (absolute value); maximal mid expiratory flow (MMEF, L/s); Mid expiratory flow from 25 to 75% (MEF25%, MEF50%, and MEF75%). Statistical analyses were carried out using Statistica software with a significance set at the 0.05 level. RESULTS: A significant increase in FeNO is noted between groups with respective age ranges of (5, 17) and (17, 25) years with a breakpoint at 1,397,034 years. A significant decrease of FeNO is noted between groups with respective age ranges of (45, 55) and (55, 65) years with a breakpoint at 6,366,052 years. No statistical significant difference was found between females' and males' means FeNO data. Finally, SEL, obesity status, and hypertension contribute significantly in the variations of FeNO values. CONCLUSION: The development and aging of the lung touched non-respiratory functions and so modified FeNO values in healthy North African subjects.

The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study.

No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 106/mm3) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm3). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.

Cortisol cut-points for the glucagon stimulation test in the evaluation of hypothalamic pituitary adrenal axis.

Diagnosis of adrenal insufficiency requires evaluation by dynamic stimulation tests. The insulin tolerance test (ITT) is accepted as the gold-standard test for the evaluation of hypothalamo-pituitary-adrenal (HPA) axis but the test is unpleasant and dangerous. Although it takes more time, glucagon stimulation test (GST) is a good alternative to ITT. The primary aim of this study was to compare the ITT and GSTs in the evaluation of HPA axe in patients with pituitary disorders. We conducted a prospective study in which ITT and GST were performed within 7 days in 81 patients. Serum cortisol was measured. We divided our population in Group 1 (G1): Adrenal Insufficiency (Peak cortisol under ITT <200 ng/mL) and Group 2 (G2): normal response (Peak cortisol under ITT >200 ng/mL). Receiver-operating characteristic (ROC) analysis was performed to identify the thresholds for GST. The mean peak of cortisol under GST was not significantly different from that obtained after ITT in the whole cohort (182.67 ± 89.07 ng/mL vs. 179.75 ± 79.01 ng/mL), and it was significantly reduced in patients of G1 (p < 10-3). ROC curve analysis showed that the best diagnostic accuracy was obtained with a peak cortisol cut-off to GST of 167 ng/mL (sensitivity, 89%; specificity, 79%). Using this cut-off, 86.4% of the patients were correctly classified. In our prospective series, GST is a potential accurate and safe alternative test for the assessment HPA. Test-specific cut-offs should be applied to avoid misinterpretation.

Defining and grading an obstructive ventilatory defect (OVD): 'FEV1/FVC lower limit of normal (LLN) vs. Z-score' and 'FEV1 percentage predicted (%pred) vs. Z-score'.

An obstructive ventilatory defect (OVD) is defined by a low forced expiratory volume/'forced/slow' vital capacity (FEV1/FVC) (e.g. 70%), moderate (60-69%), moderately severe (50-59%), severe (35-49%), and very severe (<35%) and GLI (FEV1 Z-score): mild (≥ -2.0), moderate (-2.0 to -2.5), moderately severe (-2.5 to -3.0), severe (-3.0 to -4.0), and very severe (<-4.0). The frequencies of OVD were 14.4% (ATS/ERS method) and 10.5% (GLI method) (p < 0.05). Among the 103 participants having an OVD according to the two methods, the severity classification was mild (34.95% vs. 37.86%, p < 0.05), moderate (25.24% vs. 18.45%, p < 0.05), moderately severe (23.30% vs. 15.53%, p = 0.144), severe (9.71% vs. 20.39%, p < 0.05), and very severe (6.80% vs. 7.77%, p = 0.785), respectively for the ATS/ERS and GLI classifications. The two OVD definitions were not exchangeable. Moreover, the two grading severity systems misclassified the OVD grades.

"Spirometric" lung age reference equations: A narrative review.

The aim of the present paper was to conduct a narrative review of the published norms of the "spirometric" lung-age (SLA). A literature search which covered the period 1970 to June 2017, was conducted using the Pubmed. The search strategy had used the following MeSH words: "Spirometry"[Majr]) AND "Aging"[Majr]. Six original studies have reported equations predicting SLA for adults aged 18-90 years [USA (n=2), Japan (n=2); Australia (n=1) and Tunisia (n=1)]. Their sample sizes varied from 125 to 15238, with a total of 32334 volunteers (11788 men). Several models of norms were developed. They included one (often, FEV1) or more spirometric data in addition to one (often, height) or more anthropometric data. All studies have validated their norms in additional one or more groups, with satisfactory results. Only three authors have proposed algorithms to interpret SLA. All studies presented several limitations concerning the sample size and/or representation, the age distribution, the use of old spirometric data and/or equipment, the application of old spirometric methods, and especially mathematical and statistical flaws.

Effect of ultrasonic degradation of hyaluronic acid extracted from rooster comb on antioxidant and antiglycation activities.

CONTENT: Recently, low-molecular-weight hyaluronic acid (LMWHA) has been reported to have novel features, such as free radical scavenging activities, antioxidant activities and dietary supplements. OBJECTIVE: In this study, hyaluronic acid (HA) was extracted from rooster comb and LMWHA was obtained by ultrasonic degradation in order to assess their antioxidant and antiglycation activities. MATERIALS AND METHODS: Molecular weight (Mw) and the content of glucuronic acid (GlcA) were used as the index for comparison of the effect of ultrasonic treatment. The effects on the structure were determined by ultraviolet (UV) spectra and Fourier transform infrared spectra (FTIR). The antioxidant activity was determined by three analytical assays (DPPH, NO and TBARS), and the inhibitory effect against glycated-BSA was also assessed. RESULTS: The GlcA content of HA and LMWHA was estimated at about 48.6% and 47.3%, respectively. The results demonstrate that ultrasonic irradiation decreases the Mw (1090-181 kDa) and intrinsic viscosity (1550-473 mL/g), which indicate the cleavage of the glycosidic bonds. The FTIR and UV spectra did not significantly change before and after degradation. The IC50 value of HA and LWMHA was 1.43, 0.76 and 0.36 mg/mL and 1.20, 0.89 and 0.17 mg/mL toward DPPH, NO and TBARS, respectively. Likewise LMWHA exhibited significant inhibitory effects on the AGEs formation than HA. DISCUSSION AND CONCLUSION: The results demonstrated that the ultrasonic irradiation did not damage and change the chemical structure of HA after degradation; furthermore, decreasing Mw and viscosity of LMWHA after degradation may enhance the antioxidant and antiglycation activity.

Effects of Ramadan intermittent fasting on North African children's heart rate and oxy-haemoglobin saturation at rest and during sub-maximal exercise.

AIM: To examine the effects of Ramadan intermittent fasting (RIF) on the heart rate (HR) and oxyhaemoglobin saturation levels (oxy-sat) of boys at rest and during a six-minute walking test (6MWT). METHODS: Eighteen boys (age: 11.9 ± 0.8 years, height: 153.00 ± 8.93 cm, body mass: 55.4 ± 18.2 kg), who fasted the entire month of Ramadan in 2012 for the first time in their lives, were included. The experimental protocol comprised four testing phases: two weeks before Ramadan (pre-R), the end of the second week of Ramadan (R-2), the end of the fourth week of Ramadan (R-4), and 10 to 12 days after the end of Ramadan (post-R). During each phase, participants performed the 6MWT at approximately 15:00. HR (expressed as percentage of maximal predicted HR) and oxy-sat (%) were determined at rest and in each minute of the 6MWT. RESULTS: R-4 HR values were lower than those of (1) pre-R (in the second minute), (2) R-2 (in the first and second minutes), and (3) post-R (in the first, second, fourth, fifth and sixth minutes). R-2 oxy-sat values were higher than those of pre-R (in the third minute) and those of post-R (in the fifth minute). Post-R oxy-sat values were lower than those of pre-R and R-4 in the fifth minute. These oxy-sat changes were not clinically significant since the difference was less than five points. CONCLUSION: In non-athletic children, their first RIF influenced their heart rate data but had a minimal effect on oxy-sat values.

6-min walk-distance norms in adults Arab populations: a literature review.

INTRODUCTION: The primary outcome of the 6-min walk-test is the 6-min walk-distance (6MWD). Its interpretation relies upon the comparison of the measured 6MWD with the predicted one from published norms. OBJECTIVE: The aim of the present review is to report the 6MWD norms published for healthy adults Arab populations. METHODS: The review includes a literature search, from 1970 to January 5th 2017 using the PubMed search engine. Reference equations lists of retrieved English/French articles were searched for any supplementary references. The research includes the combination of the following (or their synonyms) "Medical Subject Headings" or "Title/Abstract" terms: «walking¼ AND «reference values¼ AND «Arabs¼. RESULTS: Five studies, conducted in Saudi-Arabia (n=2), Tunisia (n=2) and Algeria (n=1) were included. Norms comprised the following factors: age (Yrs), height (cm), weight (kg), body mass index (BMI, kg/m2), sex (0:women; 1:men) and physical activity level. Five norms were proposed for Tunisian aged 40-79 years [6MWD (m) = 299.8 - 4.34xAge + 3.43xHeight - 1.46xWeight + 62.5xSex] or aged 40-85 years [6MWD (m) = 720.50 + 160.27xSex - 5.14xAge - 2.23xWeight + 2.72xHeight], for Saudi-Arabian aged 16-50 years [6MWD (m) = - 28.5 + 2.81xHeight + 0.79xAge] or aged 18-71 years [6MWD (m) = 342.650 + 74.31xPhysical activity level + 33.88xSex - 4.25xAge] and for Algerian aged 16-40 years [6MWD (m) = 800.05 + 64.71xSex - 10.23xBMI - 1.63xAge + 2.05xWeight]. These norms explained 25% to 77% of the 6MWD variability. CONCLUSION: Fewer 6MWD norms exist for adults' Arab population. Other norms are welcome.

Influencing factors of the 6-min walk distance in adult Arab populations: a literature review.

Background Walk tests, especially the 6-min walk-test (6MWT), are commonly used in order to evaluate submaximal exercise capacity. The primary outcome of the 6MWT is the 6-min walk-distance (6MWD). Numerous demographic, physiological and anthropometric factors can influence the 6MWD in healthy adults. Objective The purpose of the present review is to highlight and discuss the 6MWD influencing factors in healthy of the healthy adult Arab populations. Methods It is a review including a literature search, from 1970 to September 31th 2015 using the PubMed, the Science Direct databases and the World Wide Web on Google search engine. Reference lists of retrieved English/French articles were searched for any additional references. Results Six studies, conducted in Tunisia (n=2), Saudi Arabia (n=3) and Algeria (n=1) were included. All studies were conducted according to the 2002-American-thoracic-society guidelines for the 6MWT. In addition to anthropometric data (sex, age, height, weight, body mass index, lean mass), the following data were recognized as 6MWD influencing factors: schooling and socioeconomic levels, urban origin, parity, physical activity score or status, metabolic equivalent task for moderate activity, spirometric data, end-walk heart-rate, resting diastolic blood pressure, dyspnoea Borg value and niqab-wearing. Conclusion The 6MWD influencing factors in adult Arab populations are numerous and include some specific predictors such as parity, physical activity level and niqab-wearing.

Incapacity, Handicap, and Oxidative Stress Markers of Male Smokers With and Without COPD.

BACKGROUND: Mechanisms of incapacity and quality of life (QOL) of smokers with COPD and those free from COPD (non-COPD) are still unclear. The aims of this work were to compare the submaximal exercise, the QOL, and the blood and lung oxidative stress biomarker data of smokers without and with COPD. METHODS: Thirty-two male-smokers 40-60 y old were included (16 with COPD). QOL (Saint George Respiratory Questionnaire) and physical activity (Voorrips questionnaire) scores were determined. Blood sample levels of malondialdehyde, protein sulfhydryl, and glutathione were measured. Fraction of exhaled nitric oxide, plethysmographic data, and 6-min walk distance (6MWD) were collected. All data are presented as mean ± SD, except oxidative stress biomarkers expressed as mean ± SE. Correlation coefficient (r) evaluated the association between oxidative stress biomarkers and 6MWD, QOL, and physical activity data. RESULTS: Two age- and amount of tobacco used-matched groups of smokers were included. Compared with the non-COPD group, the COPD group had significantly lower 6MWD (573 ± 63 vs 476 ± 53 m) and physical activity score (7.14 ± 1.50 vs 2.86 ± 1.50) and significantly worse QOL (19.47 ± 15.33 vs 47.70 ± 16.73) and lower glutathione level (39.44 ± 6.28 vs 24.67 ± 5.41 µg/mL). The COPD group malondialdehyde level was significantly correlated with 6MWD, symptoms, and QOL scores (good r value between 0.50 and 0.70). The non-COPD group fraction of exhaled nitric oxide and glutathione levels were significantly correlated with leisure activity score and 6MWD, respectively (good r value between 0.50 and 0.70). CONCLUSIONS: Compared with the non-COPD group, the COPD group had a marked decrease in submaximal exercise data and in QOL score. Oxidative stress could be one explanation of incapacity and handicap observed in the COPD group.

Oral health effects associated with narghile use.

Background - As dentists are certain to encounter narghile-smokers amongst their patients, it is important to inform them of the possible detrimental impacts of narghile-use on oral-health. Objective - To review the literature on the oral-health effects of narghile-use. Methods - Data Sources - We made a search on pubmed until June 30th, 2015 for the chronic oral-health effects of narghile-use using the terms "oral-lesions" or "oral-cancer" or "dry-socket" or "periodontium" and 'narghile' or its different synonyms. Study selection - Only original studies and case reports or series focusing on clinical human studies were included. Sixteen studies met the selection criteria and 14 were retained. Data extraction - Data were abstracted by two authors and summarized into tables. Abstracted data, including study type and results, were analyzed jointly by four authors. Results - Data synthesis. Narghile-use has harmful effects on oral-cavity including periodontal diseases, dry-sockets and oral-mucosa lesions. Conclusion - Narghile-use is associated with a variety of adverse long-term oral-health effects that should reinforce the need for stronger regulation. Key-words - Tobacco - Oral lesions - Oral cancer - Periodontium - Dry-socket.

[Women smoking in the Tunisian center: socio demographic characteristics and effects on functional respiratory parameters]. / La tabagisme au feminin au centre Tunisien : Caractéristiques sociodémographiques et retentissement fonctionnel respiratoire.

UNLABELLED: Objectives of this study were to describe sociodemographic characteristics of Tunisian woman smoker and to study her respiratory functional profile. METHODS: all women answered for a questionnaire and benefited of a total physical plethysmography and of a carbon monoxide lung transfer measure (TLCO). RESULTS: 101 smoking women were selected. These women consumed cigarettes (74 %), the snuff "neffa "(10 %) and the water pipe (15 %). A chronic bronchitis was present at 22 women. A proximal bronchial obstruction was found at 11 women who were consumer of the "neffa" and cigarettes. A lower airway obstruction was found in all women consumer of water pipe. The TLCO was low at "neffa" group of women. CONCLUSION: woman smoking has a negative influence on pulmonary function which depends on sociocultural characteristics and on the history of smoking.