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2.
PLoS One ; 15(8): e0237769, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817718

RESUMO

Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991-1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999-2003, and ECRHS III in 2010-2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean ß (95% CI), comparing active versus non-active individuals: 58 mL (21-95) for forced expiratory volume in one second and 83 mL (36-130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.


Assuntos
Asma/terapia , Exercício Físico , Pulmão/fisiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Asma/etiologia , Asma/fisiopatologia , Peso Corporal/fisiologia , Dieta , Feminino , Volume Expiratório Forçado/fisiologia , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Fumantes , Fumar/efeitos adversos , Capacidade Vital/fisiologia , Adulto Jovem
3.
PLoS One ; 15(8): e0237080, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764779

RESUMO

We previously demonstrated corticosteroid administration on the neonatal intensive care unit was associated with reduced lung function at 11 to 14 years of age in children born very prematurely. The objective of this observational study was to assess if lung function remained impaired at 16 to 19 years of age in those who had received postnatal corticosteroids and whether the trajectory of lung function with increasing age differed between those who had and had not received corticosteroids. One hundred and fifty-nine children born prior to 29 weeks of gestational age had comprehensive lung function measurements; 49 had received postnatal dexamethasone. Lung function outcomes were compared between those who had and had not received postnatal dexamethasone after adjustment for neonatal factors. Forced expiratory flow at 75%, 50%, 25% and 25-75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes (total lung capacity and residual volume) were assessed. The majority of results were significantly lower in those who received dexamethasone (between 0.61 to 0.78 standard deviations). Lung function reduced as the number of courses of dexamethasone increased. Between 11 and 14 years and 16 to 19 years, lung function improved in the unexposed group, but forced expiratory flow at 75% of the expired vital capacity and forced expiratory volume in one second deteriorated in those who had received postnatal corticosteroids (p = 0.0006). These results suggest that prematurely born young people who received postnatal corticosteroids may be at risk of premature onset of chronic obstructive pulmonary disease.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Dexametasona/efeitos adversos , Lactente Extremamente Prematuro/fisiologia , Nascimento Prematuro/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Displasia Broncopulmonar/etiologia , Criança , Dexametasona/administração & dosagem , Feminino , Seguimentos , Volume Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/fisiologia , Humanos , Recém-Nascido , Masculino , Nascimento Prematuro/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Reino Unido/epidemiologia , Capacidade Vital/efeitos dos fármacos , Capacidade Vital/fisiologia
4.
Transplantation ; 104(8): 1712-1719, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732851

RESUMO

BACKGROUND: Spirometry is the cornerstone of monitoring allograft function after lung transplantation (LT). We sought to determine the association of variables on best spirometry during the first year after bilateral LT with 3-year posttransplant survival. METHODS: We reviewed charts of patients who survived at least 3 months after bilateral LT (n = 157; age ± SD: 54 ± 13 y, male:female = 91:66). Best spirometry was calculated as the average of 2 highest measurements at least 3 weeks apart during the first year. Airway obstruction was defined as forced expiratory volume in 1-second (FEV1)/forced vital capacity (FVC) ratio <0.7. Survival was compared based on the ventilatory defect and among groups based on the best FEV1 and FVC measurements (>80%, 60%-80%, and <60% predicted). Primary outcome was 3-year survival. RESULTS: Overall, 3-year survival was 67% (n = 106). Obstructive defect was uncommon (7%) and did not have an association with 3-year survival (72% versus 67%, P = 0.7). Although one-half patients achieved an FVC>80% predicted (49%), 1 in 5 (19%) remained below 60% predicted. Irrespective of the type of ventilatory defect, survival worsened as the best FVC (% predicted) got lower (>80: 80.8%; 60-80: 63.3%; <60: 40%; P < 0.001). On multivariate logistic regression analysis, after adjusting for age, gender, transplant indication, and annual bronchoscopy findings, best FVC (% predicted) during the first year after LT was independently associated with 3-year survival. CONCLUSIONS: A significant proportion of bilateral LT patients do not achieve FVC>80% predicted. Although the type of ventilatory defect on best spirometry does not predict survival, failure to achieve FVC>80% predicted during the first year was independently associated with 3-year mortality.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/cirurgia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Espirometria/estatística & dados numéricos , Adulto , Idoso , Aloenxertos/fisiopatologia , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Estimativa de Kaplan-Meier , Pulmão/fisiopatologia , Pneumopatias/mortalidade , Pneumopatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Espirometria/métodos , Resultado do Tratamento , Capacidade Vital/fisiologia
5.
Respir Res ; 21(1): 163, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600344

RESUMO

OBJECTIVE: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. METHODS: A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. RESULTS: Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. CONCLUSION: Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Músculos Respiratórios/fisiopatologia , Síndrome Respiratória Aguda Grave/diagnóstico , Adulto , Idoso , Distribuição de Qui-Quadrado , China/epidemiologia , Estudos de Coortes , Convalescença , Teste de Esforço , Feminino , Seguimentos , Volume Expiratório Forçado , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Força Muscular , Pandemias , Alta do Paciente , Radiografia Torácica/métodos , Testes de Função Respiratória , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia , Espirometria/métodos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Capacidade Vital/fisiologia
6.
Lancet Respir Med ; 8(11): 1081-1093, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32598906

RESUMO

BACKGROUND: Small airway dysfunction is a common but neglected respiratory abnormality. Little is known about its prevalence, risk factors, and prognostic factors in China or anywhere else in the world. We aimed to estimate the prevalence of small airway dysfunction using spirometry before and after bronchodilation, both overall and in specific population subgroups; assess its association with a range of lifestyle and environmental factors (particularly smoking); and estimate the burden of small airway dysfunction in China. METHODS: From June, 2012, to May, 2015, the nationally representative China Pulmonary Health study invited 57 779 adults to participate using a multistage stratified sampling method from ten provinces (or equivalent), and 50 479 patients with valid lung function testing results were included in the analysis. We diagnosed small airway dysfunction on the basis of at least two of the following three indicators of lung function being less than 65% of predicted: maximal mid-expiratory flow, forced expiratory flow (FEF) 50%, and FEF 75%. Small airway dysfunction was further categorised into pre-small airway dysfunction (defined as having normal FEV1 and FEV1/forced vital capacity [FVC] ratio before bronchodilator inhalation), and post-small airway dysfunction (defined as having normal FEV1 and FEV1/FVC ratio both before and after bronchodilator inhalation). Logistic regression yielded adjusted odds ratios (ORs) for small airway dysfunction associated with smoking and other lifestyle and environmental factors. We further estimated the total number of cases of small airway dysfunction in China by applying present study findings to national census data. FINDINGS: Overall the prevalence of small airway dysfunction was 43·5% (95% CI 40·7-46·3), pre-small airway dysfunction was 25·5% (23·6-27·5), and post-small airway dysfunction was 11·3% (10·3-12·5). After multifactor regression analysis, the risk of small airway dysfunction was significantly associated with age, gender, urbanisation, education level, cigarette smoking, passive smoking, biomass use, exposure to high particulate matter with a diameter less than 2·5 µm (PM2·5) concentrations, history of chronic cough during childhood, history of childhood pneumonia or bronchitis, parental history of respiratory diseases, and increase of body-mass index (BMI) by 5 kg/m2. The ORs for small airway dysfunction and pre-small airway dysfunction were similar, whereas larger effect sizes were generally seen for post-small airway dysfunction than for either small airway dysfunction or pre-small airway dysfunction. For post-small airway dysfunction, cigarette smoking, exposure to PM2·5, and increase of BMI by 5 kg/m2 were significantly associated with increased risk, among preventable risk factors. There was also a dose-response association between cigarette smoking and post-small airway dysfunction among men, but not among women. We estimate that, in 2015, 426 (95% CI 411-468) million adults had small airway dysfunction, 253 (238-278) million had pre-small airway dysfunction, and 111 (104-126) million had post-small airway dysfunction in China. INTERPRETATION: In China, spirometry-defined small airway dysfunction is highly prevalent, with cigarette smoking being a major modifiable risk factor, along with PM2·5 exposure and increase of BMI by 5 kg/m2. Our findings emphasise the urgent need to develop and implement effective primary and secondary prevention strategies to reduce the burden of this condition in the general population. FUNDING: Ministry of Science and Technology of China; National Natural Science Foundation of China; National Health Commission of China.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Broncopatias/epidemiologia , Broncopatias/etiologia , Broncodilatadores/administração & dosagem , Obesidade/complicações , Fumar/efeitos adversos , Adulto , Distribuição por Idade , Broncopatias/diagnóstico , Broncopatias/tratamento farmacológico , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Testes de Função Respiratória , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Fumar/epidemiologia , Espirometria , Capacidade Vital/fisiologia , Adulto Jovem
7.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(6): 520-524, 2020 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-32486559

RESUMO

Objective: To explore the end criteria of forced vital capacity(FVC) curve in adults. Methods: A multicenter cross-sectional study was performed in Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Fujian Medical University, and the Third Affiliated Hospital of Inner Mongolia Medical University from January 2017 to August 2017. A consecutive sample of subjects who completed the spirometry test and FVC curves met end criteria of no volume change (<0.025 L) for ≥ 1 s were qualified in this study. Subjects were divided into a normal group (n=610), an obstructive group (n=536), and a restrictive group(n=306) according to pulmonary function test results. The FET values in different groups were compared. The side effects in the 3 groups and the diagnostic accuracy, specificity and security of different FET in the obstructive group were assessed. Results: The FET values of the normal group, the obstructive group, and the restricted group were (4.00±1.07) s, (8.08±1.56) s and (2.97±0.76) s respectively, and the 95% CI of FET in the 3 groups were between 3.88-4.12 s, 7.02-10.14 and 2.21- 3.73 s (F=2 263.80, P<0.01). When the exhalation platform was used as the standard of FVC curve, the adverse reaction rate in the normal group and the restricted group were 1.1% and 1.3% respectively, lower than the rate of 17.2% in the obstructive group (χ(2)=92.73, χ(2)=48.49 respectively; all P<0.05). In the obstructive group, 7 s as the ending criterion had similar incidence of adverse reactions to 6 s (χ(2)=0.01, P=0.93). With further extension of expiration time, the incidence of adverse reactions increased significantly. In the obstructive group, the sensitivity of FEV(1)/FEV(7) was 99.25%, higher than that at FEV(1)/FEV(6) (χ(2)=4.06, P=0.04), and the specificity of diagnosis was very similar and 100%. Conclusions: FET was variable in subjects with different lung function status. It is not appropriate to use a fixed FET≥ 6 s as the end criterion of spirometry for adults. For patients with normal lung function or restrictive lung function defect, exhalation platform should be used as the end of exhalation standard. For patients with obstructive lung function defect, an FET of up to 7 s is appropriate.


Assuntos
Espirometria/estatística & dados numéricos , Capacidade Pulmonar Total/fisiologia , Capacidade Vital/fisiologia , Adulto , China , Estudos Transversais , Humanos , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade
8.
Thorax ; 75(8): 648-654, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32345689

RESUMO

AIMS: Patients with idiopathic pulmonary fibrosis (IPF) receiving antifibrotic medication and patients with non-IPF fibrosing lung disease often demonstrate rates of annualised forced vital capacity (FVC) decline within the range of measurement variation (5.0%-9.9%). We examined whether change in visual CT variables could help confirm whether marginal FVC declines represented genuine clinical deterioration rather than measurement noise. METHODS: In two IPF cohorts (cohort 1: n=103, cohort 2: n=108), separate pairs of radiologists scored paired volumetric CTs (acquired between 6 and 24 months from baseline). Change in interstitial lung disease, honeycombing, reticulation, ground-glass opacity extents and traction bronchiectasis severity was evaluated using a 5-point scale, with mortality prediction analysed using univariable and multivariable Cox regression analyses. Both IPF populations were then combined to determine whether change in CT variables could predict mortality in patients with marginal FVC declines. RESULTS: On univariate analysis, change in all CT variables except ground-glass opacity predicted mortality in both cohorts. On multivariate analysis adjusted for patient age, gender, antifibrotic use and baseline disease severity (diffusing capacity for carbon monoxide), change in traction bronchiectasis severity predicted mortality independent of FVC decline. Change in traction bronchiectasis severity demonstrated good interobserver agreement among both scorer pairs. Across all study patients with marginal FVC declines, change in traction bronchiectasis severity independently predicted mortality and identified more patients with deterioration than change in honeycombing extent. CONCLUSIONS: Change in traction bronchiectasis severity is a measure of disease progression that could be used to help resolve the clinical importance of marginal FVC declines.


Assuntos
Fibrose Pulmonar Idiopática/diagnóstico por imagem , Fibrose Pulmonar Idiopática/fisiopatologia , Capacidade Vital/fisiologia , Idoso , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Fibrose Pulmonar Idiopática/terapia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores de Tempo , Tomografia Computadorizada por Raios X
9.
Muscle Nerve ; 62(1): 70-75, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32297335

RESUMO

INTRODUCTION: Radiologically inserted gastrostomy (RIG) placement in patients with amyotrophic lateral sclerosis (ALS) carries risks related to periprocedural sedation and analgesia. To minimize these risks, we used a paravertebral block (PVB) technique for RIG placement. METHODS: We retrospectively reviewed patients with ALS undergoing RIG placement under PVB between 2013 and 2017. RESULTS: Ninety-nine patients with ALS underwent RIG placement under PVB. Median (range) age was 66 (28 to 86) years, ALS Functional Rating Scale-Revised score was 27 (6 to 45), and forced vital capacity was 47% (8%-79%) at time of RIG placement. Eighty-five (85.9%) patients underwent RIG placement as outpatients, with a mean postanesthesia care unit stay of 2.3 hours. The readmission rate was 4% at both 1 and 30 days postprocedure. DISCUSSION: PVB for RIG placement has a low rate of adverse events and provides effective periprocedural analgesia in patients with ALS, the majority of whom can be treated as outpatients.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico por imagem , Esclerose Amiotrófica Lateral/cirurgia , Gastrostomia/métodos , Bloqueio Nervoso/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Capacidade Vital/fisiologia
10.
Am J Respir Crit Care Med ; 202(2): 210-218, 2020 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-32289231

RESUMO

Rationale: Chronic obstructive pulmonary disease (COPD) can develop not only through a lung function trajectory dominated by an accelerated decline of FEV1 from normal maximally attained FEV1 in early adulthood (normal maximally attained FEV1 trajectory) but also through a trajectory with FEV1 below normal in early adulthood (low maximally attained FEV1 trajectory).Objectives: To test whether the long-term risk of exacerbations and mortality differs between these two subtypes of COPD.Methods: The cohort included 1,170 young adults enrolled in the Copenhagen City Heart Study during the 1970s and 1980s. In 2001-2003, which served as the baseline for the present analyses, 79 participants had developed COPD through normal maximally attained FEV1 trajectory, 65 had developed COPD through low maximally attained FEV1 trajectory, and 1,026 did not have COPD.Measurements and Main Results: From 2001 until 2018, we observed 139 severe exacerbations of COPD and 215 deaths, of which 55 were due to nonmalignant respiratory disease. In Cox models, there was no difference with regard to risk of severe exacerbations between the two trajectories, but individuals with normal maximally attained FEV1 had an increased risk of nonmalignant respiratory disease mortality (using inverse probability of censoring weighting with adjusted hazard ratio [HR], 6.20; 95% confidence interval [CI], 2.09-18.37; P = 0.001) and all-cause mortality (adjusted HR, 1.93; 95% CI, 1.14-3.26; P = 0.01) compared with individuals with low maximally attained FEV1.Conclusions: COPD developed through normal maximally attained FEV1 trajectory is associated with an increased risk of respiratory and all-cause mortality compared with COPD developed through low maximally attained FEV1 trajectory.


Assuntos
Volume Expiratório Forçado/fisiologia , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Exacerbação dos Sintomas , Capacidade Vital/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais
11.
J Bras Pneumol ; 46(3): e20190138, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32236343

RESUMO

OBJECTIVE: To generate reference values for spirometry in Brazilian children 3-12 years of age and to compare those values with the values employed in the equations currently in use in Brazil. METHODS: This study involved healthy children, 3-12 years of age, recruited from 14 centers (primary data) and spirometry results from children with the same characteristics in six databases (secondary data). Reference equations by quantile regressions were generated after log transformation of the spirometric and anthropometric data. Skin color was classified as self-reported by the participants. To determine the suitability of the results obtained, they were compared with those predicted by the equations currently in use in Brazil. RESULTS: We included 1,990 individuals from a total of 21 primary and secondary data sources. Of those, 1,059 (53%) were female. Equations for FEV1, FVC, the FEV1/FVC ratio, FEF between 25% and 75% of the FVC (FEF25-75%) and the FEF25-75%/FVC ratio were generated for white-, black-, and brown-skinned children. The logarithms for height and age, together with skin color, were the best predictors of FEV1 and FVC. The reference values obtained were significantly higher than those employed in the equations currently in use in Brazil, for predicted values, as well as for the lower limit of normality, particularly in children with self-reported black or brown skin. CONCLUSIONS: New spirometric equations were generated for Brazilian children 3-12 years of age, in the three skin-color categories defined. The equations currently in use in Brazil seem to underestimate the lung function of Brazilian children 3-12 years of age and should be replaced by the equations proposed in this study.


Assuntos
Espirometria/normas , Capacidade Vital/fisiologia , Brasil , Criança , Pré-Escolar , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Valor Preditivo dos Testes , Valores de Referência , Espirometria/métodos
12.
Biomed Res Int ; 2020: 7530498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32185217

RESUMO

Objective: To investigate the pulmonary function responses to respiratory muscle training (RMT) in individuals with tetraplegia and provide a systematic review of the included studies. Methods: Computerized retrieval of randomized controlled trials (RCT) in PubMed, Embase, and the Cochrane Library on the improvement of respiratory function in patients with spinal cord injury by RMT was conducted until May 2019. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Articles were scored for their methodological quality using the Cochrane Collaboration risk of bias assessment tool. Results: Sixteen studies were identified. A significant benefit of RMT was revealed for five outcomes: force vital capacity (FVC, WMD: -0.43, 95% CI -0.84 to -0.03, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12. Conclusion: Our findings demonstrate that RMT can effectively improve spinal cord injury pulmonary function of the patient, which is marked by increasing respiratory strength, function, and endurance. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.


Assuntos
Exercícios Respiratórios , Músculos Respiratórios/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Expiração/fisiologia , Humanos , Inalação/fisiologia , Pulmão/fisiopatologia , Força Muscular/fisiologia , Capacidade Vital/fisiologia
13.
Rev. Asoc. Esp. Espec. Med. Trab ; 29(1): 34-41, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192281

RESUMO

OBJETIVO: Determinar la variación temporal de los valores espirométricos según la altitud geográfica de la sede laboral en un grupo de trabajadores de una minera. MATERIAL Y MÉTODOS: Estudio longitudinal que usó los valores de espirometría tomados en varios años a trabajadores de dos sedes, una a nivel del mar y otra en gran altura de la serranía peruana. Se usó los valores del volumen espiratorio forzado al primer segundo (VEF1), la capacidad vital forzada (CVF) e índice TIffeneau (VEF1/CVF). Se analizó con modelos que permiten ajustar por el tiempo (PA-GEE), con familia Gaussian, función de enlace identity y modelos robustos, la variable tiempo fue el año de la toma de espirometría. Se encontró los valores p y signos de coeficiente en cada caso. RESULTADOS: De 1349 registros el 86% (1162) fueron varones, la mediana de las edades fue 35 años (rango intercuartílico: 22-66 años). En el análisis multivariado se encontró que hubo una variación en los valores del VEF1 y CVF, estos aumentaron en los hombres, entre los que tenían mayor estatura y en los operarios, pero disminuyeron conforme aumentaba la edad del trabajador. El índice TIffeneau únicamente disminuía según la edad del trabajador, ajustado por todas las variables mencionadas. CONCLUSIONES: Según lo analizado, el cambio en los valores espirométricos está influido por las variables socio-antropométricas y el tipo de trabajo que realizan. Esto debe ser aplicado para el seguimiento de trabajadores que estén expuestos a condiciones similares, como parte de programas de vigilancia ocupacional


OBJECTIVE: To determine the temporal variation in spirometric values according to the geographical altitude of labor location on a group of mining workers. MATERIAL AND METHODS: A longitudinal study using spirometry values of workers taken several years at two locations, one at sea level and another at high altitude in the Peruvian highlands. The values of forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and Tiffeneau index (FEV1/FVC) were used. It were analyzed with models that adjust for time (PA-GEE), with Gaussian family, identity link function and robust models, the time variable was the year of spirometry take. P value and coefficients were used in each case. RESULTS: From 1349 records, 86% (1162) were male, the median age was 35 years (interquartile range: 22-66). In multivariate analysis we found that there was a variation in the values of FEV1 and FVC, these increased in men, among those with greater stature and operators, but decreased with increasing age of the worker. The Tiffeneau index decreased only according to age of the worker, adjusted for all variables. CONCLUSIONS: According to these data, the change in spirometric values is influenced by the socio-anthropometric variables and the type of work they do. This must be applied for monitoring of employees who are exposed to similar conditions, as part of occupational surveillance programs


Assuntos
Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Humanos , Masculino , Feminino , Volume Expiratório Forçado/fisiologia , Capacidade Vital/fisiologia , Saúde do Trabalhador , Altitude , Estudos Longitudinais , Espirometria , Peru
14.
Rev. chil. enferm. respir ; 36(1): 13-17, mar. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1115457

RESUMO

Las guías ATS/ERS recomiendan utilizar valores de referencia nacionales para la interpretación de la espirometría. En 2014 se publicaron valores de referencia en población general chilena adulta, que difieren de los de Knudson actualmente en uso. Sin embargo, la mayoría de los laboratorios de función pulmonar siguen utilizando estas últimas ecuaciones. En 2012 se publicaron las ecuaciones multi-étnicas de la Global Lung Function Initiative (GLI) a fin de estandarizar mundialmente la interpretación de los exámenes de función pulmonar Nuestro objetivo fue comparar la concordancia de los informes espirométricos utilizando las ecuaciones más usadas en Chile versus las GLI. Métodos: Se comparó la concordancia en interpretación del patrón espirométrico (normal, obstructivo y restrictivo) y el grado de alteración, entre GLI con Gutiérrez 2014, con Knudson, y con NHANES III según las recomendaciones de la Sociedad Chilena de Enfermedades Respiratorias, a través del coeficiente de concordancia Kappa (K). Se estudiaron 315 sujetos mayores de 40 años (55% mujeres, edad: 59,3 ± 9,2 años), fumadores o ex fumadores, sanos o con EPOC, sometidos a una espirometría con broncodilatador como parte de un reconocimiento respiratorio. Se graficaron las diferencias utilizando el método de Bland-Altman. Resultados: La concordancia para patrón entre GLI con Gutiérrez 2014, con Knudson y con NHANES III fue buena (K = 0,73; 0,71 y 0,77 respectivamente), al igual que para patrón y grado de alteración (K = 0,68; 0,67 y 0,76 respectivamente). Conclusiones: Encontramos una buena concordancia entre las ecuaciones más usadas en Chile y las de GLI, en una muestra que incluyó adultos, fumadores, ex fumadores sanos y enfermos.


ATS/ERS recommend the use of national reference values for the interpretation of spirometry. Reference values were published (2014) in general adult Chilean population, which are different from those of Knudson currently in use. However, most pulmonary function laboratories continue to use these latter equations. Multi-ethnic Global Lung Function Initiative (GLI) equations were published (2012) in order to standardize the interpretation of pulmonary function tests worldwide. Our objective was to evaluate the agreement in the spirometric reports between the most used equations in Chile with those from GLI. Methods: We compared the agreement in the interpretation of the spirometric pattern (normal, obstructive and restrictive) and the degree of alteration between GLI with Gutiérrez 2014, with Knudson and with NHANES III according to recommendations of the Chilean Society of Respiratory Diseases, through the Kappa concordance coefficient (K). The sample correspond to 315 adults over 40 years of age (55% women, 59.3 ± 9.2 years-old), smokers or ex-smokers, healthy or with COPD, who underwent spirometry with a bronchodilator as part of a respiratory check-up. Differences were plotted using the Bland-Altman method. Results: agreement for pattern between GLI with Gutiérrez 2014, with Knudson and with NHANES III was good (K = 0.73, 0.71 and 0.77 respectively) and also was good for the pattern and degree of alteration (K = 0.68, 0.67 and 0.76 respectively). Conclusions: We found a good agreement between the equations most used in Chile and those from the GLI, for a sample that includes subjects with and without lung disease, smokers and ex-smokers.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Espirometria/métodos , Espirometria/normas , Pulmão/fisiologia , Modelos Teóricos , Valores de Referência , Testes de Função Respiratória/métodos , Testes de Função Respiratória/normas , Sociedades Médicas , Capacidade Vital/fisiologia , Volume Expiratório Forçado/fisiologia
15.
Thorax ; 75(4): 313-320, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32098862

RESUMO

BACKGROUND: Previous studies have reported an association between weight increase and excess lung function decline in young adults followed for short periods. We aimed to estimate lung function trajectories during adulthood from 20-year weight change profiles using data from the population-based European Community Respiratory Health Survey (ECRHS). METHODS: We included 3673 participants recruited at age 20-44 years with repeated measurements of weight and lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)) in three study waves (1991-93, 1999-2003, 2010-14) until they were 39-67 years of age. We classified subjects into weight change profiles according to baseline body mass index (BMI) categories and weight change over 20 years. We estimated trajectories of lung function over time as a function of weight change profiles using population-averaged generalised estimating equations. RESULTS: In individuals with normal BMI, overweight and obesity at baseline, moderate (0.25-1 kg/year) and high weight gain (>1 kg/year) during follow-up were associated with accelerated FVC and FEV1 declines. Compared with participants with baseline normal BMI and stable weight (±0.25 kg/year), obese individuals with high weight gain during follow-up had -1011 mL (95% CI -1.259 to -763) lower estimated FVC at 65 years despite similar estimated FVC levels at 25 years. Obese individuals at baseline who lost weight (<-0.25 kg/year) exhibited an attenuation of FVC and FEV1 declines. We found no association between weight change profiles and FEV1/FVC decline. CONCLUSION: Moderate and high weight gain over 20 years was associated with accelerated lung function decline, while weight loss was related to its attenuation. Control of weight gain is important for maintaining good lung function in adult life.


Assuntos
Índice de Massa Corporal , Peso Corporal/fisiologia , Estilo de Vida , Obesidade/epidemiologia , Testes de Função Respiratória/métodos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , União Europeia , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Obesidade/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Medição de Risco , Fatores Sexuais , Capacidade Vital/fisiologia , Ganho de Peso/fisiologia , Perda de Peso/fisiologia , Adulto Jovem
16.
Respir Res ; 21(1): 36, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000772

RESUMO

BACKGROUND: In the Phase III INPULSIS® trials, treatment of patients with idiopathic pulmonary fibrosis (IPF) with nintedanib significantly reduced the annual rate of decline in forced vital capacity (FVC) versus placebo, consistent with slowing disease progression. However, nintedanib was not associated with a benefit in health-related quality of life (HRQoL) assessed using the St George's respiratory questionnaire (SGRQ). We aimed to further examine the impact of IPF progression on HRQoL and symptoms, and to explore the effect of nintedanib on HRQoL in patients from the INPULSIS® trials stratified by clinical factors associated with disease progression. METHODS: Patient-reported outcome (PRO) data from the INPULSIS® trials were included in three post hoc analyses. Two analyses used the pooled data set to examine PRO changes from baseline to week 52 according to 1) decline in FVC and 2) occurrence of acute exacerbations. In the third analysis, patients were stratified based on clinical indicators of disease progression (gender, age and physiology [GAP] stage; FVC % predicted; diffusing capacity of the lung for carbon monoxide [DLCO] % predicted; composite physiologic index [CPI]; and SGRQ total score) at baseline; median change from baseline was measured at 52 weeks and treatment groups were compared using the Wilcoxon two-sample test. RESULTS: Data from 1061 patients (638 nintedanib, 423 placebo) were analyzed. Greater categorical decline from baseline in FVC % predicted over 52 weeks was associated with significant worsening of HRQoL and symptoms across all PRO measures. Acute exacerbations were associated with deterioration in HRQoL and worsened symptoms. In general, patients with advanced disease at baseline (defined as GAP II/III, FVC ≤ 80%, DLCO ≤ 40%, CPI >  45, or SGRQ > 40) experienced greater deterioration in PROs than patients with less-advanced disease. Among patients with advanced disease, compared with placebo, nintedanib slowed deterioration in several PROs; benefit was most apparent on the SGRQ (total and activity scores). CONCLUSIONS: In patients with advanced IPF, compared with placebo, nintedanib slowed deterioration in HRQoL and symptoms as assessed by several PROs. HRQoL measures have a higher responsiveness to change in advanced disease and may lack sensitivity to capture change in patients with less-advanced IPF.


Assuntos
Fibrose Pulmonar Idiopática/tratamento farmacológico , Fibrose Pulmonar Idiopática/psicologia , Indóis/uso terapêutico , Qualidade de Vida/psicologia , Capacidade Vital/efeitos dos fármacos , Idoso , Método Duplo-Cego , Feminino , Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Indóis/farmacologia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Inibidores de Proteínas Quinases/farmacologia , Inibidores de Proteínas Quinases/uso terapêutico , Resultado do Tratamento , Capacidade Vital/fisiologia
17.
BMC Public Health ; 20(1): 6, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906909

RESUMO

BACKGROUND: Although previous studies have reported the benefits of physical activity (PA) to lung function in middle-aged and older adults, the biological mechanisms are still unclear. This study aimed to assess the extent to which C-reactive protein (CRP) mediates the association between leisure-time PA and lung function. METHODS: A population-based sample was recruited from English Longitudinal Study of Ageing (ELSA), Wave 6 (2012-2013). PA was self-reported by questionnaires. CRP was analyzed from peripheral blood. Lung function parameters including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by using a spirometer. Baron and Kenny's causal steps method and multiple linear regression models based on the Karlson/Holm/Bree (KHB) method were used to assess the mediating effect. RESULTS: Among 6875 participants, 28.4% were classified into low PA, 49.8% into moderate PA, and 21.8% into high PA. Multiple linear regression models suggested that higher PA was associated with lower levels of CRP (ß = - 0.048, P = 0.002 for moderate PA; ß = - 0.108, P < 0.001 for high PA). CRP negatively correlated with FEV1 (ß = - 0.180, P < 0.001) and FVC (ß = - 0.181, P < 0.001). Higher levels of PA were associated with better FEV1 (ß = 0.085, P < 0.001 for moderate PA; ß = 0.150, P < 0.001 for high PA) and FVC (ß = 0.131, P < 0.001 for moderate PA; ß = 0.211, P < 0.001 for high PA). After introducing the CRP into the models, regression coefficients of PA with FEV1 (ß = 0.077, P < 0.001 for moderated PA; ß = 0.130, P < 0.001 for high PA) and FVC (ß = 0.123, P < 0.001 for moderated PA; ß = 0.188, P < 0.001 for high PA) decreased. The indirect effect of high PA on lung function via CRP was significant, with 9.42-12.99% of the total effect being mediated. CONCLUSIONS: The association between PA and lung function is mediated by CRP, suggesting that this association may be partially explained by an inflammation-related biological mechanism. This finding highlights the possible importance of PA in systemic inflammation and lung function, thus, middle-aged and older adults should be encouraged to enhance PA levels.


Assuntos
Proteína C-Reativa/análise , Exercício Físico/fisiologia , Volume Expiratório Forçado/fisiologia , Atividades de Lazer , Capacidade Vital/fisiologia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Autorrelato
18.
Sci Rep ; 10(1): 1238, 2020 01 27.
Artigo em Inglês | MEDLINE | ID: mdl-31988425

RESUMO

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide. COPD is frequently punctuated by acute exacerbations that are precipitated primarily by infections, which increase both morbidity and mortality and inflates healthcare costs. Despite the significance of exacerbations, little understanding of immune function in COPD exacerbations exists. Natural killer (NK) cells are important effectors of innate and adaptive immune responses to pathogens and NK cell function is altered in smokers and COPD. Using high-dimensional flow cytometry, we phenotyped peripheral blood NK cells from never smokers, smokers, and COPD patients and employed a non-supervised clustering algorithm to define and detect changes in NK cell populations. We identified greater than 1,000 unique NK cell subpopulations across patient groups and describe 13 altered NK populations in patients who experienced prior exacerbations. Based upon cluster sizes and associated fluorescence data, we generated a logistic regression model to predict patients with a history of exacerbations with high sensitivity and specificity. Moreover, highly enriched NK cell subpopulations implicated in the regression model exhibited enhanced effector functions as defined by in vitro cytotoxicity assays. These novel data reflect the effects of smoking and disease on peripheral blood NK cell phenotypes, provide insight into the potential immune pathophysiology of COPD exacerbations, and indicate that NK cell phenotyping may be a useful and biologically relevant marker to predict COPD exacerbations.


Assuntos
Células Matadoras Naturais/classificação , Células Matadoras Naturais/metabolismo , Doença Pulmonar Obstrutiva Crônica/imunologia , Adulto , Feminino , Citometria de Fluxo/métodos , Humanos , Células Matadoras Naturais/fisiologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/metabolismo , Fatores de Risco , Capacidade Vital/fisiologia
19.
PLoS One ; 15(1): e0227730, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945115

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with poor quality of life, hospitalization and mortality. COPD phenotype includes using pulmonary function tests to determine airflow obstruction from the forced expiratory volume in one second (FEV1):forced vital capacity. FEV1 is a commonly used value for severity but is difficult to identify in structured electronic health record (EHR) data. DATA SOURCE AND METHODS: Using the Microsoft SQL Server's full-text search feature and string functions supporting regular-expression-like operations, we developed an automated tool to extract FEV1 values from progress notes to improve ascertainment of FEV1 in EHR in the Veterans Aging Cohort Study (VACS). RESULTS: The automated tool increased quantifiable FEV1 values from 12,425 to 16,274 (24% increase in numeric FEV1). Using chart review as the reference, positive predictive value of the tool was 99% (95% Confidence interval: 98.2-100.0%) for identifying quantifiable FEV1 values and a recall value of 100%, yielding an F-measure of 0.99. The tool correctly identified FEV1 measurements in 95% of cases. CONCLUSION: A SQL-based full text search of clinical notes for quantifiable FEV1 is efficient and improves the number of values available in VA data. Future work will examine how these methods can improve phenotyping of patients with COPD in the VA.


Assuntos
Mineração de Dados/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Volume Expiratório Forçado/fisiologia , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Capacidade Vital/fisiologia , Estudos de Coortes , Sistemas de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Pulmão/fisiopatologia , Processamento de Linguagem Natural , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Software , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/estatística & dados numéricos
20.
Thorax ; 75(2): 116-122, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31896733

RESUMO

BACKGROUND: Fractal dimension (D) characterises the size distribution of low attenuation clusters on CT and assesses the spatial heterogeneity of emphysema that per cent low attenuation volume (%LAV) cannot detect. This study tested the hypothesis that %LAV and D have different roles in predicting decline in FEV1, exacerbation and mortality in patients with COPD. METHODS: Chest inspiratory CT scans in the baseline and longitudinal follow-up records for FEV1, exacerbation and mortality prospectively collected over 10 years in the Hokkaido COPD Cohort Study were examined (n=96). The associations between CT measures and long-term outcomes were replicated in the Kyoto University cohort (n=130). RESULTS: In the Hokkaido COPD cohort, higher %LAV, but not D, was associated with a greater decline in FEV1 and 10-year mortality, whereas lower D, but not %LAV, was associated with shorter time to first exacerbation. Multivariable analysis for the Kyoto University cohort confirmed that lower D at baseline was independently associated with shorter time to first exacerbation and that higher LAV% was independently associated with increased mortality after adjusting for age, height, weight, FEV1 and smoking status. CONCLUSION: These well-established cohorts clarify the different prognostic roles of %LAV and D, whereby lower D is associated with a higher risk of exacerbation and higher %LAV is associated with a rapid decline in lung function and long-term mortality. Combination of %LAV and fractal D may identify COPD subgroups at high risk of a poor clinical outcome more sensitively.


Assuntos
Causas de Morte , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Estudos de Coortes , Feminino , Volume Expiratório Forçado/fisiologia , Fractais , Hospitais Universitários , Humanos , Japão , Estimativa de Kaplan-Meier , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/mortalidade , Radiografia Torácica/métodos , Testes de Função Respiratória , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Capacidade Vital/fisiologia
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