Reference values for lung function screening in 10- to 81-year-old, healthy, never-smoking residents of Southeast China

Inhalation Bioaccessibility and Risk Assessment of Metals in PM2.5 Based on a Multiple-Path Particle Dosimetry Model in the Smelting District of Northeast China

PM2.5 can deposit and partially dissolve in the pulmonary region. In order to be consistent with the reality of the pulmonary region and avoid overestimating the inhalation human health risk, the bioaccessibility of PM2.5 heavy metals and the deposition fraction (DF) urgently needs to be considered. This paper simulates the bioaccessibility of PM2.5 heavy metals in acidic intracellular and neutral extracellular deposition environments by simulating lung fluid. The multipath particle dosimetry model was used to simulate DF of PM2.5. According to the exposure assessment method of the U.S. Environmental Protection Agency, the inhalation exposure dose threshold was calculated, and the human health risk with different inhalation exposure doses was compared. The bioaccessibility of heavy metals is 12.1−36.2%. The total DF of PM2.5 in adults was higher than that in children, and children were higher than adults in the pulmonary region, and gradually decreased with age. The inhalation exposure dose threshold is 0.04−14.2 mg·kg−1·day−1 for the non-carcinogenic exposure dose and 0.007−0.043 mg·kg−1·day−1 for the carcinogenic exposure dose. Cd and Pb in PM2.5 in the study area have a non-carcinogenic risk to human health (hazard index < 1), and Cd has no or a potential carcinogenic risk to human health. A revised inhalation health risk assessment may avoid overestimation.

Predictive Equations for Adult Pulmonary Function in Zhejiang Province, China

Background

Accurate interpretation of lung function tests requires appropriate spirometry reference values derived from large-scale population-specific epidemiological surveys. The aim of this cross-sectional study was to establish normal spirometric values for the population of healthy, nonsmoking Han Chinese adults residing in Zhejiang province, China.

Methods

We measured lung function parameters such as forced expiratory volume in 1 s, forced vital capacity, peak expiratory flow, maximal midexpiratory flow, and diffusion capacity for carbon monoxide and considered age, height, and weight as independent factors that may modify these parameters. The clinical data were divided into the study arm and validation group. The study arms were used to construct predictive equations using stepwise multiple linear regression, and data from the validation group were used to assess the robustness of the equations.

Results

The 3866 participants were randomized into a study arm (n = 1,949) and a validation arm (n = 1,917). Lung function parameters had a negative association with age and a positive association with height. Data from the two groups were similar. Predictive equations were constructed from the study arm, and the validation group was used to test the feasibility of the reference equations.

Conclusions

The reference values we derived can be used to evaluate lung function in this cohort in both epidemiological studies and clinical practice.

Nocebo Effects of Clinical Communication and Placebo Effects of Positive Suggestions on Respiratory Muscle Strength

Introduction:

The effects of specific suggestions are usually studied by measuring parameters that are directly addressed by these suggestions. We recently proposed the use of a uniform, unrelated, and objective measure like maximal muscle strength that allows comparison of suggestions to avoid nocebo effects and thus to improve communication. Since reduced breathing strength might impair respiration and increase the risk of post-operative pulmonary complications, the aim of the present study was to evaluate the effects of the suggestions on respiratory muscle power. Both the identification and neutralization of negative suggestions in the clinical context and stimulating suggestions could improve breathing force, a predictor of physical fitness and convalescence.

Methods

In 50 healthy, adult volunteers, respiratory muscle strength was measured by maximal inspiratory and expiratory pressures, as well as by maximal inspiratory and expiratory flows. Baseline was compared to values after application of eleven suggestions, five out of clinical context, including memory of negative or positive past, risk information for informed consent, and a non-verbal suggestion. Six stimulating suggestions included self-affirmation, empowering words, a heroic mirror image, and an imagination.

Results

All suggestions showed an impact on respiratory muscle strength, indicating placebo and nocebo effects. No single parameter could represent the breathing force in its complexity, however, trends and different specific aspects of it were measured. The strongest reaction was observed with the recall of a previous negative situation resulting in a reduction in expiratory flow to 96.1% of baseline (p = 0.041). After risk information, a decrease was observed in three of the parameters, with the highest extend in expiratory pressure by 4.4%. This nocebo effect was neutralized by adding positive aspects to the risk information. Every intended strengthening suggestion resulted in statistically significant increases of at least one parameter, with changes of up to 10% (e.g., MEP 110.3%, p = 0.001), indicating placebo effects. Here, expiration was more affected than inspiration. Sex was the only influencing factor reaching statistical significance, with stronger reactions in women.

Conclusion

Respiratory muscle strength proved to be sensitive to suggestions with clinical context, as well as suggestions intended for stimulation. With this objective measurement, evaluation, and comparison of different suggestions is possible to help avoid nocebo effects. The demonstrated effect of supporting suggestions can be followed up and used in clinical practice.

Sex differences in pulmonary function parameters among Indigenous Australians with and without chronic airway disease

Background

Studies assessing normative values and sex differences in pulmonary function test parameters (PFTPs) among Indigenous populations are sparse.

Methods

PFTPs were compared between male and female Indigenous Australian adults with and without chest radiologically proven chronic airway diseases (CADs).

Results

485 adults (56% were female) with no significant difference in age, body mass index or smoking status between sexes were included. Females displayed a higher prevalence of radiology without CADs compared to males (66 vs. 52%, respectively). Among patients without CADs, after adjustment for age, stature and smoking, males displayed significantly higher absolute values of Forced Vital Capacity (FVC) (mean difference, 0.41L (0.21,0.62), p<0.001) and Forced Expiratory Volume in one second (FEV₁) (mean difference 0.27L (0.07,0.47), p<0.001), with no significant difference in FEV₁/FVC ratio (mean difference -0.02 (-0.06, 0.02), p = 0.174). Male and female patients with radiologically proven CADs demonstrated lower FEV₁/FVC values. However, compared to females, males showed significantly greater reductions in pre- [-0.53 (-0.74, -0.32) vs. -0.29 (-0.42, -0.16), p = 0.045] and post- [-0.51 (-0.72, -0.3) vs. -0.27 (-0.39, -0.14), p = 0.049] bronchodilator FEV₁.

Conclusions

There are significant sex differences in the PFTPs among Indigenous Australians. Recognising these differences may be of value in the accurate diagnosis, management, monitoring and prognostication of CADs in this population.

The health impact of an innovative summer camp for older adults: a pilot study using an interdisciplinary collaborative approach

Background

Healthy aging with dignity and aging in place are important for Taiwanese individuals. Although Taiwan did not experience COVID-19 outbreaks prior to May 2021, many older adults have been encouraged to stay at home since the beginning of the global pandemic in January 2020. Such shelter-in-place recommendations have resulted in significant lifestyle changes, limiting activities associated with aging with dignity such as exercise and community engagement. Few studies have explored how to promote or maintain holistic health practices and physical fitness in older adults residing in rural communities during the COVID-19 pandemic. This pilot study aimed to establish an interdisciplinary collaboration with community care workers (CCWs) and evaluate the impact of an innovative summer camp (ISC) program for older adults residing in rural areas.

Methods

A quasi-experimental pre-post-test design with an interdisciplinary collaborative approach was implemented. The ISC program was based on a standardized protocol of modified Baduanjin exercise combined with three recreational breathing games. Participants were recruited from three community centers around the western coastal region of Yunlin County between June and August 2020. The ISC program was designed and executed by a nurse-led health promotion research team that collaborated with trained CCWs for 90 min per day, five days per week, for 12 weeks. Participants and CCWs wore facemasks during all activities. Paired t-test was used to measure changes in physical biomarkers, pulmonary lung function, and health-related fitness changes.

Results

Sixty-eight participants completed the ISC program. The ISC program significantly improved the participants’ physiological biomarkers and health-related fitness, including reduced body weight, waistline, and systolic blood pressure, and increased forced vital capacity, biceps arm flexion, and ability to sit and stand from a chair, step with a knee up in situ, and stand on one foot with eyes open. Most participants reported that they felt happy, satisfied, and hoped that this program would be continued in their community center.

Conclusions

This interdisciplinary, collaborative ISC program improved physical biomarkers and health-related fitness in older adults. Despite limitations, results strongly suggested that primary healthcare providers and CCWs can employ the described ISC program to promote wellness in older adults.

Children's lung function in relation to changes in socioeconomic, nutritional, and household factors over 20 years in Lanzhou

Background

Lanzhou has experienced rapid urbanization, leading to changes in socioeconomic, nutritional, and household factors. These changes may affect children’s lung function.

Methods

Two cross-sectional studies of school-age children (6–13 years of age) from the urban (Chengguan) (Period 1 in 1996 with n=390; Period 2 in 2017 with n=192) and the suburban (Xigu) (Period 1 n=344; Period 2 n=492) district were conducted. Demographic information, household factors, and nutrition status were obtained via a questionnaire survey. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) were measured in each period. Student’s t-test analysis of variance was used to assess the differences in FVC and FEV₁ between Periods 1 and 2. Generalized linear models were used to analyze the associations between questionnaire derived factors and lung function. Analyses were done separately for girls and boys.

Results

Children had significantly lower mean FEV₁ and FVC measures in Period 2 than in Period 1. This reduction was greater in children living in the urban area than those living in the suburban area. Obese children had significantly lower lung function but this was only statistically significant in Period 1.

Conclusions

Children’s lung function (FVC and FEV₁) were lower in 2017 than in 1996. Rapid urbanization may have contributed to the decline of lung function. Obesity may be a risk factor for impaired lung function in children living in Lanzhou and possibly elsewhere.

Changes in children's lung function over two decades in relation to socioeconomic, parental and household factors in Wuhan, China

Background

It is important to identify risk and beneficial factors for children's lung function. This study aims to ascertain potential changes in children's lung function in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning 25 years in Wuhan, the largest metropolis in central China.

Methods

In two cross-sectional studies, lung function measurements and questionnaire surveys were conducted on school-age children in 1993-1996 (Period I) and in 2018 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Demographic information, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Spirometric lung function was measured, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75), and peak expiratory flow (PEF). Wilcoxon analysis of variances was used to assess the differences in lung function indexes between Period I and Period II. Multiple linear regression models were used to estimate the association of lung function with regard to socioeconomic, parental and household factors, respectively.

Results

Significant prevalence reductions were observed for household coal use, paternal smoking and maternal asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds and breastfeeding, ventilation use during cooking, and parental education level from Period I to Period II. When adjusted for age, height, weight, sex and other factors assessed in the study, children had significant lower values of FVC, FEV₁, and PEF in Period II than in Period I. Enclosed kitchen was significantly associated with lower lung function in children in Period I. Urban living condition and higher maternal education level were each associated with a higher FVC, while father having no fixed income was associated with a lower FVC and a lower FEV₁, respectively, in Period II. In comparison with Period I, the beneficial impact of urban living and that of breastfeeding were enhanced and the detrimental effect of poor household condition was weakened in Period II.

Conclusions

Lung function was lower in 2018 than in 1993-1996 in school-age children living in Wuhan. Although improvements in urban living and household environmental conditions as well as increased breastfeeding in Period II could have contributed to increased lung function, other unmeasured risk factors may have played a more dominant role in leading to a net decrease in lung function from Period I to Period II. Future studies are needed to identify these risk factors.

Lung function impairment and cardiometabolic risks among rural adults: implication for an aging society

BACKGROUND

Early detection and prevention of cardiometabolic risk factors in an increasingly aging society are a global public health concern. Maintaining adequate lung function is important for healthy aging. Few studies exist on lung function impairment and decline in primary healthcare settings, especially among rural adults with cardiometabolic risks. This study aimed to explore the prevalence of impaired lung function and its association with cardiometabolic risks among rural adults.

METHODS

A community-based, cross-sectional study was conducted between March and December 2019 in western coastal Yunlin County, Taiwan. The lung function test was measured by spirometry, based on the American Thoracic Society recommendations. Three lung function parameters were obstructive lung impairment, restrictive lung impairment, and mixed lung impairment. Restrictive, obstructive, and mixed type lung function was categorized as impaired. Cardiometabolic risk factors and metabolic syndrome were based on the national standard and include five abnormal biomarkers, including abdominal obesity, blood pressure, fasting plasma glucose, triglycerides, and decreased high-density cholesterol levels.

RESULTS

The median age of the 1653 (92.9%) participants with complete data was 66 years (interquartile range: 55 to 75 years). The prevalence of impaired lung function was 37%, including 31.7% restrictive, 2.5% obstructive, and 2.7% mixed type. Adults with impaired lung function (86% restrictive type) engaged more in smoking and betel nut chewing, ate fewer vegetables and fruit, and drank less water compared to the normal lung function group. After adjusting for potential confounding variables, multivariate logistic regression analysis showed that cardiometabolic risk factors were independently associated with restrictive lung impairment, while cigarette smoking (OR = 2.27, 95% CI = 1.14-4.53) and betel nut chewing (OR = 2.33, 95% CI = 1.09-5.01) were significantly associated with the obstructive type of lung impairment.

CONCLUSIONS

A high prevalence of restrictive lung impairment, cardiometabolic risks, and unhealthy lifestyles among rural adults were found in this study. For adults with cardiometabolic risks in rural areas, initiating lifestyle modifications with culture-tailored programs to improve lung function should be an important issue for clinicians and primary healthcare providers.

Prevalence of and Factors Associated with Cardiometabolic Risks and Lung Function Impairment among Middle-Aged Women in Rural Taiwan

Background: This study aims to explore the prevalence of and factors associated with cardiometabolic risks and lung function impairment among middle-aged women. Methods: A nurse-led community health development and cross-sectional study design was applied in Yunlin County, Taiwan. Lung function test was performed by a certified technician using a valid spirometer, during annual community health checkups conducted by a collaborating local hospital. Lung function impairment and cardiometabolic risks were measured and defined, based on the medical diagnosis and the national standard, by the hospital. Results: From a total of 439 middle-aged women, the prevalence of lung function impairment and metabolic syndrome were 26% and 47.2%, respectively. Many women adopted few health habits, e.g., only 30.5% engaged in regular exercise. A significant association between lung function impairment and four cardiometabolic risk factors (p < 0.05) was found. The multivariate logistic regression analysis showed that adopting few exercises (OR = 0.56, 95% CI 0.36–0.87) and lung function impairment (OR = 2.12, 95% CI 1.34–3.35) were independently associated with metabolic syndrome, after adjusting for confounding factors, such as age and education. Conclusions: The findings revealed that middle-aged women have a high prevalence of cardiometabolic risks and lung function impairment. Lung function impairment and physical inactivity were independently associated with an increased risk of having metabolic syndrome.

Dexmedetomidine for early postoperative cognitive dysfunction after video-assisted thoracoscopic lobectomy in elderly male patients with lung cancer

This retrospective study explored the efficacy and safety of dexmedetomidine in treating early postoperative cognitive dysfunction (EPPNCD) after video-assisted thoracoscopic lobectomy (VATL) in elderly male patients with lung cancer (LC).This study included a total of 80 elderly male patients with LC who received VATL. All of them were equally assigned to a treatment group and a control group, with 40 patients each group. The primary outcome included cognitive dysfunction, as evaluated by mini-mental state examination scale. The secondary outcomes consisted of incidence of EPPNCD, lung function (as measured by forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, and maximal voluntary ventilation), and adverse events. All outcome data were analyzed before and 3 days after surgery.After surgery, all patients in the treatment group exerted better efficacy in mini-mental state examination scale (P < .01) and incidence of EPPNCD (P = .03), than patients in the control group. However, no significant differences were detected in forced vital capacity (P = .65), forced expiratory volume in 1 second (P = .50), peak expiratory flow (P = .73), and maximal voluntary ventilation (P = .27) between 2 groups. In addition, there is similar safety profile between 2 groups.The findings of this study showed that dexmedetomidine may benefit EPPNCD after VATL in elderly male patients with LC. Future studies are needed to warrant the present conclusions.

Effects of Specific Core Re-Warm-Ups on Core Function, Leg Perfusion and Second-Half Team Sport-Specific Sprint Performance: A Randomized Crossover Study

This study examined the effects of a specific core exercise program, as a re-warm-up regime during the half-time period, on inspiratory (IM) and core (CM) muscle functions, leg perfusion and the team sport-specific sprint performance in the initial stage of the second half of a simulated exercise task. Nine team-sports players performed a simulated team-sport intermittent exercise protocol (IEP) in two phases, on a non-motorized treadmill, interspersed by a 15-min half-time break. During the half-time period subsequent to the 25-min Phase-1 IEP, the players either rested passively or performed 4-min CM exercise concomitant with inspiratory loaded breathing following 11-min passive recovery. The changes in IM and CM functions, leg perfusion and repeated-sprint ability mediated by the two recovery modes were compared. Following Phase-1 IEP, there was a significant decline in IM and CM functions respectively, revealed by the decreases in maximal inspiratory pressure (PImax: -8.1%) and performance of a sport-specific endurance plank test (SEPT: -29.7%, p < 0.05). With the 15-min passive recovery, the decline in IM and CM functions from pre-exercise levels were not restored satisfactorily (PImax: -6.4%, SEPT: -19.0%, p < 0.05). Moreover, repeated-sprint ability during the Phase-2 IEP tended to decrease (peak velocity: -2.3%, mean velocity: -2.1%) from the levels recorded in Phase-1. In contrast, following the re-warm-up exercises during half-time, the restoration of IM and CM function was accelerated (PImax: -0.9%, SEPT: -3.3%, p <0 .05). This was associated with enhanced repeated-sprint ability (peak velocity: +3.0%, mean velocity: +2.0%, p < 0.05) in Phase-2 IEP. Nevertheless, the changes in the anterior thigh muscle perfusion assessed by near-infrared spectroscopy following the re-warm-up exercises was not different from that of passive recovery (p > 0.05). The findings suggest that a brief inspiratory-loaded CM exercise regime appears to be an effective re-warm-up strategy that optimizes second-half repeated-sprint performance and core function of players in team sports.