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2.
Neumol. pediátr. (En línea) ; 15(1): 257-266, Mar. 2020. tab, ilus, graf
Artigo em Espanhol | LILACS | ID: biblio-1088094

RESUMO

Pulmonary function testing in children includes a large number of methods and aspects. Children constitute a very heterogeneous group of individuals, among which are non-collaborative infants and preschoolers who represent a challenge in the development of new methods that do not require collaboration or coordination. This review attempts to achieve a comprehensive approach to pulmonary function tests in children that allow the physician working in pediatrics to get to know: their pathophysiological bases; the reasons for a request for a pulmonary function test taking into account the underlying pathophysiological process that is suspected; the study procedures; the possible clinical findings and their interpretation; the advantages and limitations of several of the tests. Information related to spirometry is developed more specifically, since it is the most widespread, accessible and widely validated methods.


El estudio de la función pulmonar (FP) en niños abarca un gran número de métodos y aspectos. La edad pediátrica en sí constituye un grupo muy heterogéneo de individuos, entre los que se encuentran los de edades más tempranas que son no colaborativos y que representan un desafío en el desarrollo de nuevos métodos que no requieran colaboración ni coordinación. En esta revisión se describirá un enfoque integral de los estudios de FP más utilizados en niños. Se mencionan sus bases fisiopatológicas; los motivos de un pedido de estudio de FP teniendo en cuenta el proceso fisiopatológico subyacente que se sospecha; los posibles hallazgos clínicos y su interpretación y las ventajas y limitaciones de varios de los test.


Assuntos
Humanos , Criança , Testes de Função Respiratória/métodos , Pneumopatias/fisiopatologia , Pletismografia Total , Espirometria , Pneumopatias/diagnóstico , Óxido Nítrico/análise
3.
Isr Med Assoc J ; 22(2): 104-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043328

RESUMO

BACKGROUND: Autologous hematological stem cell transplantation (HSCT) is a novel therapy for systemic sclerosis (SSc) that has been validated in three randomized controlled trials. OBJECTIVES: To report the first Israeli experience with HSCT for progressive SSc and review the current literature. METHODS: Five SSc patients who were evaluated in our department and were treated by HSCT were included. Medical records were evaluated retrospectively. Demographic, clinical, and laboratory data were recorded. Continuous data are presented as the mean ± standard deviation. Categorical variables are presented as frequencies and percentages. RESULTS: Five SSc patients were treated with HSCT. Four patients were adults (mean age 53 ± 12 years) and one was a 12-year-old pediatric patient. All patients were female. HSCT was initiated 1.4 ± 0.8 years after diagnosis. Two patients were RNA POLIII positive, two were anti-topoisomerase 1 positive, and one only antinuclear antibodies positive. All patients had skin and lung involvement. The mean modified Rodnan Skin Score was 29 ± 4.7 before HSCT, which improved to 10.4 ± 9.6 after HSCT. The forced vital capacity improved from 68 ± 13% to 90 ± 28%. Diffusing capacity of the lungs for carbon monoxide increased by 6%. Among severe adverse events were cyclophosphamide-related congestive heart failure, antithymocyte globulin-related capillary leak syndrome, and scleroderma renal crisis. All symptoms completely resolved with treatment without sequela. No treatment related mortality was recorded. CONCLUSIONS: HSCT is an important step in the treatment of progressive SSc in Israel. Careful patient selection reduces treatment related morbidity and mortality.


Assuntos
Ciclofosfamida , Transplante de Células-Tronco Hematopoéticas , Escleroderma Sistêmico , Adulto , Autoanticorpos/sangue , Autoanticorpos/classificação , Criança , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Israel/epidemiologia , Pulmão/patologia , Monitorização Fisiológica/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologia , Escleroderma Sistêmico/imunologia , Escleroderma Sistêmico/terapia , Pele/patologia , Transplante Autólogo
4.
Ann Allergy Asthma Immunol ; 124(4): 366-372, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31945475

RESUMO

BACKGROUND: The assessment of airway function in preschool children can be done using simple measurement techniques such as interrupter resistance (Rint) or specific airway resistance (sRaw). OBJECTIVE: The aim of the study was to assess the relationship and the agreement between Rint and sRaw baseline measurements expressed in z-score and bronchodilator response (BDR) in accordance with the latest reference equations and recommended procedures. METHODS: One hundred thirty children aged 3 to 6 years old, referred to our pediatric pulmonary function test unit for assessment of airway function were consecutively included. Children performed baseline and post-bronchodilator measurements of Rint and sRaw. RESULTS: One hundred twenty baseline measurements were obtained (98.7%) with both techniques. At baseline there was a strong correlation between Rint and sRaw z-score (r = 0.5, P < .01) despite the poor agreement (Cohen Kappa coefficient 0.09 [-0.08; 0.26]). The agreement for BDR was fair, with Cohen Kappa coefficient (95% IC) = 0.33 (0.13; 0.54). Children with poorly or partially controlled asthma had both higher baseline Rint and sRaw (P < .01), and higher post-bronchodilator mean change (P < .01), than children with well-controlled asthma. CONCLUSION: The poor agreement between the Rint and sRaw reference measurements demonstrates the lack of reliability of sole Rint or sRaw technique for airway obstruction diagnosis and the need to perform each technique concomitantly with BDR test. Other longitudinal and larger sample studies are needed to confirm the threshold value for a positive BDR, especially for sRaw.


Assuntos
Pneumopatias/diagnóstico , Testes de Função Respiratória/métodos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
5.
Int Arch Allergy Immunol ; 181(2): 141-148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914443

RESUMO

BACKGROUND: There have been very few studiesin real-life settingscomparing the treatment effects of allergen immunotherapy (AIT) and pharmacotherapy for perennial allergic rhinitis (AR). OBJECTIVE: This study was performed to compare AIT and pharmacotherapy in terms of their effects on the symptom control and quality of life (QOL) of AR patients with/without asthma. METHODS: A total of 250 patients diagnosed with AR with/without asthma were included and assigned to the immunotherapy (AIT plus pharmacological treatment) or control (pharmacological treatment only) group. Clinical and medication scores, QOL scores, and lung function (forced expiratory volume in one second as a percentage; FEV1%) were measured at baseline and 3 years after the start of treatment. RESULTS: This study showed that there was clinical improvement in AR symptoms in the AIT group, whereas standard pharmacotherapy alone had no significant effect on nasal symptoms. The QOL and satisfaction scores, as evaluated with a visual analogue scale (VAS), were further improved compared to the pharmacotherapy group. There was a significant improvement in medication scores in both AIT groups. According to our results, while total asthma scores and asthma control test scores were significantly improved in the HDM AIT group, they did not change in the Parietaria pollen AIT group. In our study FEV1% was increased compared to the baseline value in the AIT group, but it was not statistically significant. On the other hand, FEV1% remained without any improvement in patients on standard pharmacotherapy. CONCLUSION: Perennial AIT was found to be superior to pharmacotherapy in decreasing symptoms as well as in improving QOL scores in AR patients with/without asthma. HDM AIT was more effective for asthma symptoms than Parietaria pollen AIT.


Assuntos
Asma/imunologia , Rinite Alérgica Perene/imunologia , Adolescente , Adulto , Alérgenos/imunologia , Dessensibilização Imunológica/métodos , Feminino , Volume Expiratório Forçado/imunologia , Humanos , Pulmão/imunologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Testes de Função Respiratória/métodos , Adulto Jovem
7.
Vet Clin North Am Small Anim Pract ; 50(2): 273-294, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31858992

RESUMO

Pulmonary function tests (PFTs) are important diagnostic tools that have wide clinical applications in human and veterinary medicine. Widespread use of PFTs in measuring lung volumes in veterinary medicine was historically limited by the need for specialized equipment to accurately perform and interpret these tests, and by lack of patient cooperation. However, recent advances and modifications have allowed PFTs to be safely performed in conscious veterinary patients with minimal stress. This article focuses on the most commonly used tests of pulmonary function including tests of pulmonary mechanics and of gas exchange in the lungs.


Assuntos
Doenças do Gato/diagnóstico , Doenças do Gato/fisiopatologia , Doenças do Cão/diagnóstico , Doenças do Cão/fisiopatologia , Testes de Função Respiratória/veterinária , Doenças Respiratórias/veterinária , Animais , Gatos , Cães , Testes de Função Respiratória/métodos , Doenças Respiratórias/diagnóstico , Doenças Respiratórias/fisiopatologia
8.
Rev. chil. enferm. respir ; 35(4): 304-307, dic. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1092711

RESUMO

La fibrosis pulmonar idiopática (FPI) se ha clasificado en enfermedad leve o temprana-moderada-severa o Avanzada, sin puntos de corte en parámetros clínicos, funcionales o imagenológicos. No existe aún consenso en cual es el principal parámetro que se debe medir. Si bien las variables funcionales como la capacidad vital forzada (CVF), capacidad de difusión de monóxido de carbono (DLCO) y test de caminata de 6 minutos se han utilizado de forma rutinaria en la practica clínica y en los principales estudios clínicos de tratamiento muchas veces no son representativos de la evolución clínica. Por lo anterior se han desarrollado, índices o puntajes compuestos como la escala GAP (Gender-Age-Physiology) que podrían ser útiles en el seguimiento de los pacientes.


Idiopathic pulmonary fibrosis (IPF) has been classified as mild or early - moderate - severe or advanced disease, with no cut-off points in clinical, functional or imaging parameters. There is no consensus yet on which is the main parameter to be measured although the functional variables such as forced vital capacity (FVC), carbon monoxide diffusion capacity (DLCO) and 6-minute walk test, have been routinely used in clinical practice and in the main clinical studies of treatment, are often not representative of the clinical evolution. Therefore, composite indices or scores such as the GAP (Gender-Age-Physiology) scale have been developed that could be useful in the follow-up of patients.


Assuntos
Humanos , Fibrose Pulmonar Idiopática/diagnóstico , Fibrose Pulmonar Idiopática/fisiopatologia , Testes de Função Respiratória/métodos , Evolução Clínica , Medição de Risco , Tosse/etiologia , Dispneia/etiologia
9.
PLoS One ; 14(12): e0226290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31841537

RESUMO

PURPOSE: The purpose of this study was to assess the accuracy of the Cosmed K5 portable metabolic system dynamic mixing chamber (MC) and breath-by-breath (BxB) modes against the criterion Douglas bag (DB) method. METHODS: Fifteen participants (mean age±SD, 30.6±7.4 yrs) had their metabolic variables measured at rest and during cycling at 50, 100, 150, 200, and 250W. During each stage, participants were connected to the first respiratory gas collection method (randomized) for the first four minutes to reach steady state, followed by 3-min (or 5-min for DB) collection periods for the resting condition, and 2-min collection periods for all cycling intensities. Collection periods for the second and third methods were preceded by a washout of 1-3 min. Repeated measures ANOVAs were used to compare metabolic variables measured by each method, for seated rest and each cycling work rate. RESULTS: For ventilation (VE) and oxygen uptake (VO2), the K5 MC and BxB modes were within 2.1 l/min (VE) and 0.08 l/min (VO2) of the DB (p≥0.05). Compared to DB values, carbon dioxide production (VCO2) was significantly underestimated by the K5 BxB mode at work rates ≥150W by 0.12-0.31 l/min (p<0.05). K5 MC and BxB respiratory exchange ratio values were significantly lower than DB at cycling work rates ≥100W by 0.03-0.08 (p<0.05). CONCLUSION: Compared to the DB method, the K5 MC and BxB modes are acceptable for measuring VE and VO2 across a wide range of cycling intensities. Both K5 modes provided comparable values to each other.


Assuntos
Calorimetria/instrumentação , Monitorização Ambulatorial/instrumentação , Consumo de Oxigênio/fisiologia , Troca Gasosa Pulmonar/fisiologia , Adulto , Ciclismo/fisiologia , Calorimetria/métodos , Desenho de Equipamento , Exercício Físico/fisiologia , Teste de Esforço/instrumentação , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Aplicativos Móveis , Reprodutibilidade dos Testes , Respiração , Testes de Função Respiratória/instrumentação , Testes de Função Respiratória/métodos , Descanso/fisiologia , Adulto Jovem
10.
Br J Nurs ; 28(18): 1196-1200, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597050

RESUMO

Bronchiolitis obliterans syndrome (BOS) following allogenic haematopoietic stem cell transplant is considered the manifestation of chronic graft versus host disease (cGvHD) in the lung, and affects about 14% of patients with cGvHD, mainly in the first 2 years after transplant. Despite advances in assessment, diagnosis and treatment, the clinical prognosis remains poor for patients with pulmonary manifestations of cGvHD. A pilot study of 50 patients was devised to establish whether a relationship exists between forced expiratory volume in 1 second (FEV1) via pulmonary function test (PFT) and the equivalent peak expiratory flow (PEF) via peak flow handheld spirometry in cGvHD patients receiving extracorporeal photopheresis (ECP). Only PEF observed within 2 days of PFT could be compared with data at month 3, 6, 9 and 12. This pilot study illustrated that monitoring via handheld peak flow readings has the potential to become an acceptable method of monitoring lung function longitudinally in cGvHD patients.


Assuntos
Doença Enxerto-Hospedeiro/fisiopatologia , Pulmão/fisiologia , Testes de Função Respiratória/métodos , Adolescente , Adulto , Idoso , Doença Crônica , Feminino , Fluxo Expiratório Forçado , Doença Enxerto-Hospedeiro/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório , Fotoferese , Projetos Piloto , Reprodutibilidade dos Testes , Espirometria/instrumentação , Espirometria/métodos , Adulto Jovem
11.
Med Sci Monit ; 25: 7763-7769, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31618191

RESUMO

BACKGROUND Pulmonary hypertension is a common complication of interstitial lung disease. This study was conducted to retrospectively analyze the incidence of pulmonary hypertension among interstitial lung disease patients and the correlation between systolic pulmonary artery pressure (PASP) and pulmonary functions. We also intended to investigate whether antinuclear antibody (ANA) could be an effective indicator of pulmonary hypertension. MATERIAL AND METHODS There were 182 patients diagnosed with interstitial lung disease through high-resolution computed tomography (HRCT). Pulmonary hypertension was defined as an increase of mean pulmonary arterial pressure (PAPm) ≥25 mmHg (~PASP ≥40 mmHg) at rest. Severe pulmonary hypertension was defined as PAPm ≥35 mmHg. There were 104 cases including in this study. There were 67 cases from the ANA positive (ANA+) group and 37 cases from the ANA negative (ANA-) group. All study patients had pulmonary function tests, which included the measurements of maximal voluntary ventilation (MVV), residual volume (RV), total lung capacity (TLC), forced expiratory volume (FVC), vital capacity (VC), and diffusing capacity of the lungs for carbon monoxide (DLCO). RESULTS The pulmonary hypertension incidence in the study cohort was 25%, and the severe pulmonary hypertension incidence was 6.48%. The incidence of pulmonary hypertension in ANA+ cases was 22.22%. The incidence of pulmonary hypertension in the ANA- cases was 32.14%. The lung function test results showed moderate relationships between DLCO, FVC%, VC%, and PASP; no relationship between MVV, FEV1/FVC%, RV/TLC, and PASP; minimum relationship between FVC%, VC%, and PASP in the ANA+ group; and moderate relationship between FVC%, VC%, and PASP in the ANA- group. CONCLUSIONS Pulmonary hypertension occurred in 25% of the 182 interstitial lung disease patients and was negatively associated with deteriorated lung functions (specifically VC%, FVC%, and DLCO parameters). ANA level was not associated with the prognosis of pulmonary hypertension of patients with interstitial lung disease, and it did not significantly affect the correlation between PASP and pulmonary functions. Thus, ANA level did not seem to be a necessary indicator of pulmonary hypertension, and a more effective treatment method for pulmonary hypertension of patients with interstitial lung disease is urgently needed.


Assuntos
Hipertensão Pulmonar/epidemiologia , Doenças Pulmonares Intersticiais/epidemiologia , Idoso , Anticorpos Antinucleares/análise , Biomarcadores/sangue , Pressão Sanguínea/fisiologia , China/epidemiologia , Estudos de Coortes , Feminino , Volume Expiratório Forçado , Humanos , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Capacidade Vital
12.
Arch. bronconeumol. (Ed. impr.) ; 55(10): 513-518, oct. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-186200

RESUMO

Introduction: People with Down syndrome (DS) have high respiratory morbidity, evaluating their respiratory health with standardized, objective tests is desirable. Thus, the objective of this study was to evaluate the technical quality of Pulmonary Function Tests (PFTs) to determine which ones are most suitable for this population. Methods: Participants included children, teenagers and adults with DS, 5 years of age or older (n = 302). The technical quality of the impulse oscillometry system (IOS), forced spirometry, lung-diffusing capacity for carbon monoxide (DLCO), and 6-min walk test (6MWT) were analyzed by age group. Capnography and pulse oximetry were included in the study. Technical quality was determined on the basis of current international PFTs standards. Results: Fifty-one percent of participants were males. A total of 184 participants (71%) who completed the IOS fulfilled the quality criteria, while 210 (70%) completed the 6MWT. Performance on forced spirometry and DLCO was poor. All pulse oximetries and 96% percent heart rates obtained had good quality, but exhaled carbon dioxide (PetCO2) and respiratory rate (RR) showed deficient repeatability. Conclusions: IOS appears to be the most reliable instrument for evaluating lung mechanics in individuals with DS


Introducción: Las personas con síndrome de Down (SD) tienen una elevada morbilidad respiratoria, por lo que se recomienda evaluar su salud respiratoria con test objetivos estandarizados. El objetivo de este estudio fue evaluar la calidad técnica de los test de función pulmonar (TFP) para determinar cuáles son los más adecuados para este tipo de población. Métodos: Entre los participantes se incluyeron niños, adolescentes y adultos con SD y edad ≥ 5 años (n = 302). Se analizaron por grupos de edad la calidad técnica de la oscilometría de impulso (IOS), la oscilometría forzada, la capacidad pulmonar de difusión del monóxido de carbono (DLCO) y de la prueba de la marcha de 6 minutos (6MWT). Se incluyeron en el análisis la capnografía y la oximetría de pulso. La calidad técnica se determinó de acuerdo con los estándares internaciones actuales para los TFP. Resultados: El 51% de los pacientes eran varones. Un total de 184 participantes (71%) cumplieron los criterios de calidad de la IOS, mientras que 201 (70%) completaron la prueba 6MWT. El desempeño de la espirometría forzada y de la DLCO fue reducido. Todas las oximetrías de pulso que se obtuvieron, así como el 96% de las frecuencias de pulso presentaron buena calidad. Sin embargo, tanto el dióxido de carbono exhalado (PetCO2) como la frecuencia respiratoria (FR) presentaron una reproducibilidad deficiente. Conclusiones: La IOS parece ser la herramienta más fiable para la evaluación de la mecánica pulmonar en individuos con SD


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Síndrome de Down/complicações , Testes de Função Respiratória/instrumentação , Qualidade da Assistência à Saúde , Testes de Função Respiratória/métodos , Testes de Função Respiratória/tendências , Espirometria , Oscilometria , Capnografia , Oximetria , Antropometria
13.
Arch. bronconeumol. (Ed. impr.) ; 55(10): 519-525, oct. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-186201

RESUMO

Objective: Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of specific organic antigens or low-molecular weight substances in genetically susceptible individuals. Although small airway involvement is prominent in patients with chronic HP, conventional pulmonary function tests (PFTs) are relatively insensitive to identify it. Thus, the authors aimed to evaluate resistance (R5) and reactance (X5) values at 5Hz on inspiration, expiration, and whole breath, as well as small airway resistance (R5-19) values using a forced oscillation technique (FOT) in patients with chronic HP, and their responses after bronchodilator. In addition, R5 and X5 values according to the presence or absence of mosaic attenuation on computed tomography (CT) were compared. Methods: PFTs with plethysmography, diffusing capacity of the lungs for carbon monoxide (DLCO) and FOT measurements were performed pre-bronchodilator and post-bronchodilator. High-resolution CT was performed at the same visit, and classified according to the presence or absence of mosaic attenuation. R5 and X5 values were then compared according to the presence or absence of mosaic attenuation on CT. Results: Twenty-eight patients with chronic HP (57.1% female; mean age, 56 ± 11.5 years; mean forced vital capacity 57 ± 17% predicted) were evaluated. All patients had low X5 values, reflecting lower lung compliance, and only three (8%) demonstrated elevated R5 (whole-breath) values. No patients exhibited bronchodilator response in R5, X5 and R5-19 values. In patients who exhibited greater extension of mosaic attenuation (n = 11), R5 and X5 values could not discriminate those with a greater presence of these areas on CT. Conclusions: The results suggest that FOT does not help to additionally characterise concomitant small airway involvement in patients with chronic fibrotic HP who demonstrate restrictive ventilatory pattern in conventional PFTs. Nevertheless, FOT appeared to better characterise decreased lung compliance due to fibrosis through X5. Bronchodilator therapy did not appear to induce an acute response in chronic HP patients with restrictive disease. The precise role of FOT in subacute HP and obstructive chronic HP, therefore, must be evaluated


Objetivo: La neumonitis por hipersensibilidad (HP) es una enfermedad pulmonar intersticial causada por la inhalación de antígenos orgánicos específicos o sustancias de bajo peso molecular en individuos genéticamente susceptibles. Aunque la implicación de las vías aéreas pequeñas es típica en pacientes con HP crónica, a las pruebas habituales de función pulmonar (PFP) les falta sensibilidad para detectarla. El objetivo fue evaluar los valores de resistencia (R5) y de reactancia (X5) a 5Hz durante la inspiración, la espiración y el ciclo completo, así como los valores de resistencia de las vías aéreas pequeñas y las respuestas tras broncodilatador. Para ello se utilizó la técnica de oscilación forzada (TOF) en pacientes con HP crónica. Además, se comprobaron los valores R5 y X5, de acuerdo con la presencia o ausencia de patrones de atenuación en mosaico mediante tomografía computarizada (TC). Métodos: Se evaluaron las PFP con pletismografía, la capacidad de difusión pulmonar para el monóxido de carbono (DLCO) y la TOF antes y después de broncodilatador (pre- y posbroncodilatador, respectivamente). La TC de alta resolución se realizó en la misma visita, y los resultados se clasificaron en función de la presencia o ausencia de patrones de atenuación en mosaico. Resultados: Se evaluaron 28 pacientes con HP crónica (57,1% mujeres; edad media: 56 ± 11,5 años; capacidad vital forzada media estimada: 57 ± 17%). Todos los pacientes tuvieron valores X5 bajos, indicativo de una distensibilidad pulmonar baja, y solo 3 (8%) presentaron valores elevados de R5 (respiración completa). Ningún paciente exhibió respuesta broncodilatadora en valores R5, X5 y R5-19. Los valores de R5 y X5 no permitieron discriminar a aquellos pacientes que presentaron patrón de atenuación en mosaico extenso en la TC (n = 11). Conclusiones: Los resultados sugieren que la TOF no proporciona información extra en la caracterización de la implicación concomitante de las vías aéreas pequeñas en pacientes con HP crónica que presentan patrones ventilatorios restrictivos en PFP convencionales. Sin embargo, la TOF parece permitir una mejor caracterización de la disminución de la distensibilidad pulmonar debido a fibrosis a través del valor X5. La terapia broncodilatadora no indujo respuesta aguda en pacientes con HP crónica y enfermedad restrictiva. Por tanto, se debe evaluar el papel específico de la TOF en la HP subaguda y la HP obstructiva crónica


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Alveolite Alérgica Extrínseca/diagnóstico , Testes de Função Respiratória/instrumentação , Capacidade Vital , Testes de Função Respiratória/métodos , Tomografia Computadorizada de Emissão , Pletismografia , Volume Expiratório Forçado , Oscilometria
15.
Adv Respir Med ; 87(4): 235-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476011

RESUMO

Pulmonary function testing involves a battery of tests from the simple pulse oximetry to the cardiopulmonary exercise testing. Impulse oscillometry (IOS) is one of the newly described pulmonary function tests. It is based on the old principle of forced oscillatory technique modified and refined as per research and advances. It involves the use of sound waves during normal tidal breathing, which gives information on oscillatory pressure-flow relationships and eventually resistance and reactance. The resistance at 20 Hz (R20) represents the resistance of the large airways. The resistance at 5 Hz (R5) means the total airway resistance. (R5-R20) reflects resistance in the small airways. The reactance at 5 Hz (X5) indicates the elastic recoil of the peripheral airways. Resonant frequency and area of reactance are also measured. IOS has major uses in diagnosis and control of asthma in children and the elderly, where spirometry is otherwise normal. IOS has been studied in other respiratory diseases like COPD, ILD and supraglottic stenosis.


Assuntos
Oscilometria/normas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Testes de Função Respiratória/normas , Humanos , Oscilometria/métodos , Reprodutibilidade dos Testes , Testes de Função Respiratória/métodos
16.
EBioMedicine ; 47: 58-64, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31495719

RESUMO

BACKGROUND: Impaired lung health represents a significant burden on global health, including chronic obstructive pulmonary disease (COPD) and lung cancer. Given its global health impact, it is important to understand the determinants of impaired lung function and its relation to lung cancer risk independent of smoking. However, to date, no study has evaluated determinants of impaired lung function in a cohort exclusively of never-smokers, who also represent a growing proportion of all lung cancers. METHODS: A total of 222,274 never-smokers with reproducible spirograms were identified in the UK Biobank population-based cohort and included in the analysis. Baseline volumetric measures of lung function, including forced expiratory volume in 1-s (FEV1) and forced vital capacity (FVC), were used to define lung function impairment. Determinants of impaired lung function were evaluated using Poisson regression with robust variance estimation. The added value of lung function in lung cancer prediction was evaluated using Fine and Gray regression accounting for the competing risk of all-cause mortality. FINDINGS: Lung function impairment was associated with low birthweight, ambient air pollution (PM2·5 µg/mm3), and overweight, after adjustment for other important risk factors. We observed modest improvement in discrimination by adding lung function to our lung cancer prediction model for never-smokers. The highest optimism-corrected AUC at 3 (0·700, 95% CI: 0·654-0·734) and 5 years (0·694, 95% CI: 0·658-0·736) included FEV1 (% of GLI predicted FEV1), while the highest AUC at 7 years was based on the inclusion of FEV1/FVC (0·722, 95% CI: 0·687-0·762). INTERPRETATION: We identified several modifiable risk factors associated with increased risk of lung function impairment among lifetime never-smokers in UKB. We achieved moderate discrimination for lung cancer risk-prediction for never-smokers, and found modest improvement with the inclusion of lung function. FUND: This study was supported by a Canada Research Chair to RJH.


Assuntos
Neoplasias Pulmonares/epidemiologia , Testes de Função Respiratória , Fumantes , Adulto , Idoso , Bancos de Espécimes Biológicos , Biomarcadores , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Tomografia Computadorizada por Raios X
17.
Int J Chron Obstruct Pulmon Dis ; 14: 1639-1655, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413559

RESUMO

Rationale: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 is based on an ABCD assessment tool of symptoms and exacerbation history and grade 1-4 of airflow limitation severity, facilitating classification either into 4 groups (ABCD) or 16 groups (1A-4D). We aimed to compare the GOLD 2011, GOLD 2017 ABCD, and GOLD 2017 1A-4D classifications in terms of their distribution and prediction of mortality and hospitalizations. Methods: In the GenKOLS study, 912 COPD patients with FEV1 less than 80% of the predicted answered questionnaires and performed lung function testing in 2003-2005. The patients were recruited from a hospital patient registry (n=662) and from the general population (n=250), followed up until 2011 with respect to all-cause and respiratory mortality, and all-cause and respiratory hospitalizations. We performed logistic regression and receiver operating curve (ROC) analyses for the different classifications with estimations of area under the curve (AUC) for comparisons. Results: Mean age at baseline was 60 years (SD 11), 55% were male. Mean duration of follow-up was 91 months. By GOLD 2011, 21% were classified as group A, 29% group B, 6% group C, and 43% as group D, corresponding percentages for GOLD 2017 were: 25%, 52%, 3%, and 20%. The GOLD 2011 classification had higher AUC values than the GOLD 2017 group ABCD classification for respiratory mortality and hospitalization, but after inclusion of airflow limitation severity in GOLD 2017 groups 2A-4D, AUC values were significantly higher with GOLD 2017. Conclusion: In a clinically relevant sample of COPD patients, the GOLD 2017 classification doubles the prevalence of group B and halves the prevalence of groups C and D as compared to the GOLD 2011 classification. The prediction of respiratory mortality and respiratory hospitalization was better for GOLD 2017 2A-4D taking airflow limitation severity into account, as compared to GOLD 2017 ABCD and GOLD 2011.


Assuntos
Classificação/métodos , Doença Pulmonar Obstrutiva Crônica , Testes de Função Respiratória , Área Sob a Curva , Progressão da Doença , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Prevalência , Prognóstico , Doença Pulmonar Obstrutiva Crônica/classificação , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Sistema de Registros/estatística & dados numéricos , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Índice de Gravidade de Doença
18.
Int J Chron Obstruct Pulmon Dis ; 14: 1657-1668, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413560

RESUMO

Backgroud and objectives: Although lung attenuation distribution and lung volume on computed tomography (CT) have been widely used in evaluating COPD and interstitial lung disease, there are only a few studies regarding the normal range of these indices, especially in Chinese subjects. We aimed to describe the normal range of lung attenuation distribution and lung volume based on CT. Methods: Subjects with normal lung function and basically normal chest CT findings (derivation group) at Ruijin Hospital, Shanghai (from January 2010 to June 2014) were included according to inclusion and exclusion criteria. The range of the percentage of lung volume occupied by low attenuation areas (LAA%), percentile of the histogram of attenuation values (Perc n), and total lung volume were analyzed. Relationships of these measures with demographic variables were evaluated. Participants who underwent chest CT examination for disease screening and had basically normal CT findings served as an external validation group. Results: The number of subjects in the derivation group and external validation groups were 564 and 1,787, respectively. Mean total lung volumes were 4,468±1,271 mL and 4,668±1,192 mL, and median LAA%(-950 HU) was 0.19 (0.03-0.43) and 0.17 (0.01-0.41), in the derivation and external validation groups, respectively. Reference equations for lung volume and attenuation distribution (LAA% using -1,000-210 HU, Perc 1 to Perc 98) were generated: Lung volume (mL) = -1.015 *10^4+605.3*Sex (1= male, 0= female)+92.61*Height (cm) -12.99*Weight (kg) ±1766; LAA% (-950 HU)=[0.2027+0.05926*Sex (1= male, 0= female) -4.111*10^-3*Weight (kg) +4.924*10^-3*Height (cm) +8.504*10^-4*Age]^7.341-0.05; Upper limit of normal range: [0.2027+0.05926*Sex-4.111*10^-3*Weight+4.924*10^-3*Height+8.504*10^-4*Age+0.1993]^7.341-0.05. Conclusion: This large population-based retrospective study demonstrated the normal range of LAA%, Perc n, and total lung volume measured on CT scans among subjects with normal lung function and CT findings. Reference equations are provided.


Assuntos
Medidas de Volume Pulmonar/métodos , Pulmão , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Testes de Função Respiratória/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , China/epidemiologia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Testes de Função Respiratória/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
Int J Chron Obstruct Pulmon Dis ; 14: 1583-1593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31409984

RESUMO

Purpose: Quantitative analysis of CT scans has proven to be a reproducible technique, which might help to understand the pathophysiology of chronic obstructive pulmonary disease (COPD) and combined pulmonary fibrosis and emphysema. The aim of this retrospective study was to find out if the lung function of patients with COPD with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III or IV and pulmonary emphysema is measurably influenced by high attenuation areas as a correlate of concomitant unspecific fibrotic changes of lung parenchyma. Patients and methods: Eighty-eight patients with COPD GOLD stage III or IV underwent CT and pulmonary function tests. Quantitative CT analysis was performed to determine low attenuation volume (LAV) and high attenuation volume (HAV), which are considered to be equivalents of fibrotic (HAV) and emphysematous (LAV) changes of lung parenchyma. Both parameters were determined for the whole lung, as well as peripheral and central lung areas only. Multivariate regression analysis was used to correlate HAV with different parameters of lung function. Results: Unlike LAV, HAV did not show significant correlation with parameters of lung function. Even in patients with a relatively high HAV of more than 10%, in contrast to HAV (p=0.786) only LAV showed a significantly negative correlation with forced expiratory volume in 1 second (r=-0.309, R2=0.096, p=0.003). A severe decrease of DLCO% was associated with both larger HAV (p=0.045) and larger LAV (p=0.001). Residual volume and FVC were not influenced by LAV or HAV. Conclusion: In patients with COPD GOLD stage III-IV, emphysematous changes of lung parenchyma seem to have such a strong influence on lung function, which is a possible effect of concomitant unspecific fibrosis is overwhelmed.


Assuntos
Pulmão , Doença Pulmonar Obstrutiva Crônica , Enfisema Pulmonar , Fibrose Pulmonar , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X , Idoso , Correlação de Dados , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/etiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
20.
Medicine (Baltimore) ; 98(32): e16596, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393359

RESUMO

We explored the effects of smoking and exercise on pulmonary function (PF) in young adults.This was a 2-year, prospective cross-sectional study on university students. We recorded age, gender, weight, height, pulmonary symptoms, smoking status, and sports habits. Spirometry was used to evaluate lung function; we recorded the forced expiratory volume in 1 second (FEV1), the forced vital capacity (FVC), and the FEV1/FVC ratio.A total of 1014 (552 female, 464 male) subjects were included. Smokers reported significantly more wheezing and sputum production than nonsmokers, but exhibited better FVC and FEV1 values. Those who smoked less than half a pack/d had significantly poorer FVC and FEV1 levels than nonsmokers. Smokers exhibited significantly lower FEV1/FVC ratios than nonsmokers. Overall, those who exercised exhibited better FEV1 and FVC levels, but this was attributable entirely to females.The spirometric percentile data were adjusted for gender, age, and height, and used as indicators of health status (good: >90: average: 25-90, poor <25). ln males, PF was associated with regular exercise (good: 7.8, average: 6.5, poor: 14.2, P = .02). The smoking rate was higher in the "good" group (males: good: 31.3, average: 30, poor: 17.9, P = .02/females: good: 22.4, average: 17.9, poor: 10.4, P = .02).On multivariate regression analysis, above-average PF test results were associated with age (1.32 [1.04-1.69]) and exercising at least once per week (4.06 [1.16-14.20]) in males. In females, above-average results were associated with irregular exercise (2.88 [1.36-6.09]), age (1.85 [1.44-2.37]), and exercising until palpitations developed (0.18 [0.04-0.88]).Smoking improves lung function in young adults; these are "healthy smokers." Physical activity did not improve lung function, but the absence of physical activity significantly worsened lung function.


Assuntos
Exercício Físico/fisiologia , Testes de Função Respiratória/estatística & dados numéricos , Fumar/fisiopatologia , Adolescente , Adulto , Fatores Etários , Pesos e Medidas Corporais , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Prospectivos , Testes de Função Respiratória/métodos , Sons Respiratórios/fisiopatologia , Fatores Sexuais , Esportes/fisiologia , Escarro/metabolismo , Universidades , Adulto Jovem
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