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1.
Prim Care ; 48(4): 645-654, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752275

RESUMO

Pulmonary function testing (PFT) is an important component of the evaluation, monitoring, and management of patients with suspected or established lung disease. Spirometry is easily accomplished in the primary care office setting; determination of lung volumes and diffusion capacity is performed in a pulmonary laboratory. Spirometry evaluates vital capacity of the lungs and expiratory flow rates and provides both numeric data and a graphic depiction of respiratory air flow. Characteristic patterns in spirometry-derived data allow the clinician to identify potential lung disease, as well as establish relative reversibility of airflow abnormalities.


Assuntos
Volume Expiratório Forçado , Humanos , Medidas de Volume Pulmonar , Testes de Função Respiratória , Espirometria , Capacidade Vital
2.
Int J Chron Obstruct Pulmon Dis ; 16: 2953-2962, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34737560

RESUMO

Introduction: Chronic obstructive pulmonary disease (COPD) is a worldwide public health problem. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as a common, preventable and treatable disease characterized by progressive airflow limitation. Nowadays, COPD has become the third leading cause of death and fourth cause of mortality in the world. Objective: To assess chronic obstructive pulmonary disease and associated factors in Arba Minch - Health and Demographic Surveillance Site (AMU-HDSS) of Arba Minch University. Methods: A community-based cross-sectional study was conducted in AMU-HDSS among 615 individuals who were >15 years of age. Study participants were selected randomly by the lottery method. Spirometer device was used to measure lung function. Binary logistic regression analysis was computed to assess the crude association between dependent and independent variables. Finally, variables which showed association in binary logistic regression analysis and have a P-value less than 0.3 were entered into multivariable logistic regression model to identify significant factors. Results: The prevalence of spirometry diagnosed COPD was 10.6%. Highland residence showed higher proportion of COPD case which accounts 63.8% compared to 36.2% in lowland residence. Study participants who were in advanced age >41 years adjusted odd ratio (AOR) 3.65 (1.83, 7.28), living in highland area AOR 1.71 (1, 2.92), those who are elementary education level 2.45 (1.13, 5.28), who had no separate house for domestic animals AOR 2.84 (1.38, 5.85), having house which had no windows AOR 3.05 (5.79, 1.12) and living in traditional hut (tukulu), AOR 5.92 (1.19, 29.42) were significantly associated with chronic obstructive pulmonary disease in the study area. Conclusion and Recommendation: Chronic obstructive pulmonary disease was one of respiratory illnesses in people who live in highland and traditional house lacking windows for air circulation. Improving housing condition of traditional hut by constructing window, separating domestic animals house from humans and minimizing animal dung smoke exposure is necessary to reduce the respiratory illness.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Adulto , Animais , Estudos Transversais , Humanos , Modelos Logísticos , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Espirometria
3.
J Glob Health ; 11: 04065, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34737865

RESUMO

Background: Our previous scoping review revealed limitations and inconsistencies in population surveys of chronic respiratory disease. Informed by this review, we piloted a cross-sectional survey of adults in four South/South-East Asian low-and middle-income countries (LMICs) to assess survey feasibility and identify variables that predicted asthma or chronic obstructive pulmonary disease (COPD). Methods: We administered relevant translations of the BOLD-1 questionnaire with additional questions from ECRHS-II, performed spirometry and arranged specialist clinical review for a sub-group to confirm the diagnosis. Using random sampling, we piloted a community-based survey at five sites in four LMICs and noted any practical barriers to conducting the survey. Three clinicians independently used information from questionnaires, spirometry and specialist reviews, and reached consensus on a clinical diagnosis. We used lasso regression to identify variables that predicted the clinical diagnoses and attempted to develop an algorithm for detecting asthma and COPD. Results: Of 508 participants, 55.9% reported one or more chronic respiratory symptoms. The prevalence of asthma was 16.3%; COPD 4.5%; and 'other chronic respiratory disease' 3.0%. Based on consensus categorisation (n = 483 complete records), "Wheezing in last 12 months" and "Waking up with a feeling of tightness" were the strongest predictors for asthma. For COPD, age and spirometry results were the strongest predictors. Practical challenges included logistics (participant recruitment; researcher safety); misinterpretation of questions due to local dialects; and assuring quality spirometry in the field. Conclusion: Detecting asthma in population surveys relies on symptoms and history. In contrast, spirometry and age were the best predictors of COPD. Logistical, language and spirometry-related challenges need to be addressed.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Adulto , Asma/diagnóstico , Asma/epidemiologia , Estudos Transversais , Países em Desenvolvimento , Humanos , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Espirometria , Inquéritos e Questionários
4.
An Pediatr (Engl Ed) ; 95(5): 298-306, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34776098

RESUMO

INTRODUCTION: Necrotizing pneumonia (NP) is a serious complication of community-acquired pneumonia characterised by the destruction of normal lung parenchyma. No study has evaluated the repercussions of the lung damage in the years following the episode. The aim of this study was to assess the long-term impact on lung function and respiratory symptoms in children hospitalised due to NP. METHODS: We analysed outcomes in children given a diagnosis of NP between January 2003 and April 2016. We selected patients aged more than 4 years capable of undergoing a lung function test, that had been followed up for at least 2 years. The patients completed a respiratory questionnaire and underwent a lung function test. RESULTS: We included a total of 24 patients (12 male). The median age at the time of diagnosis was 28 months, the median length of stay was 15 days, and 18 patients required pleural drainage. The mean duration of follow-up after NP was 8.75 years. During the evaluation, none of the patients exhibited asthma, cough, or exercise-induced symptoms. Three children had a second episode of pneumonia that did not require hospital admission. The spirometry results were the following (given as mean±standard deviation): FEV1 Z-score, -0.47±0.65; FVC Z-score, -0.56±0.73; and FEV1/FVC Z-score, 0.19±0.98. We found no evidence of obstructive pulmonary disease or restrictive patterns. CONCLUSIONS: The long-term outcomes of paediatric NP are good. However, patients exhibited mildly impaired lung function several years after the episode. We recommend follow-up of these patients due to potential impairments in lung function in adulthood.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia Necrosante , Pneumonia , Adulto , Criança , Humanos , Pulmão , Masculino , Espirometria
5.
Int J Chron Obstruct Pulmon Dis ; 16: 3093-3103, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795480

RESUMO

Background and Objectives: Despite a population of 600,000 people from 900 islands, there is little published data on the prevalence of lung disease in the Solomon Islands. We sought to 1) estimate the prevalence of obstructive lung disease (OLD) in Gizo, Solomon Islands, 2) identify risk factors for respiratory disease in this population and 3) review current management practices for respiratory disease through an audit of local emergency department (ED) presentations. Methods: A two-part mixed methods study was performed between March and May 2019; the first was a population-based, cross-sectional study conducted in Gizo, Solomon Islands, with a random sample undergoing questionnaires and spirometry. The second was an audit of Gizo Hospital ED records to assess presentation numbers, diagnoses and outcomes. Results: A total of 104 patients were randomly selected for spirometry. The mean age was 46.9 years. Current smoking rates were high (24.0% overall, 43.3% age < 40, 16.2% age ≥ 40) as was regular (>10h/week) exposure to indoor/enclosed wood fire ovens (51.5%). The prevalence of COPD was 3.2% overall. A further 9.7% of participants demonstrated significant bronchodilator responsiveness suggestive of possible asthma. Most patients seen in ED presented with a respiratory condition or fever/viral illness, but spirometry was not available. Only four outpatients were prescribed salbutamol and two patients inhaled corticosteroid. Conclusion: There appears to be a high burden of obstructive lung disease in the Solomon Islands with high smoking rates, indoor smoke exposure and bronchodilator responsiveness. Respiratory symptoms are common amongst hospital ED presentations; however, inhaled asthma treatments are infrequently prescribed to outpatients.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Broncodilatadores/uso terapêutico , Estudos Transversais , Humanos , Pulmão , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Espirometria
6.
Int J Chron Obstruct Pulmon Dis ; 16: 3083-3091, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34803377

RESUMO

Introduction: Few studies have examined the prevalence and associated factors of early chronic obstructive pulmonary disease (COPD) in Asians. Objective: To evaluate the prevalence of early COPD and its associated factors among non-institutionalized middle-aged Korean adults. Methods: A total of 3195 participants aged 40-49 years from the 2016-2018 Korea National Health and Nutrition Examination Survey were included in this study. Patients (1) aged less than 50 years, (2) with a minimum of 10 pack-years of smoking, and (3) with forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) below the lower limit of normal were diagnosed with early COPD. The prevalence and odds ratio (OR) for early COPD were measured using multivariate logistic regression analysis, and the demographic data, anthropometric measurements, socioeconomic status, and lifestyle factors were considered covariates. Results: The overall prevalence of early COPD among the middle-aged Korean population was 2.4% (4.4% in men and 0.4% in women), while that in participants with ≥10 pack-years was 8.2% (8.1% in men and 11.3% in women). A multivariate logistic regression model showed that male sex, urban residence, chronic sputum production, and hypertriglyceridemia were associated with increased ORs for early COPD in middle-aged, non-institutionalized Korean adults. Conclusion: Early COPD is prevalent among middle-aged smokers in Korea. Efforts are needed to reduce the potential negative effects of early COPD on public health in Korea and other Asian countries.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Adulto , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , Espirometria , Capacidade Vital
7.
Sensors (Basel) ; 21(22)2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34833650

RESUMO

Non-contact physiological measurements have been under investigation for many years, and among these measurements is non-contact spirometry, which could provide acute and chronic pulmonary disease monitoring and diagnosis. This work presents a feasibility study for non-contact spirometry measurements using a mobile thermal imaging system. Thermal images were acquired from 19 subjects for measuring the respiration rate and the volume of inhaled and exhaled air. A mobile application was built to measure the respiration rate and export the respiration signal to a personal computer. The mobile application acquired thermal video images at a rate of nine frames/second and the OpenCV library was used for localization of the area of interest (nose and mouth). Artificial intelligence regressors were used to predict the inhalation and exhalation air volume. Several regressors were tested and four of them showed excellent performance: random forest, adaptive boosting, gradient boosting, and decision trees. The latter showed the best regression results, with an R-square value of 0.9998 and a mean square error of 0.0023. The results of this study showed that non-contact spirometry based on a thermal imaging system is feasible and provides all the basic measurements that the conventional spirometers support.


Assuntos
Inteligência Artificial , Respiração , Expiração , Humanos , Taxa Respiratória , Espirometria
8.
Int J Chron Obstruct Pulmon Dis ; 16: 3065-3082, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795479

RESUMO

Background: Bronchodilator responsiveness (BDR) is commonly used in the diagnosis of lung disease. Although small airways dysfunction is a feature of asthma and COPD, physiological tests of small airways are not included in guidelines for BDR testing. This systematic review assessed the current evidence of BDR using small airways function in asthma and COPD. Methods: The systematic review used standard methodology with the protocol prospectively registered on PROSPERO (CRD42020164140). Electronic medical databases (EMBASE and Medline) were searched using related keywords. Abstracts and full texts were screened independently by two reviewers. Studies that reported the change of physiological small airways function and FEV1 were included in the review. The revised Cochrane risk of bias tool for RCT and NIH quality assessment tool for cohort and cross-sectional studies were used to evaluate the studies. Results: A total of 934 articles were identified, with 12 meeting the inclusion criteria. Ten studies included asthma patients, 1 study included COPD patients and 1 study included both asthma and COPD. A total of 1104 participants were included, of whom 941 were asthmatic, 64 had COPD and 109 were healthy controls. Studies were heterogeneous in design including the device, dose and time intervals for BDR assessment. A small airway BDR was seen for most tests in asthma and COPD, including oscillometry (R5-20, reactance (X5), area of reactance (AX) and resonant frequency (Fres)) and Maximal Mid Expiratory Flow. Conclusion: There is a measurable BDR in the small airways. However, with no consensus on how to assess BDR, studies were heterogeneous. Further research is needed to inform how BDR should be assessed, its clinical impact and place in routine clinical practice.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Adulto , Asma/diagnóstico , Asma/tratamento farmacológico , Broncodilatadores , Estudos Transversais , Volume Expiratório Forçado , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Espirometria
10.
Int J Chron Obstruct Pulmon Dis ; 16: 2769-2781, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34675502

RESUMO

Background: Readmission following COPD exacerbation is a common and challenging clinical problem. New approaches to predicting readmissions are required to help mitigate risk and develop novel interventions. Methods: We conducted a prospective cohort study in 82 COPD patients admitted due to an exacerbation of COPD. Lung function measures [spirometry, forced oscillation technique (FOT) indices and peak inspiratory flow rate (PIFR)], inflammatory biomarkers and patient-reported outcomes including previous exacerbation history, breathlessness, quality of life and frailty were measured at admission and discharge. We prospectively followed patients for 30 and 90 days to identify predictors for readmission. Results: The readmission rate within 30 days was 38%, and 56% within 90 days. Previous exacerbations, higher COPD Assessment Test score at discharge, frailty, reduced PIFR and increased length of stay were significantly associated with 30-day readmission. PIFR at discharge and frailty had the highest predictive ability for 30-day readmission using area under receiver operating characteristic curves (AUC 0.86, 95% CI 0.78-0.95, p < 0.001 and AUC 0.81, 95% CI 0.71-0.90, p < 0.001, respectively). Ninety-day readmissions were significantly associated with previous exacerbations and hospitalisations, higher CAT score at discharge, frailty, depression, lower PIFR and greater expiratory flow limitation (EFL) in the supine position. The best predictive variable in multivariable analysis for both 30- and 90-day readmission was PIFR at discharge. Conclusion: PIFR, CAT score, frailty, and EFL were found to be associated with 30- and 90-day readmission following COPD exacerbation. These findings help identify those at highest risk and to optimise care prior to discharge.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Progressão da Doença , Humanos , Readmissão do Paciente , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Fatores de Risco , Espirometria
11.
Int J Chron Obstruct Pulmon Dis ; 16: 2833-2843, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34703219

RESUMO

Background: COPD prevalence and mortality in Kyrgyzstan are high. Data on clinical and economic impact of COPD in Kyrgyzstan are scarce. This study was part of the FRESH AIR research project that focused on prevention, diagnosis and treatment of chronic lung diseases in low-resource settings. Aim: We aimed to evaluate the clinical characteristics, treatment patterns and economic burden of COPD in Kyrgyzstan. Methods: A representative sample of patients with a spirometry-confirmed diagnosis of COPD was included. All patients were registered in one of the five major hospitals in Kyrgyzstan. Patients were surveyed on COPD risk factors, health-care utilization and patient reported outcomes (CCQ, MRC). Associations with high symptom burden (MRC score ≥4) and cost were assessed using logistic regression analyses. Results: A total of 306 patients were included with mean age 62.1 (SD: 11.2), 61.4% being male, mean BMI 26.9 (SD: 5.2) and mean monthly income $85.1 (SD: 75.4). Biomass was used for heating and cooking by 71.2% and 52.0%. Current and ex-smokers accounted 14.1% and 32%. Mean FEV1 was 46% (SD: 12.8), 71.9% had COPD GOLD III-IV and most frequent co-morbidities were hypertension (25.2%), diabetes (5.6%) and heart diseases (4.6%). Mean CCQ score was 2.0 (SD: 0.9) and MRC score 3.7 (SD: 0.9). Yearly mean number of hospital days due to COPD was 10.1 (SD: 3.9). Total annual per-patient costs of reimbursed health-care utilization ($107) and co-payments ($224, ie, 22% of patients' annual income) were $331. We found that only GOLD IV and hypertension were significantly associated with high symptom burden. Exacerbations and hypertension were significantly associated with high cost. Conclusion: The clinical and economic burden of COPD on patients and the government in Kyrgyzstan is considerable. Notably, almost half of interviewed patients were current or ex-smokers and biomass exposure was high.


Assuntos
Efeitos Psicossociais da Doença , Doença Pulmonar Obstrutiva Crônica , Feminino , Humanos , Quirguistão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Testes de Função Respiratória , Espirometria
12.
Int J Chron Obstruct Pulmon Dis ; 16: 2883-2894, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34703222

RESUMO

Purpose: To evaluate the value of impulse oscillometry (IOS) and quantitative HRCT parameters for differentiating asthma-COPD overlap (ACO) in COPD patients. Patients and Methods: We enrolled 44 controls and 66 COPD patients, divided into the pure COPD group (n=40) and the ACO group (n=26). Spearman correlation analysis was utilized to assess the relationship between the quantitative HRCT and IOS parameters. A binary logistic regression analysis was performed to analyze the associations between the different variables and the risk of ACO. Receiver operating characteristic (ROC) curves were employed to identify the optimal cutoff and assess the diagnostic value of relative volume change -856 HU to -950 HU (RVC-856 to -950), decrease in the resistance from 5 Hz to 20 Hz (R5-R20) and their combination in predicting ACO. Bootstrapping validation was used to evaluate the internal validation. The concordance index (C-index) and calibration plot were calculated to assess the discrimination and calibration of the prediction model. Results: Binary logistic regression analysis indicated that RVC-856 to -950 and the IOS parameters (R5-R20, R5, X5) were independently correlated with a higher risk of developing ACO after adjusting for age, sex, body mass index (BMI), history of smoking, exacerbation and atopy or allergic rhinitis. A correlation analysis showed a good correlation between the pulmonary function parameters and RVC-856 to -950, with a weaker correlation with the % area of low attenuation (LAA%) in ACO patients. Combining RVC-856 to -950 and R5-R20 to predict ACO, the AUC was 0.909, and the optimal cutoff value was >-0.62 for RVC-856 to -950 and >0.09 for R5-R20. Good calibration and favorable discrimination were displayed with a higher C-index. Conclusion: More serious small airway impairment exists in ACO patients. The combination of RVC-856 to -950 and R5-R20 could be applied to differentiate ACO from COPD patients.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Asma/diagnóstico por imagem , Volume Expiratório Forçado , Humanos , Oscilometria , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Espirometria
13.
Maturitas ; 153: 41-47, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34654527

RESUMO

RATIONALE: The naturally occurring age-dependent decline in lung function accelerates after menopause, likely due to the change of the endocrine balance. Although increasing evidence shows suboptimal lung health in early life can increase adult  susceptibility to insults, the potential effect of poor childhood lung function on menopause-dependent lung function decline has not yet been investigated. OBJECTIVES: To study whether menopause-dependent lung function decline, assessed as forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), is determined by childhood lung function. METHODS: The Tasmanian Longitudinal Health Study, a cohort born in 1961, underwent spirometry at age seven.  At ages 45 and 50 serum samples, spirometry and questionnaire data were collected (N = 506). We measured follicle stimulating and luteinizing hormones to determine menopausal status using latent profile analysis. The menopause-dependent lung function decline was investigated using linear mixed models, adjusted for anthropometrics, occupational level, smoking, asthma, asthma medication and study year, for the whole study population and stratified by tertiles of childhood lung function. MEASUREMENTS AND MAIN RESULTS: The overall menopause-dependent lung function decline was 19.3 mL/y (95%CI 2.2 to 36.3) for FVC and 9.1 mL/y (-2.8 to 21.0) for FEV1. This was most pronounced (pinteraction=0.03) among women within the lowest tertile of childhood lung function [FVC 22.2 mL/y (1.1 to 43.4); FEV1 13.9 mL/y (-1.5 to 29.4)]. CONCLUSIONS: Lung function declines especially rapidly in postmenopausal women who had poor low lung function in childhood. This provides novel insights into respiratory health during reproductive aging and emphasizes the need for holistic public health strategies covering the whole lifespan.


Assuntos
Envelhecimento/fisiologia , Pulmão/fisiopatologia , Menopausa , História Reprodutiva , Capacidade Vital/fisiologia , Austrália , Feminino , Volume Expiratório Forçado , Humanos , Testes de Função Respiratória , Fatores de Risco , Espirometria
14.
Respir Care ; 66(12): 1848-1857, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34610984

RESUMO

BACKGROUND: Recent studies have demonstrated that even in the absence of lung impairment as determined by spirometry, smoking and respiratory symptoms are associated with poor overall health and well-being. However, this relationship is not well defined; and it remains unclear the degree to which symptoms are related to poor health, independent of smoking. This is of particular importance to older adults, as they are more likely to exhibit respiratory symptoms and are, therefore, at risk of not receiving appropriate treatment if they have never smoked and have normal spirometry. METHODS: We performed a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging to delineate the associations of respiratory symptoms and smoking on the health of participants age 45-86 who exhibited normal spirometry. Participant health was estimated using a frailty index, a multidimensional measure of vulnerability to adverse outcomes that has been validated in numerous health settings. RESULTS: Of the 21,293 participants included in our analysis, 87% exhibited a normal FEV1, FVC, and FEV1/FVC; of those, 45% reported at least one respiratory symptom, and 50% were former or current smokers. Both respiratory symptoms and smoking were independently associated with frailty (median interquartile range [IQR] = 0.11 [0.07-0.15]), the most substantial associations observed for those having at least one respiratory symptom (adjusted ß 0.023, 95% CI 0.022-0.025) and current smokers with > 10 pack-year exposure (adjusted ß 0.014, 95% CI [0.010-0.019). Not only was the association between symptoms and frailty evident in never smokers, a significant proportion of the total effect of smoking on frailty was observed to be mediated by symptoms. CONCLUSIONS: Our data show that respiratory symptoms, regardless of smoking history, were a significant correlate of frailty in older adults with normal spirometry. Hence, they should not be simply regarded as a benign by-product of aging.


Assuntos
Fragilidade , Fumar , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Canadá , Estudos Transversais , Volume Expiratório Forçado , Fragilidade/epidemiologia , Fragilidade/etiologia , Humanos , Estudos Longitudinais , Pulmão , Pessoa de Meia-Idade , Fumar/efeitos adversos , Espirometria
15.
BMJ Open ; 11(10): e052931, 2021 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-34610942

RESUMO

INTRODUCTION: In recent years, there has been increasing interest in the use of spirometry for the assessment of small airways obstruction (SAO) driven by the idea that these changes occur prior to development of established obstructive lung disease. Maximal mid-expiratory and distal flow rates have been widely used despite a lack of agreement regarding parameter selection or definition of an abnormal result. We aim to provide evidence from population-based studies, describing the different parameters, definitions of normal range and the resulting impact on prevalence estimates for SAO. Summarising this evidence is important to inform development of future studies in this area. METHODS AND ANALYSIS: A systematic review of population-based studies will be conducted. MEDLINE, Web of Science and Google Scholar will be searched from database inception to May 2021. Primary outcomes will include the spirometry parameter used to define SAO, and the definition of an abnormal result. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed for study selection. Study methods will be assessed using the Newcastle-Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation working group methodology. Narrative synthesis will be conducted for all included studies. Meta-analysis will also be conducted for prevalence estimates and associated risk factors where data quality and availability allow. Random effects models will be used to conduct the meta-analysis and I2 statistics will be used to assess heterogeneity across studies. Where appropriate subgroup analysis will be conducted to explore heterogeneity. ETHICS AND DISSEMINATION: There is no requirement for ethical approval for this project. Findings will be disseminated via peer-reviewed publications and other formats, for example, conferences, congresses or symposia. PROSPERO REGISTRATION NUMBER: CRD42021250206.


Assuntos
Projetos de Pesquisa , Humanos , Metanálise como Assunto , Prevalência , Fatores de Risco , Espirometria , Revisões Sistemáticas como Assunto
16.
Chron Respir Dis ; 18: 14799731211053332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34693751

RESUMO

Asthma is a common, chronic, and heterogeneous disease with a global impact and substantial economic costs. It is also associated with significant mortality and morbidity and the burden of undiagnosed asthma is significant. Asthma can be difficult to diagnose as there is no gold standard test and, while spirometry is central in diagnosing asthma, it may not be sufficient to confirm or exclude the diagnosis. The most commonly reported spirometric measures (forced expiratory volume in one second (FEV1) and forced vital capacity assess function in the larger airways. However, small airway dysfunction is highly prevalent in asthma and some studies suggest small airway involvement is one of the earliest disease manifestations. Moreover, there are new inhaled therapies with ultrafine particles that are specifically designed to target the small airways. Potentially, tests of small airways may more accurately diagnose early or mild asthma and assess the response to treatment than spirometry. Furthermore, some assessment techniques do not rely on forced ventilatory manoeuvres and may, therefore, be easier for certain groups to perform. This review discusses the current evidence of small airways tests in asthma and future research that may be needed to further assess their utility.


Assuntos
Asma , Asma/diagnóstico , Volume Expiratório Forçado , Humanos , Testes de Função Respiratória , Espirometria , Capacidade Vital
17.
Int J Tuberc Lung Dis ; 25(10): 846-853, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34615582

RESUMO

BACKGROUND: Post-TB lung disease (PTLD) is an important but under-recognised chronic respiratory disease in high TB burden settings such as Tanzania.METHODS: This was a cross-sectional survey of adults within 2 years of completion of TB treatment in Kilimanjaro, Tanzania. Data were collected using questionnaires (symptoms and exposures), spirometry and chest radiographs to assess outcome measures, which were correlated with daily life exposures, including environment and diet.RESULTS: Of the 219 participants enrolled (mean age: 45 years ± 10; 193 88% males), 98 (45%) reported chronic respiratory symptoms; 46 (22%) had received treatment for TB two or more times; and HIV prevalence was 35 (16%). Spirometric abnormalities were observed in 146 (67%). Chest X-ray abnormalities occurred in 177 (86%). A diagnosis of PTLD was made in 200 (91%), and half had clinically relevant PTLD. The prevalence of mMRC ≥Grade 3 chronic bronchitis and dyspnoea was respectively 11% and 26%. Older age, multiple episodes of TB and poverty indicators were linked with clinically relevant PTLD.CONCLUSIONS: We found a substantial burden of PTLD in adults who had recently completed TB treatment in Tanzania. There is a pressing need to identify effective approaches for both the prevention and management of this disease.


Assuntos
Pneumopatias , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espirometria , Tanzânia/epidemiologia
18.
Eur Respir Rev ; 30(162)2021 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34615699

RESUMO

175 years have elapsed since John Hutchinson introduced the world to his version of an apparatus that had been in development for nearly two centuries, the spirometer. Though he was not the first to build a device that sought to measure breathing and quantify the impact of disease and occupation on lung function, Hutchison coined the terms spirometer and vital capacity that are still in use today, securing his place in medical history. As Hutchinson envisioned, spirometry would become crucial to our growing knowledge of respiratory pathophysiology, from Tiffeneau and Pinelli's work on forced expiratory volumes, to Fry and Hyatt's description of the flow-volume curve. In the 20th century, standardization of spirometry further broadened its reach and prognostic potential. Today, spirometry is recognized as essential to respiratory disease diagnosis, management and research. However, controversy exists in some of its applications, uptake in primary care remains sub-optimal and there are concerns related to the way in which race is factored into interpretation. Moving forward, these failings must be addressed, and innovations like Internet-enabled portable spirometers may present novel opportunities. We must also consider the physiologic and practical limitations inherent to spirometry and further investigate complementary technologies such as respiratory oscillometry and other emerging technologies that assess lung function. Through an exploration of the storied history of spirometry, we can better contextualize its current landscape and appreciate the trends that have repeatedly arisen over time. This may help to improve our current use of spirometry and may allow us to anticipate the obstacles confronting emerging pulmonary function technologies.


Assuntos
Pulmão , Transtornos Respiratórios , Volume Expiratório Forçado , Humanos , Espirometria , Capacidade Vital
19.
Can Fam Physician ; 67(9): 661-667, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34521707

RESUMO

OBJECTIVE: To facilitate distinction between asthma and chronic obstructive pulmonary disease (COPD) in day-to-day primary care practice, and provide practical treatment strategies using spirometric cases to outline how to recognize the clinical and spirometric overlap between asthma and COPD. SOURCES OF INFORMATION: The approaches described here were developed using evidence-based guidelines and the expertise of the authors, including research findings by the authors in the areas of asthma, COPD management, and spirometric testing in primary care. MAIN MESSAGE: There are patients with clinical or spirometric features of both asthma and COPD. Both asthma and COPD are associated with some degree of inflammation of the respiratory tract, mediated by the increased expression of inflammatory proteins. However, there are clear differences between asthma and COPD in the pattern of inflammation that occurs in the lungs. Diagnostic confusion between COPD and asthma is most likely to arise in older patients with respiratory complaints, particularly against a background that includes cigarette smoke or workplace exposure. Both asthma and COPD are clinical diagnoses based on patient history, symptoms, physical examination findings, and objective measures of lung function. Postbronchodilator spirometry is always needed to confirm a new diagnosis of COPD and should also be performed prebronchodilator for the diagnosis of asthma. However, in many cases, the interpretation of spirometry results is not straightforward. CONCLUSION: Understanding the nature and extent of the spirometric overlap between asthma and COPD is critical for tailoring a therapeutic strategy that is based on factors that include medical and family history, signs and symptoms, and a clear interpretation of spirometry data. This information will be leveraged differently for individual patients to arrive at the correct clinical diagnosis and to select the most appropriate therapy.


Assuntos
Asma , Doença Pulmonar Obstrutiva Crônica , Idoso , Asma/diagnóstico , Humanos , Pulmão , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria
20.
Dan Med J ; 68(10)2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34558410

RESUMO

INTRODUCTION In recent decades, lung cancer is being diagnosed at ever earlier stages, leading to higher resection rates and improved survival. Therefore, more patients live with the sequelae of thoracic surgery. The standardised Danish follow-up programme after lung cancer resection includes CT and clinical evaluation at set times. METHODS An e-mail survey was conducted to evaluate local practices at lung cancer investigation sites with respect to the setup of follow-up programmes after lung cancer resection. In addition, 50 consecutive patients were seen three months after their lung cancer resection. Spirometry was performed and patients reported on their use of inhalation medicine, smoking status and quality of life. RESULTS The study revealed heterogeneous setups regarding routine spirometry (5/12 sites) and assessment by a respiratory physician (6/12). In a single-centre study including 50 patients three months after lung cancer resection, 22% of patients were using a bronchodilator even though 50% of patients were obstructive on spirometry and 48% reported shortness of breath (SOB). 17% of patients were active smokers, whereas the majority reported symptoms of a physical nature such as fatigue, SOB and cough. CONCLUSIONS It is important to establish the optimal follow-up setup with an emphasis on detection of recurrence, symptom improvement and smoking cessation. This study highlighted the importance of symptom assessment by a respiratory physician/nurse. A spirometry should be performed if patients experience SOB and the potential benefit of inhalation medicine should be assessed. FUNDING none. TRIAL REGISTRATION not relevant.


Assuntos
Neoplasias Pulmonares , Qualidade de Vida , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Espirometria
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