Safety of delivering bronchial thermoplasty in two treatment sessions.

BACKGROUND: Bronchial thermoplasty (BT) is a novel endoscopic therapy for severe asthma. Traditionally it is performed in three separate treatment sessions, targeting different portions of the lung, and each requires an anaesthetic and hospital admission. Compression of treatment into 2 sessions would present a more convenient alternative for patients. In this prospective observational study, the safety of compressing BT into two treatment sessions was compared with the traditional 3 treatment approach. METHODS: Sixteen patients meeting ERS/ATS criteria for severe asthma consented to participate in an accelerated treatment schedule (ABT), which treated the whole left lung followed by the right lung four weeks later. The short-term outcomes of these patients were compared with 37 patients treated with conventional BT scheduling (CBT). The outcome measures used to assess safety were (1) the requirement to remain in hospital beyond the electively planned 24-h admission and (2) the need for re-admission for any cause within of 30 days of treatment. RESULTS: The total number of radiofrequency activations delivered in the ABT group was similar to CBT (187 ± 21 vs 176 ± 40, p = 0.326). With ABT, 11 in 31 admissions (37.9%) required prolonged admission due to wheezing, compared to 5.4% with CBT (p = 0.0025). The mean hospital length of stay with ABT was 1.8 ± 1.3 days, compared to 1.1 ± 0.4 days (p < 0.001). ICU monitoring was required on 5 occasions with ABT (16.1%), compared to 0.9% with CBT (p = 0.002). Subgroup analysis demonstrated that females were more likely to require prolonged admission (OR 11.6, p = 0.0025). The 30-day hospital readmission rate was similar for both groups (6.4% vs 5.4%, p = 0.67). All patients made a complete recovery after treatment with similar outcomes at the 6-month follow-up reassessment. CONCLUSION: This study demonstrates that ABT results in greater short-term deterioration in lung function associated with a greater risk of prolonged hospital and ICU stay, predominantly affecting females. Therefore, in females, these risks need to be balanced against the convenience of fewer treatment sessions. In males, it may be an advantage to compress treatment.

Alveolar to arterial gas exchange during constant-load exercise in healthy active men and women.

Inadequate hyperventilation and inefficient alveolar to arterial gas exchange are gas exchange challenges that can limit capacity and cause exercise-induced arterial hypoxaemia (EIAH). This work evaluated if the prevalence of gas exchange inefficiencies, defined as AaDO2>25 mmHg, PaCO2>38 mmHg, and/or ΔPaO2>-10 mmHg at any point during constant-load exercise in healthy, active, but not highly trained, individuals suggested an innate sex difference that would make females more susceptible to EIAH. Sixty-four healthy, active males and females completed 18-min of cycling exercise (moderate and vigorous intensity, 9 min/stage). Arterial blood gases were measured at rest and every 3-min during exercise, while constantly assessing gas exchange. Both sexes demonstrated similar levels of AaDO2 widening until the final 3 min of vigorous exercise, where females demonstrated a trend for greater widening than males (16.3±6.2 mmHg vs. 19.1±6.0 mmHg, p=0.07). Males demonstrated a blunted ventilatory response to moderate exercise with higher PaCO2 (38.5±2.6 vs. 36.5±2.4, p=0.002) and a lower ventilation when corrected for workload (0.42±0.1 vs. 0.48±0.1, p=0.002). No significant arterial hypoxaemia occurred, but in 6 M and 5 F SaO2 dropped by ≥2%. There was no difference in prevalence of pulmonary gas exchange inefficiencies between sexes, but the type of inefficiency was influenced by sex.Abbreviations: AaDO2: alveolar-arterial oxygen difference; BP: blood pressure; EIAH: exercise-induced arterial hypoxaemia; F: females; HR: heart rate; M: males; Q: cardiac output; PaCO2: arterial partial pressure of carbon dioxide; PaO2: arterial partial pressure of oxygen; ΔPaO2: change in arterial partial pressure of oxygen; PAO2: alveolar partial pressure of oxygen; RPE: rating of perceived exertion; SaO2: arterial oxygen saturation; VE: ventilation; VE/VCO2: ventilatory equivalent for carbon dioxide; VO2PEAK: peak oxygen consumption; WMAX: workload maximum.

Effectiveness of expiratory flow acceleration in patients with Parkinson's disease and swallowing deficiency: A preliminary study.

OBJECTIVES: Parkinson's disease (PD) causes dysfunction both to swallowing and to the cough mechanism. Oropharyngeal dysphagia is the main cause of pneumonia, due to silent aspiration of food and saliva. Pneumonia is the leading cause of death in PD. Different strategies exist to reduce the risk of inhalation and associated lung infections, but evidence of their efficacy is still unclear. The aim of this preliminary study was to investigate if adding an expiratory flow acceleration (EFA®) technique to standard therapy (ST) for dysphagia can reduce the incidence of bronchopulmonary infections and improve quality of life, respiratory function parameters, cough, and airways encumbrance perception. MATERIALS AND METHODS: Twenty-five patients with PD were randomized to two groups: ST vs. ST + EFA. Patients were re-assessed at 30, 180 and 360 days from start of treatment. The primary outcome was the incidence of respiratory exacerbations together with quality of life score (PDQ-39). Secondary outcomes were changes in respiratory function tests, cough capacity (CPEF), perceived health status (Euro-QOL-VAS), cough, and upper airways encumbrance perception evaluated by visual numeric scale (VNS). RESULTS: Twenty patients concluded the study (10 each group). Albeit the difference was not significant, less respiratory infections, symptoms, hospital admissions and medical visits were found in the study group. Furthermore, there was a significant difference in cough effectiveness measured with the peak cough expiratory flow (PCEF) and other spirometry parameters (FEV1, FVC), and also in specific and generic health-related quality of life measures (PDQ-39, Euro-QoL-VAS). CONCLUSION: The results of this preliminary study support the use of EFA® technology in Parkinson's patients with dysphagia to reduce the risk of respiratory complications. Nevertheless, further studies are needed in a larger, more representative sample to definitively confirm the usefulness of this technique in PD patients.

Reduction of peak expiratory flow after a 5-meter dive with extreme exertion.

The effects of physically exerting scuba dives on the airways are expected to affect the respiratory system and therefore the spirometric flow indices directly after surfacing. After on-air open-sea dives, the flow indices were examined with standard spirometry (maximal forced expiration) within 10 minutes pre- and post-dive. Twenty volunteers, age 49 ± 14 years (m ± SD) equipped with a dive computer to record the dive profile, cylinder pressures and water temperature (27°C), as well as a heart rate monitor, performed 5-meter dives of 27 minutes at maximal swimming velocity (v). Mean pulmonary ventilation (PV) was 48 ± 10 ambient L/minute (aL.min-1). Mean v was 34 ± 6 meters/minute and mean heart rate 143 beats per minute, about 80% of the on-land theoretical maximum. None of the flow variables changed except a decrease of 7.1% ± 8.3 (p=0.001) of the peak expiratory flow (PEF), pre-dive of 11.2 ± 2.7 L/minute. A likely major cause of the reduction of PEF is expiratory muscle fatigue. A small contribution of subclinical pulmonary edema cannot be excluded. The inhalation of dry air and the cooling of the airways are expected to affect PEF minimally. Although the change is normally clinically irrelevant, during emergency it may be of importance.

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).

Prognostic value of respiratory index in haemodynamically stable patients with acute pulmonary embolism: The Respiratory Index model study.

BACKGROUND: Current strategies for prognostic stratification in haemodynamically stable patients with acute pulmonary embolism require improvement. The aims of this study in haemodynamically stable patients with acute pulmonary embolism were (a) to evaluate the prognostic value of a novel respiratory index (oxygen saturation in air to respiratory rate ratio) and (b) to derive a risk model which includes the respiratory index and evaluate its value in predicting 30-day mortality. METHODS: Prospective cohorts of haemodynamically stable patients with acute pulmonary embolism were merged to a collaborative database that served to create two subsequent derivation and validation cohorts based on a temporal criterion. The study outcome was 30-day all-cause death. RESULTS: Thirty-day all-cause death occurred in 7.5% and in 6.9% of patients in the derivation and validation cohorts (each composed of 319 patients). In the derivation cohort, the respiratory index (odds ratio 0.66, 95% confidence interval 0.48-0.90) and simplified Pulmonary Embolism Severity Index (odds ratio 9.16, 95% confidence interval 1.22-68.89) were predictors of 30-day mortality. The cut-off value of the respiratory index ⩽3.8 was identified to best predict 30-day all-cause death (15.4% vs 5.0%, odds ratio 2.94, 95% confidence interval 1.22-7.11). The respiratory index ⩽3.8 was combined with the simplified Pulmonary Embolism Severity Index to create the Respiratory Index model that showed a good discriminatory power in the derivation (c-statistic 0.703, 95% confidence interval 0.60-0.80) and in the validation cohort (c-statistic 0.838, 95% confidence interval 0.768-0.907). CONCLUSION: In hemodynamically stable patients with acute pulmonary embolism, the respiratory index was an independent predictor of 30-day all-cause death. The Respiratory Index model which includes the simplified Pulmonary Embolism Severity Index and the respiratory index, provides a good risk stratification of haemodynamically stable patients with acute pulmonary embolism.

Correlation between peak expiratory flow and abdominal muscle activity in elderly women while holding maximum expiration and performing the side bridge exercise.

INTRODUCTION: Expiratory flow is important to minimize the risk of infection by expelling foreign substances from the lungs. Abdominal muscle activities primarily produce expiratory flow. However, data on the association of abdominal muscle activity during expiratory effort and abdominal exercise posture with expiratory flow rate is limited. This study aimed to assess the correlation between expiratory flow and abdominal muscle activity while holding maximum expiration and performing the side bridge exercise in elderly women. METHODS: Rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscle activity was measured using electromyography in 14 elderly women (82.8 ±â€¯6.7 years), who could walk independently while performing 2 tasks: holding their breath after maximum expiration in the crook-lying position (maximum expiration), and performing the side bridge exercise on their knees without breathing instruction (side bridge). Peak expiratory flow (PEF) was obtained using a peak flow meter. Correlations between PEF and the abdominal muscle activity were determined using the Spearman rank correlation coefficient. RESULTS: The correlation coefficients between PEF and RA, EO, and IO activity while holding maximum expiration were 0.407 (p = 0.149), -0.345 (p = 0.227), and 0.732 (p = 0.003), respectively. The correlation coefficients between PEF and RA, EO, and IO activity while performing the side bridge exercise were -0.297 (p = 0.303), -0.552 (p = 0.041), and 0.147 (p = 0.615), respectively. CONCLUSIONS: Higher IO activity while holding maximum expiration or lower EO activity while performing the side bridge exercise was related to higher PEF. Thus, maximum expiration and abdominal exercise might be effective in the improvement or prevention of the decrease of expiratory flow.

Respiratory Disease and Lower Pulmonary Function as Risk Factors for Dementia: A Systematic Review With Meta-analysis.

BACKGROUND: In addition to affecting the oxygen supply to the brain, pulmonary function is a marker of multiple insults throughout life (including smoking, illness, and socioeconomic deprivation). In this meta-analysis of existing longitudinal studies, the hypothesis that lower pulmonary function and respiratory illness are linked to an elevated risk of dementia was tested. METHODS: A systematic review was conducted of longitudinal studies using PubMed until April 1, 2019, and, where possible, results were pooled in random effects meta-analyses. RESULTS: Ten studies relating pulmonary function to later dementia risk and 11 studies of respiratory illness and dementia (including one that assessed both factors) were identified. The lowest quartile of FEV1 compared with the highest was associated with a 1.4-fold (hazard ratio [HR], 1.46; 95% CI, 0.77-2.75) increased dementia risk (Ntotal = 62,209; two studies). A decrease of 1 SD in FEV1 was associated with a 28% increase in dementia risk (HR, 1.28; 95% CI, 1.03-1.60; Ntotal = 67,505; six studies). Respiratory illness was also associated with increased dementia risk to a similar degree (pooled HR, 1.54; 95% CI, 1.30-1.81; Ntotal = 288,641; 11 studies). CONCLUSIONS: Individuals with poor pulmonary function experience an increased risk of dementia. The extent to which the association between poor pulmonary function and dementia is causal remains unclear and requires examination.

Area under the expiratory flow-volume curve (AEX): actual versus approximated values.

Previous work has shown that area under the expiratory flow-volume curve (AEX) performs well in diagnosing and stratifying respiratory physiologic impairment, thereby lessening the need to measure lung volumes. Extending this prior work, the current study assesses the accuracy and utility of several geometric approximations of AEX based on standard instantaneous flows. These approximations can be used in spirometry interpretation when actual AEX measurements are not available. We analysed 15 308 spirometry tests performed on subjects who underwent same-day lung volume assessments in the Pulmonary Function Laboratory. Diagnostic performance of four AEX approximations (AEX1-4) was compared with that of actual AEX. All four computations included forced vital capacity (FVC) and various instantaneous flows: AEX1 was derived from peak expiratoryflow (PEF); AEX2 from PEF and forced expiratoryflow at 50% FVC (FEF50); AEX3 from FVC, PEF, FEF at 25% FVC (FEF25) and at 75% FVC (FEF75), while AEX4 was computed from all four flows, PEF, FEF25, FEF50 and FEF75 Mean AEX, AEX1, AEX2, AEX3 and AEX4 were 6.6, 8.3, 6.7, 6.3 and 6.1 L2/s, respectively. All four approximations had strong correlations with AEX, that is, 0.95-0.99. Differences were the smallest for AEX-AEX4, with a mean of 0.52 (95% CI 0.51 to 0.54) and a SD of 0.75 (95% CI 0.74 to 0.76) L2/s. In the absence of AEX and in addition to the usual spirometric variables used for assessing functional impairments, parameters such as AEX4 can provide reasonable approximations of AEX and become useful new tools in future interpretative strategies.

Flow controlled expiration does not impair pedal power during physical exercise on a bicycle ergometer.

Flow Controlled Expiration (FLEX) has been demonstrated to be lungprotective in models of ARDS during controlled mechanical ventilation. However, modern ventilation strategies in critical care include spontaneous breathing. Therefore, we investigated breathing discomfort and potential performance constraints of FLEX in 24 healthy test persons under increased ventilation demand. The subjects generated 20, 50 or 100 W pedal power on a bicycle ergometer while breathing with and without FLEX and rated breathing discomfort on a scale ranging from 0 (comfortable) to 10 (not tolerable). Then the subjects were asked to indicate the power they could maintain for 30 min with and without FLEX. With FLEX, tidal volume was higher and respiratory rate lower than without. Breathing discomfort was slightly increased by FLEX (on average from 2.2 to 3.2, p = 0.002). The estimated maintainable power was similar with and without FLEX (p = 0.986). We conclude that FLEX does not intolerably increase breathing discomfort and does not impair physical performance.

Combining spirometry and fractional exhaled nitric oxide improves diagnostic accuracy for childhood asthma.

OBJECTIVES: There are insufficient evidences supporting the use of spirometric indices along with tests for airway inflammation to improve diagnostic accuracy for asthma. We aimed to study the utility of combination of spirometric indices and fractional exhaled nitric oxide (FeNO) measured at the initial visit in diagnosing asthma. METHODS: Consecutive children aged 8-16 years who were referred for evaluation of possible asthma were included. At referral, all participants completed FeNO measurements and spirometry. The diagnosis of asthma was established with conventional criteria. Diagnostic performance of the spirometric indices and FeNO was determined using receiver-operator characteristic (ROC) curve analyses. RESULTS: Of 275 participants, 191 children were diagnosed with asthma and showed lower spirometric indices and higher FeNO than non-asthmatics. In the ROC curve analyses, forced expiratory flow between 25% and 75% of vital capacity (FEF25-75 ) percent predicted demonstrated diagnostic performance with the area under the ROC curve (AUC) value of 0.81 (95% CI: 0.76-0.87) which was significantly higher than those for forced expiratory volume in the first second (FEV1 ) percent predicted and FEV1 /forced vital capacity. The combined use of FEF25-75 percent predicted and FeNO improved the AUC to 0.90 (95% CI: 0.86-0.93). In addition, compared to FEF25-75 percent predicted or FeNO alone, this combination improved sensitivity with comparable specificity. CONCLUSIONS: FEF25-75 percent predicted had a better diagnostic value in detection of childhood asthma than other standard spirometric indices and its combination with FeNO improves the diagnostic accuracy for childhood asthma.

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.

Computed tomography-derived area and density of pectoralis muscle associated disease severity and longitudinal changes in chronic obstructive pulmonary disease: a case control study.

BACKGROUND: Muscle wasting is associated with prognosis in patients with chronic obstructive pulmonary disease (COPD). The cross-sectional area of skeletal muscles on computed tomography (CT) could serve as a method to evaluate body composition. The present study aimed to determine the ability of CT-derived pectoralis muscle area (PMA) and pectoralis muscle density (PMD) to determine the severity of COPD and change in longitudinal pulmonary function in patients with COPD. METHODS: A total of 293 participants were enrolled in this study, a whom 222 had undergone at least two spirometry measurements within 3 years after baseline data acquisition. PMA and PMD were measured from a single axial slice of chest CT above the aortic arch at baseline. The emphysema index and bronchial wall thickness were quantitatively assessed in all scans. The generalized linear model was used to determine the correlation between PMA and PMD measurements and pulmonary function. RESULTS: PMA and PMD were significantly associated with baseline lung function and the severity of emphysema (P < 0.05). Patients with the lowest PMA and PMD exhibited significantly more severe airflow obstruction (ß = - 0.06; 95% confidence interval: - 0.09 to - 0.03]. PMA was statistically associated with COPD assessment test (CAT) score (P = 0.033). However, PMD did not exhibit statistically significant correlation with either CAT scores or modified Medical Research Council scores (P > 0.05). Furthermore, neither PMA nor PMD were associated with changes in forced expiratory volume in 1 s over a 3-year periods. CONCLUSIONS: CT-derived features of the pectoralis muscle may be helpful in predicting disease severity in patients with COPD, but are not necessarily associated with longitudinal changes in lung function.

Efeito das estações do ano no pico de fluxo expiratório de idosos institucionalizados e não institucionalizados / Efecto de las estaciones del año en el flujo espiratorio máximo de ancianos institucionalizados y no institucionalizados / Effect of the seasons on the peak expiratory flow in institutionalized and noninstitutionalized elderly

RESUMO As doenças respiratórias afetam milhões de pessoas, principalmente os idosos, e as mudanças climáticas estão entre os fatores predisponentes, interferindo na saúde dessa população. O objetivo deste estudo foi avaliar o pico de fluxo expiratório de idosos institucionalizados e não institucionalizados durante as quatro estações do ano. Estudo de coorte prospectivo com 67 idosos de ambos os sexos, residentes na cidade de Maringá (PR) e divididos em dois grupos: idosos institucionalizados (n=37) e idosos não institucionalizados (n=30). Os dados foram coletados durante um mês, uma vez por semana nas quatro estações do ano, totalizando 16 avaliações. O pico de fluxo expiratório foi avaliado com o equipamento peak flow meter. A comparação dos dois grupos de idosos foi feita por análise de variância de dois fatores utilizando o post-hoc de Bonferroni. A menor média de pico de fluxo expiratório para os idosos institucionalizados e não institucionalizados foi no verão (176,2±60,2 e 263,2±116,2), seguido pelo outono (193,4±59,5 e 287,5±118), inverno (215,3±82,5 e 291,5±08,4) e primavera (221,7±83,5 e 291,5±08,4). Conclui-se que o pico de fluxo expiratório de idosos varia de acordo com as estações do ano, porém os institucionalizados apresentam valores mais baixos. Os mais altos são encontrados na primavera, embora aquém do valor predito para os idosos de ambos os grupos.

RESUMEN Las enfermedades respiratorias afectan a millones de personas, especialmente a los ancianos, y el cambio climático es uno de los factores predisponentes que interfieren en la salud de esta población. El presente estudio tuvo como objetivo evaluar el flujo espiratorio máximo de ancianos institucionalizados y no institucionalizados durante las cuatro estaciones del año. Se realizó un estudio prospectivo de cohorte con 67 ancianos de ambos sexos que viven en la ciudad de Maringá (PR), los cuales se dividieron en dos grupos: ancianos institucionalizados (n=37) y ancianos no institucionalizados (n=30). Los datos se recolectaron durante un mes, una vez a la semana en las cuatro estaciones del año, y totalizó 16 evaluaciones. El flujo espiratorio máximo se evaluó con la herramienta peak flow meter. La comparación de los dos grupos de ancianos se realizó mediante el análisis de la varianza de dos factores utilizando el post hoc de Bonferroni. El promedio más bajo del flujo espiratorio máximo para los ancianos institucionalizados y no institucionalizados se registró en verano (176,2±60,2 y 263,2±116,2), seguido del otoño (193,4±59,5 y 287,5±118), invierno (215,3±82,5 y 291,5±08,4) y primavera (221,7±83,5 y 291,5±08,4). Se concluye que el flujo espiratorio máximo de los ancianos varía según las estaciones del año, sin embargo, los ancianos institucionalizados tienen los valores más bajos. Los más altos se encuentran en la primavera, aunque por debajo del valor previsto para los ancianos de ambos grupos.

ABSTRACT Respiratory diseases affect millions of people, especially the elderly, and climate change is among the predisposing factors interfering with the health of this population. This study aimed to evaluate the peak expiratory flow in institutionalized and noninstitutionalized elderly during the four seasons of the year. A prospective cohort study with 67 elderly men and women living in the city of Maringá, Paraná, Brazil, divided into two groups: institutionalized elderly (n=37) and noninstitutionalized elderly (n=30). The data were collected for one month, once a week in the four seasons of the year, totaling 16 evaluations. The peak expiratory flow was evaluated using the Peak-Flow Meter equipment. The two groups of elderly were compared by two-way analysis of variance using the Bonferroni post-hoc. The lowest mean peak expiratory flow for institutionalized and noninstitutionalized elderly was observed in the summer (176.2±60.2 and 263.2±116.2), followed by fall (193.4±59.5 and 287.5±118), winter (215.3±82.5 and 291.5±08.4), and spring (221.7±83.5 and 291.5±08.4). The conclusion was that the peak of expiratory flow of the elderly varies according to the seasons, but the institutionalized ones have lower values. The highest values are found in the spring, although below the value predicted for the elderly of both groups.

Smoking and lung function among adults with newly onset asthma.

Introduction: Smoking increases the risk of asthma and reduces lung function among subjects with and without asthma. We assessed the effects of smoking on lung function reflecting both central and small airways among adults with newly onset asthma. Methods: In a population-based study, 521 (response rate 86%) working-aged adults with clinically defined newly diagnosed asthma answered a questionnaire on personal smoking and other factors potentially influencing lung function, and performed spirometry. We applied multiple linear regression analysis to estimate the relations between smoking and lung function adjusting for confounding. Results: Among asthmatics, FEV1 level was reduced significantly, on average 208 mL, related to regular smoking (adjusted effect estimate -0.208, 95% CI -0.355 to -0.061) and 245 mL in relation to former smoking, that is, among those who quit less than a year ago (-0.245, 95% CI -0.485 to -0.004). In contrast, FEV1 was not significantly related to occasional smoking or former smoking among those who quit over a year ago. Forced expiratory flow (FEF) levels (L/s) were also significantly reduced among regular smokers (FEF25-75%: -0.372, 95% CI -0.607 to -0.137; FEF50%: -0.476, 95% CI -0.750 to -0.202). An exposure-response pattern related to both daily smoking rate and lifetime cumulative smoking was seen both among men and women. Conclusions: This study provides new evidence that among working-aged adults with new asthma, regular smoking and former smoking reduce lung function levels with a dose-response pattern. The lung function parameters applied as outcomes reflect both larger and smaller airways.

Glucose tolerance in Canadian and French cystic fibrosis adult patients.

Cystic fibrosis (CF)-related diabetes is associated with increased mortality. We analysed the clinical and glycemic profiles of two cohorts of patients treated according to the same guidelines in France and Canada. To investigate incidence differences in phenotypic and glucose abnormalities and to explore the evolution over a 4-year follow-up period, two cohorts of 224 Canadian and 147 French adult CF patients (≥18 years) without treated CF-related diabetes (CFRD) were followed over a 4 year period. In each of these groups, we investigated the longitudinal relationship between glucose tolerance and pulmonary function. An annual 2-hour oral glucose tolerance test was performed: fasting blood glucose (G0) and 2-h blood glucose (G2) were measured. Patients were classified at inclusion according to their glucose tolerance status: Normal glucose tolerant, abnormal glucose tolerant or de novo CFRD. Age, sex ratio and proportion of F508del homozygous patients were not statistically different between both cohorts. Canadian patients had better pulmonary function (median %FEV1 (IQR): 71.0 (55.0-82.0) vs. 64.0 (40.0-78.0), p < 0.001) and greater body mass index (BMI; median BMI in kg/m2) (IQR) 21.1 (19.5-22.8) vs. 19.9 (18.4-21.4), p < 0.001). Glucose values: G0 (5.4 (5.0-5.9) vs. 4.8 (4.5-5.1) mmol/L, p < 0.001) and G2 (7.6 (5.8-9.7) vs. 6.5 (5.2-8.5) mmol/L, p = 0.001) were higher in the Canadian cohort translating into a higher incidence of de novo CFRD diagnosis (19.2 vs. 9.8%, p = 0.003). Decline in FEV1 over time was not different between patients according to glucose tolerance groups. Despite higher glucose levels and incidence of de novo CFRD, Canadian CF patients have a better lung function and a higher BMI than French patients. In spite of these differences between the cohorts, the decline in FEV1 in patients with abnormal glucose tolerance is similar between these groups.