Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults

Low lung function in Bipolar Disorder and Schizophrenia: a hidden risk

Introduction: People with serious mental illness (SMI), such as schizophrenia and bipolar disorder, have a higher risk of premature morbidity and mortality. In the general population, impaired lung function is associated with increased morbidity and mortality. We compared lung function between people with and without serious mental illnesses using a cross-sectional study in 9 community mental health units. Methods: Subjects aged 40-70 years with a diagnosis of schizophrenia or bipolar disorder were recruited consecutively. The controls had no psychiatric diagnosis and were not receiving any psychotropics. Spirometry was performed by a trained nurse. We used the 2021 American Thoracic Society/European Respiratory Society standards for the interpretation of the spirometry results. Results: We studied 287 subjects. People with SMI (n = 169) had lower spirometry values than those without a psychiatric diagnosis (n = 118). An abnormal spirometry pattern (36.1% vs 16.9%, p < 0.001), possible restriction or non-specific (Preserved Ratio Impaired Spirometry [PRISm]) pattern (17.8% vs 7.6%, p = 0.014), and pattern of airflow obstruction or possible mixed disorder (18.3% vs 9.3%, p = 0.033) were more frequent in people with SMI. Multivariate analyses showed that the PRISm pattern was associated with abdominal circumference (odds ratio [OR] 1.05, 95%CI 1.03-1.08) and that the pattern of airflow obstruction or possible mixed disorder was associated with smoking behavior (OR 5.15, 95%CI 2.06-15.7). Conclusion: People with SMI have impaired lung function, with up to one-third of them showing an abnormal spirometry pattern. This suggests that regular monitoring of lung function and addressing modifiable risk factors, such as tobacco use and obesity, in this population is of paramount importance.

Cardiorespiratory fitness as a mediator in the relationship between lung function and blood pressure in adults

It is unclear whether physical activity and cardiorespiratory fitness (CRF) are pathways that link low pulmonary function (LPF) to increased blood pressure (BP). Therefore, we investigated the extent to which CRF and moderate-to-vigorous physical activity (MVPA) mediate the relationship between LPF and high BP in adults. We conducted a cross-sectional study with 1,362 participants that underwent cardiopulmonary exercise testing (CPET), spirometry, and wore an accelerometer to determine physical activity patterns. We performed mediation analyses using structural equations considering peak oxygen uptake (V̇O₂) and MVPA as mediators, forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) as independent variables, and systolic and diastolic blood pressure (SBP, DBP) as dependent variables. The probability of alpha error was set at 5%. We found a significant total effect of FVC on SBP and DBP considering V̇O₂ as mediator (P<0.01). Indirect effects were also significant, with 42.6% of the total effect of FVC on SBP and 77% on DBP mediated by V̇O₂ (P<0.01). We did not observe a direct effect of FVC on SBP and DBP. Considering FEV1 as an independent variable, the total effect on SBP was also significant, as were the indirect effects, mediated by V̇O₂ at 14.8% for SBP and 7.6% for DBP (P<0.01). We did not find an indirect effect of FVC or FEV1 considering the MVPA as a mediator. CRF mediates the pathway that links LPF and elevated BP. Therefore, CRF is more sensitive to variations in FVC and FEV1 than MVPA.

Regular Physical Activity Levels and Incidence of Restrictive Spirometry Pattern: A Longitudinal Analysis of 2 Population-Based Cohorts

We estimated the association between regular physical activity and the incidence of restrictive spirometry pattern. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and physical activity were assessed in 2 population-based European cohorts (European Community Respiratory Health Survey: n = 2,757, aged 39-67 years; and Swiss Study on Air Pollution and Lung and Heart Diseases in Adults: n = 2,610, aged 36-82 years) first in 2000-2002 and again approximately 10 years later (2010-2013). Subjects with restrictive or obstructive spirometry pattern at baseline were excluded. We assessed the association of being active at baseline (defined as being physically active at least 2-3 times/week for ≥1 hour) with restrictive spirometry pattern at follow-up (defined as a postbronchodilation FEV1/FVC ratio of at least the lower limit of normal and FVC of <80% predicted) using modified Poisson regression, adjusting for relevant confounders. After 10 years of follow-up, 3.3% of participants had developed restrictive spirometry pattern. Being physically active was associated with a lower risk of developing this phenotype (relative risk = 0.76, 95% confidence interval: 0.59, 0.98). This association was stronger among those who were overweight and obese than among those of normal weight (P for interaction = 0.06). In 2 large European studies, adults practicing regular physical activity were at lower risk of developing restrictive spirometry pattern over 10 years.

Influence of cigarette smoking on biventricular systolic function independent of respiratory function: a cross-sectional study

Background

Cigarette smoking harms nearly every organ, including the heart and lungs. A comprehensive assessment of both cardiac and respiratory function is necessary for evaluating the direct effects of tobacco on the heart. However, few previous studies examining the effects of cigarette smoking on cardiac function included an assessment of lung function. This cross-sectional study investigated the influence of cigarette smoking on cardiac function, independent of respiratory function.

Methods

We retrospectively reviewed the medical records of 184 consecutive cases that underwent both spirometry and transthoracic echocardiography around the same time (within 1 month) in one hospital from April 2019 to March 2020. Participants were classified into three groups based on lifetime smoking exposure (pack-years): non-smoker (n = 49), low exposure (1–20 pack-years, n = 40), and high exposure (≥ 20 pack years, n = 95). Multiple linear regression analysis was used to assess the relationship among cigarette smoking, and cardiac and respiratory functions. The relationship between selected dependent variables and lifetime pack-years was assessed in two models with multiple linear regression analysis. Model 1 was adjusted for age and male sex; and Model 2 was adjusted for Model 1 plus forced expiratory volume percentage in 1 s and forced vital capacity percentage.

Results

Compared with the non-smokers, the participants with high smoking exposure had lower left ventricular (LV) systolic function and larger LV size. Multiple linear regression analysis revealed a negative association of cumulative lifetime pack-years with LV and right ventricular (RV) systolic functions, even after adjustment for age, sex, and spirometric parameters (forced expiratory volume percentage in 1 s and forced vital capacity percentage). Meanwhile, there was no significant association of smoking exposure with LV diastolic function (E/e′ and E/A) and RV diastolic function (e′t and e′t/a′t).

Conclusions

Cumulative smoking exposure was associated with a negative effect on biventricular systolic function in patients with relatively preserved cardiac function, independent of respiratory function.

Effects of obesity on postural balance and occurrence of falls in asymptomatic adults

Abstract Introduction: Previous studies suggested that body weight is a strong predictor for postural balance. High body mass index (BMI) presented an association with increased postural sway. However, it seems controversial since studies reported no difference between obese and control group regarding the position of the center of pressure in static postural balance (PB). Also, there is a lack of investigations about the impact of obesity on PB, free of the confound effect of cardiometabolic risk. Objective: The aim of this study was to evaluate the effects of obesity in static PB and occurrence of falls in asymptomatic adults and older adults over 40 years old. Method: The PB of 624 subjects divided into quartiles for BMI, waist-to-hip ratio, waist-to-height and fat body mass as percentage (%FBM) was assessed with and without vision using a force platform. An MANOVA was used to determine if there were differences between quartiles and a logistic regression analysis adjusted for confounders variables were applied to determine the obesity role in the occurrence of falls. Results: We found weak to moderate bivariate correlations between obesity and static PB, which became non-significant after adjustment. We found significant differences between first and fourth quartiles, especially using %FBM. Obesity was not related to the occurrence of falls since the odds ratio values became non-significant for all the indices of obesity after adjustment. Conclusion: Obesity presents little influence on maintaining static PB and seems not to determine the occurrence of falls among subjects over 40 years old.

Glomerular hyperfiltration may be a novel risk factor of restrictive spirometry pattern: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES) 2009-2015

BACKGROUND AND OBJECTIVES

There have been limited studies regarding the association between glomerular hyperfiltration (GHF) and restrictive spirometry pattern (RSP) in Korean adults.

METHODS

We used data of 23,189 adults from the Korea National Health and Nutritional Examination Survey 2009-2015 with a complete data set including spirometry, serum creatinine, and anthropometric measurements. Spirometry data included the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). We defined GHF as the >90th percentile of age & sex adjusted estimated glomerular filtration rate (eGFR), and RSP was defined as an FVC <80%-predicted value and an FEV1/FVC ratio ≥0.7.

RESULTS

Participants with RSP showed higher blood pressure, fasting glucose, and triglyceride, reduced high density lipoprotein cholesterol, and central obesity, which resulted in a higher prevalence of metabolic syndrome (MetS) compared to those without RSP. Multivariate logistic regression revealed that the odds for RSP were significantly increased with an increased number of MetS components. In addition, increased eGFR was associated with decreased FVC, showing an inverted J-shaped relationship in a multivariate generalized additive model analysis. In the multivariate logistic regression analysis, the adjusted odds ratio and 95% confidence interval of GHF for RSP was 1.184 (1.026-1.368, P = 0.021), which was evident in groups without metabolic disorders.

CONCLUSIONS

We concluded that GHF was associated with increased odds for RSP, particularly in groups without metabolic disorders. Further prospective studies are needed to confirm our study results.

Intraoperative immunomodulatory effects of sevoflurane versus total intravenous anesthesia with propofol in bariatric surgery (the OBESITA trial): study protocol for a randomized controlled pilot trial

Background

Obesity is associated with a chronic systemic inflammatory process. Volatile or intravenous anesthetic agents may modulate immune function, and may do so differentially in obesity. However, no study has evaluated whether these potential immunomodulatory effects differ according to type of anesthesia in obese patients undergoing laparoscopic bariatric surgery.

Methods/design

The OBESITA trial is a prospective, nonblinded, single-center, randomized, controlled clinical pilot trial. The trial will include 48 patients with a body mass index ≥ 35 kg/m², scheduled for laparoscopic bariatric surgery using sleeve or a Roux-en-Y gastric bypass technique, who will be allocated 1:1 to undergo general inhalational anesthesia with sevoflurane or total intravenous anesthesia (TIVA) with propofol. The primary endpoint is the difference in plasma interleukin (IL)-6 levels when comparing the two anesthetic agents. Blood samples will be collected prior to anesthesia induction (baseline), immediately after anesthetic induction, and before endotracheal extubation. Levels of other proinflammatory and anti-inflammatory cytokines, neutrophil chemotaxis, macrophage differentiation, phagocytosis, and occurrence of intraoperative and postoperative complications will also be evaluated.

Discussion

To our knowledge, this is the first randomized clinical trial designed to compare the effects of two different anesthetics on immunomodulation in obese patients undergoing laparoscopic bariatric surgery. Our hypothesis is that anesthesia with sevoflurane will result in a weaker proinflammatory response compared to anesthesia with propofol, with lower circulating levels of IL-6 and other proinflammatory mediators, and increased macrophage differentiation into the M2 phenotype in adipose tissue.

Trial registration

Registro Brasileiro de Ensaios Clínicos, RBR-77kfj5. Registered on 25 July 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3399-z) contains supplementary material, which is available to authorized users.

Association of urinary 3-phenoxybenzoic acid level with pulmonary function reduction in an urban elderly population with repeated measures data

Pyrethroids are a class of man-made insecticides associated with various adverse health outcomes including respiratory problems. However, there were limited evidences on the relation between 3-phenoxybenzoic acid (3-PBA) as a metabolite of pyrethroids and pulmonary function, particularly among elderly population who have declining pulmonary function. Therefore, we collected urine samples and performed pulmonary function test (PFT) repeatedly in a total of 559 Korean elderly living in Seoul as an urban area. After measurement of urinary 3-PBA levels, cross-sectional relations of visit-to-visit variation in 3-PBA level on visit-to-visit variation in PFT parameters were evaluated using linear mixed effect models and generalized additive mixed models after adjustment for age, sex, body mass index, smoking status, education, visit episode, and phthalate metabolite levels. The Korean elderly were highly exposed to pyrethroids with 30.2% of elderly people with 3-PBA level over reference value derived on the 95th percentile of representative samples (2 ng/mL). Forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC (FEF_25-75) as PFT parameters showed significant reductions by an increase of 3-PBA level (FEV₁, β = -1.48, p-value < 0.01; FVC, β = -1.14, p-value < 0.01; and FEF_25-75, β = -1.11, p-value = 0.03). The negative associations of 3-PBA level with FEV₁, FVC, and FEF_25-75 were found only for females (FEV₁, β = -1.64, p-value < 0.01; FVC, β = -1.47, p-value < 0.01; and FEF_25-75, β = -1.06, p-value = 0.07), but not for males. However, the longitudinal effect of 3-PBA level on the trajectory of FEV₁, FVC, and FEF_25-75 declines in females was not found. Community-level exposure to pyrethroids was associated with pulmonary function reduction in elderly population, indicating that more stringent control of pyrethroids is necessary to protect the elderly who have declining pulmonary function.

The association between physical activity, sedentary behavior and the occurrence of falls in asymptomatic adults over 40 years old

Abstract Introduction: Sedentary behavior (SB) has been described as an independent risk factor for health, regardless of the recommended amount of moderate-to-vigorous physical activity (MVPA). However, SB and MVPA as predictors of falls have been poorly investigated. Objective: To compare the associations between SB and MVPA and the occurrence of falls in middle-aged and older adults. Method: The participants wore a triaxial accelerometer over the dominant hip for seven days to measure SB and MVPA. The occurrence of falls and cardiovascular risk factors were assessed by self-report. Isokinetic peak torque (PT) of knee extension, peak oxygen uptake (V’O2) in a ramp treadmill protocol, and lean (LBM) body mass and body fat (BFM) (bioelectrical impedance) were also assessed. The critical roles of SB and MVPA on the occurrence of falls were compared by multiple logistic regression adjusted for age, sex, cardiovascular risk factors, LBM, peak V’O2, and PT of knee extension. Results: 379 participants were evaluated, aged 40-80 years. Forty-eight participants reported at least one fall in the previous 12 months (14.5%). Fallers presented lower SB and higher MVPA. They were predominantly women and older adults with lower physical fitness. After multivariate analysis, MVPA, but not SB, was selected as an independent predictor of falls, increasing the odds ratio of having a fall (1.184, 95% confidence interval, 1.016 - 1.378). Conclusion: Episodes of falls in predominantly middle-aged and women subjects were associated with a higher amount of MVPA, not the opposite, indicating an adverse effect of MVPA in these subjects.

Restrictive spirometry pattern is associated with low physical activity levels. A population based international study

INTRODUCTION

Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry.

METHODS

Restrictive spirometry pattern was defined as a having post-bronchodilator FEV₁/FVC ≥ Lower Limit of Normal and a FVC<80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (<1st study-specific tertile) was evaluated using adjusted logistic regression models.

RESULTS

Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding.

CONCLUSION

Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

Association between phthalate exposure and lower lung function in an urban elderly population: A repeated-measures longitudinal study

BACKGROUND

Lung function is a major predictor of morbidity and mortality. Only a few studies have explored the association between phthalate exposure and lung function.

OBJECTIVE

To evaluate the association between phthalate exposure and lung function in the elderly.

METHODS

A total of 3 repeated-measures surveys were conducted in 559 elderly individuals aged ≥60 years in Seoul, Korea, at 1-year intervals (2012-2015). During each survey, urinary mono-(2-ethyl-5-hydrohexyl) phthalate (MEHHP) (geometric mean, 15.68 μg/L), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) (11.97 μg/L), and mono-n-butyl phthalate (MnBP) (2.09 μg/L) levels were measured; moreover, lung function tests and a structured questionnaire interview were performed. We constructed linear mixed models to assess the association between urinary phthalate metabolite levels and lung function.

RESULTS

A doubling of creatinine-adjusted urinary phthalate metabolite levels was inversely associated with forced expiratory volume in 1 s (L) (β = -0.01, 95% confidence interval [CI]: -0.02, 0.004 for MEHHP; β = -0.02, 95% CI: -0.03, -0.01 for MEOHP; β = -0.01, 95% CI: -0.03, -0.003 for MnBP) and forced vital capacity (L) (β = -0.02, 95% CI: -0.03, -0.001 for MEHHP; β = -0.02, 95% CI: -0.03, -0.004 for MEOHP; β = -0.02, 95% CI: -0.03, -0.001 for MnBP). A doubling of creatinine-adjusted MnBP levels was associated with increased rates of annual decline in forced vital capacity (L/year) (β = -0.01, 95% CI: -0.02, -0.001).

CONCLUSIONS

Urinary phthalate metabolite levels were associated with lower lung function and an increased rate of decline in lung function in an elderly population.

Effect of chest and abdominal wall mobility and respiratory muscle strength on forced vital capacity in older adults

This study investigated by sex the effect of chest and abdominal wall mobility and respiratory muscle strength on forced vital capacity (FVC) in older adults. FVC, respiratory muscle strength, and chest and abdominal wall mobility were assessed in 154 community-dwelling older adults. As an index of the chest and abdominal wall mobility, chest (upper and lower chest) and total (upper chest, lower chest, and abdomen) scale values were measured using the breathing movement scale. Subjects with a restrictive spirometric pattern showed significantly lower chest and total scale values in both sexes, maximal inspiratory strength in women, and maximal expiratory strength in men. Chest and total scale values were significantly associated with FVC in the multiple regression analysis. The receiver operating characteristic analysis showed fair to good specificity of chest and total scale values for detecting a restrictive spirometric pattern. The results show that chest and abdominal wall mobility is closely associated with FVC in community-dwelling older adults without airflow limitation.

Living near the port area is associated with physical inactivity and sedentary behavior

CONTEXT AND OBJECTIVE:

The impact of the port of Santos, Brazil, on the population's health is unknown. We aimed to evaluate the association between living near the port area and physical inactivity and sedentary behavior.

DESIGN AND SETTING:

Cross-sectional study developed at a university laboratory and a diagnostic clinic.

METHODS:

553 healthy adults were selected and their level of physical activity in daily life was assessed using accelerometers. Multiple linear and logistic regressions were performed using physical inactivity and sedentary behavior as the outcomes and living near the port area as the main risk factor, with adjustments for the main confounders.

RESULTS:

Among all the participants, 15% were resident near the port area. They took 699 steps/day and presented, weekly, 2.4% more sedentary physical activity, 2.0% less time in standing position and 0.9% more time lying down than residents of other regions. Additionally, living near the port area increased the risk of physical inactivity by 2.50 times and the risk of higher amounts of sedentary behavior (≥ 10 hours/day) by 1.32 times.

CONCLUSION:

Living near the port of Santos is associated with physical inactivity and higher sedentary behavior among adults, regardless of confounders. The reasons for this association should be investigated in longitudinal studies.