Association Between Maternal Prenatal Exposure to Household Air Pollution and Child Respiratory Health: A Systematic Review and Meta-analysis

Maternal prenatal exposure to household air pollution (HAP) is a critical public health concern with potential long-term implications for child respiratory health. The objective of this study is to assess the level of association between prenatal household air pollution and child respiratory health, and to identify which HAP pollutants are associated with specific respiratory illnesses or symptoms and to what degree. Relevant studies were retrieved from PubMed databases up to April 27, 2010, and their reference lists were reviewed. Random effects models were applied to estimate summarized relative risks (RRs) and 95% confidence intervals (CIs). The analysis involved 11 studies comprising 387 767 mother-child pairs in total, assessing various respiratory health outcomes in children exposed to maternal prenatal HAP. Children with prenatal exposure to HAP pollutants exhibited a summary RR of 1.26 (95% CI=1.08-1.33) with moderate between-study heterogeneity (I²=49.22%) for developing respiratory illnesses. Specific associations were found between prenatal exposure to carbon monoxide (CO) (RR=1.11, 95% CI: 1.09-1.13), Nitrogen Oxides (NOx) (RR=1.46, 95% CI: 1.09-1.60), and particulate matter (PM) (RR=1.26, 95% CI: 1.2186-1.3152) and child respiratory illnesses (all had I² close to 0%, indicating no heterogeneity). Positive associations with child respiratory illnesses were also found with ultrafine particles (UFP), polycyclic aromatic hydrocarbons (PAH), and ozone (O3). However, no significant association was observed for prenatal exposure to sulfur dioxide (SO2). In summary, maternal prenatal exposure to HAP may contribute to a higher risk of child respiratory health issues, emphasizing the need for interventions to reduce this exposure during pregnancy. Targeted public health strategies such as improved ventilation, cleaner cooking technologies, and awareness campaigns should be implemented to minimize adverse respiratory effects on children.

Increased Apolipoprotein B/Apolipoprotein A-I Ratio Is Associated With Decline in Lung Function in Healthy Individuals: The Kangbuk Samsung Health Study

BACKGROUND

Lung dysfunction and high apolipoprotein B/apolipoprotein A-I (apoB/apoA-I) ratio are both recognized risk factors for cardiovascular disease. However, few studies have examined the association between the apoB/ApoA-I ratio and lung function. Therefore, we investigated whether this ratio is associated with decreased lung function in a large healthy cohort.

METHODS

We performed a cohort study on 68,418 healthy Koreans (34,797 males, mean age: 38.1 years) who underwent a health examination in 2019. ApoB/apoA-I ratio was categorized into quartiles. Spirometric values at the fifth percentile in our population were considered the lower limit of normal (LLN), which was used to define lung function impairment. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs), using the lowest quartile as the reference, were estimated to determine lung function impairment.

RESULTS

Mean apoB/apoA-I ratio was 0.67 ± 0.21. Subjects with the highest quartile of this ratio had the lowest predicted forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%) after controlling for covariates (P < 0.001). However, FEV1/FVC ratio was not significantly different among the four quartiles (P = 0.059). Compared with the lowest quartile (Q1, reference), the aORs (95% CI) for FEV1% < LLN across increasing quartiles (from Q2 to Q4) were 1.216 (1.094-1.351), 1.293 (1.156-1.448), and 1.481 (1.311-1.672) (P for trend < 0.001), respectively. Similarly, the aORs for FVC% < LLN compared with the reference were 1.212 (1.090-1.348), 1.283 (1.147-1.436), and 1.502 (1.331-1.695) with increasing quartiles (P for trend < 0.001). However, the aORs for FEV1/FVC < LLN were not significantly different among groups (P for trend = 0.273).

CONCLUSION

High apoB/apoA-I ratio was associated with decreased lung function. However, longitudinal follow-up studies are required to validate our findings.

Exploring Prognostically Significant Factors in COVID-19-Associated Pulmonary Fibrosis after Adaptive Lung Ventilation

Background

Research data on hospitalized coronavirus 2019 (COVID-19) survivors indicate the persistence of symptoms, radiological abnormalities, and physiological disorders months after the initial infection. Given the scale of the ongoing pandemic, a substantial number of patients with severe residual pulmonary fibrosis (PF) and oxygen dependence are anticipated. Currently, the search for risk factors associated with the development of fibrotic radiological abnormalities after moderate to severe COVID-19 is underway. Furthermore, the extent to which computed tomography (CT) data correlate with postdischarge symptoms and physical functions remains unclear. This study aimed to characterize patients experiencing persistent pulmonary consequences after hospital discharge. We examined clinical, radiological, and laboratory predictors of pulmonary fibrosis after COVID-19 infection.

Methods

We retrospectively evaluated fibrosis-like lung changes and their prognostic factors in COVID-19 survivors. Our study included 77 patients with laboratory-confirmed COVID-19 who received inpatient treatment at City Clinical Hospital No. 1 in Almaty between November and December 2020. We assessed patients during the acute phase of the disease and again 6 to 8 months after discharge using high-resolution computed tomography (CT). Patients were classified into 2 cohorts based on semi-quantitative analysis of subsequently added tomograms-those with radiological fibrosis-like abnormalities (main group) and those who had recovered (control group).

Results

Parenchymal cords, irregular interfaces, reticulation, and traction bronchiectasis were common CT findings among all COVID-19 patients. Our study focused on patients who developed pulmonary fibrosis within 1 month after the onset of the disease. After 6 to 8 months, fibrosis-like lung changes persisted in 49.35% of patients (leading group), while 50.65% showed disease resolution (control group). Age, body mass index, high interleukin-6 (IL-6) levels, low IO levels, and the need for mechanical ventilation were identified as prognostic indicators for the persistence of pulmonary fibrosis.

Conclusion

Our study revealed that pulmonary function can return to normal in over half of COVID-19 patients 8 months after infection onset. Despite advancements in COVID-19 treatment, there remains a significant knowledge gap in managing long-term effects, especially pulmonary fibrosis. Continued clinical trials and research on post COVID-19 fibrosis are essential to prevent early mortality due to the long-term impacts on these patients.

Interstitial Lung Abnormalities, Emphysema and Spirometry in Smokers

BACKGROUND

Most pulmonary conditions reduce forced vital capacity (FVC), but studies of patients with combined pulmonary fibrosis and emphysema demonstrate that reductions in FVC are less than expected when these two conditions coexist clinically.

RESEARCH QUESTION

Do interstitial lung abnormalities (ILA), chest computed tomography (CT) imaging findings that may suggest an early stage of pulmonary fibrosis in undiagnosed individuals, affect the association between emphysema and FVC?

STUDY DESIGN AND METHODS

Measures of ILA and emphysema were available in 9579 and 5277 participants from phases 1 (2007-2011) and 2 (2012-2016) of COPDGene, respectively. ILA were defined by Fleischner Society guidelines. Adjusted linear regression models were used to assess the associations and interactions between ILA, emphysema, measures of spirometry and lung function.

RESULTS

ILA were present in 528 (6%), and 580 (11%), of participants in phases 1 and 2 of COPDGene, respectively. ILA modified the association between emphysema and FVC (P<0.0001 for interaction) in both phases. In phase 1, in those without ILA, a 5% increase in emphysema was associated with a reduction in FVC (-110 cc, 95% confidence interval [CI] -121, -100; P<0.0001) however, in those with ILA it was not (-11cc, 95% CI -53,31; P=0.59). In contrast, there was no interaction between ILA and emphysema on total lung capacity (TLC) nor on diffusing capacity of carbon monoxide (DLCO).

INTERPRETATION

The presence of ILA attenuates the reduction in FVC associated with emphysema.

Personal Exposure to PM2.5 Oxidative Potential in Association with Pulmonary Pathophysiologic Outcomes in Children with Asthma

Fine particulate matter (PM_2.5) with a higher oxidative potential has been thought to be more detrimental to pulmonary health. We aim to investigate the associations between personal exposure to PM_2.5 oxidative potential and pulmonary outcomes in asthmatic children. We measured each of the 43 asthmatic children 4 times for airway mechanics, lung function, airway inflammation, and asthma symptom scores. Coupling measured indoor and outdoor concentrations of PM_2.5 mass, constituents, and oxidative potential with individual time-activity data, we calculated 24 h average personal exposures 0-3 days prior to a health outcome measurement. We found that increases in daily personal exposure to PM_2.5 oxidative potential were significantly associated with increased small, large, and total airway resistance, increased airway impedance, decreased lung function, and worsened scores of individual asthma symptoms and the total symptom score. Among the PM_2.5 constituents, organic matters largely of indoor origin contributed the greatest to PM_2.5 oxidative potential. Given that the variability in PM_2.5 oxidative potential was a stronger driver than PM_2.5 mass for the variability in the respiratory health outcomes, it is suggested to reduce PM_2.5 oxidative potential, particularly by reducing the organic matter constituent of indoor PM_2.5, as a targeted source control strategy in asthma management.

Short-term personal and outdoor exposure to ultrafine and fine particulate air pollution in association with blood pressure and lung function in healthy adults

Studies reporting on associations between short-term exposure to outdoor fine (PM_2.5), and ultrafine particles (UFP) and blood pressure and lung function have been inconsistent. Few studies have characterized exposure by personal monitoring, which especially for UFP may have resulted in substantial exposure measurement error. We investigated the association between 24-h average personal UFP, PM_2.5, and soot exposure and dose and the health parameters blood pressure and lung function. We further assessed the short-term associations between outdoor concentrations measured at a central monitoring site and near the residences and these health outcomes. We performed three 24-h personal exposure measurements for UFP, PM_2.5, and soot in 132 healthy adults from Basel (Switzerland), Amsterdam and Utrecht (the Netherlands), and Turin (Italy). Monitoring of each subject was conducted in different seasons in a one-year study period. Subject's activity levels and associated ventilation rates were measured using actigraphy to calculate the inhaled dose. After each 24-h monitoring session, blood pressure and lung function were measured. Contemporaneously with personal measurements, UFP, PM_2.5 and soot were measured outdoor at the subject's residential address and at a central site in the research area. Associations between short-term personal and outdoor exposure and dose to UFP, PM_2.5, and soot and health outcomes were tested using linear mixed effect models. The 24-h mean personal, residential and central site outdoor UFP exposures were not associated with blood pressure or lung function. UFP mean exposures in the 2-h prior to the health test was also not associated with blood pressure and lung function. Personal, central site and residential PM_2.5 exposure were positively associated with systolic blood pressure (about 1.4 mmHg increase per Interquartile range). Personal soot exposure and dose were positively associated with diastolic blood pressure (1.2 and 0.9 mmHg increase per Interquartile range). No consistent associations between PM_2.5 or soot exposure and lung function were observed. Short-term personal, residential outdoor or central site exposure to UFP was not associated with blood pressure or lung function. Short-term personal PM_2.5 and soot exposures were associated with blood pressure, but not lung function.

Direct Switch from Tiotropium to Indacaterol/Glycopyrronium in Chronic Obstructive Pulmonary Disease Patients in Korea

Background

Many chronic obstructive pulmonary disease (COPD) patients receiving monotherapy continue to experience symptoms, exacerbations and poor quality of life. This study aimed to assess the efficacy and safety of direct switch from once-daily tiotropium (TIO) 18 μg to indacaterol/glycopyrronium (IND/GLY) 110/50 μg once daily in COPD patients in Korea.

Methods

This was a randomized, open-label, parallel group, 12-week trial in mild-to-moderate COPD patients who received TIO 18 μg once daily for ≥12 weeks prior to study initiation. Patients aged ≥40 years, with predicted post-bronchodilator forced expiratory volume in 1 second (FEV₁) ≥50%, post-bronchodilator FEV₁/forced vital capacity <0.7 and smoking history of ≥10 pack-years were included. Eligible patients were randomized in a 1:1 ratio to either IND/GLY or TIO. The primary objective was to demonstrate superiority of IND/GLY over TIO in pre-dose trough FEV₁ at week 12. Secondary endpoints included transition dyspnea index (TDI) focal score, COPD assessment test (CAT) total score, and rescue medication use following the 12-week treatment, and safety assessment.

Results

Of the 442 patients screened, 379 were randomized and 347 completed the study. IND/GLY demonstrated superiority in pre-dose trough FEV₁ versus TIO at week 12 (least squares mean treatment difference [Δ], 50 mL; p=0.013). Also, numerical improvements were observed with IND/GLY in the TDI focal score (Δ, 0.31), CAT total score (Δ, −0.81), and rescue medication use (Δ, −0.09 puffs/day). Both treatments were well tolerated by patients.

Conclusion

A direct switch from TIO to IND/GLY provided improvements in lung function and other patient-reported outcomes with an acceptable safety profile in patients with mild-to-moderate airflow limitation.

Three-month Follow-up Study of Survivors of Coronavirus Disease 2019 after Discharge

BACKGROUND

Most patients including health care workers (HCWs) survived the coronavirus disease 2019 (COVID-19), however, knowledge about the sequelae of COVID-19 after discharge remains limited.

METHODS

A prospectively observational 3-month follow-up study evaluated symptoms, dynamic changes of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG and IgM, lung function, and high resolution computed tomography (HRCT) of survivors of COVID-19 after discharge at Wuhan Union Hospital, China.

RESULTS

Seventy-six survivors (55 females) with a mean age of 41.3 ± 13.8 years were enrolled, and 65 (86%) were HCWs. A total of 69 (91%) patients had returned to their original work at 3-months after discharge. Most of the survivors had symptoms including fever, sputum production, fatigue, diarrhea, dyspnea, cough, chest tightness on exertion and palpitations in the three months after discharge. The serum troponin-I levels during the acute illness showed high correlation with the symptom of fatigue after hospital discharge (r = 0.782; P = 0.008) and lymphopenia was correlated with the symptoms of chest tightness and palpitations on exertion of patients after hospital discharge (r = -.285, P = 0.027; r = -.363, P = 0.004, respectively). The mean values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity and diffusion capacity were all normal (> 80% predicted) and lung HRCTs returned to normal in most of the patients (82%), however, 42% of survivors had mild pulmonary function abnormalities at 3-months after discharge. SARS-CoV-2 IgG turned negative in 11% (6 of 57 patients), 8% (4 of 52 patients) and 13% (7 of 55 patients), and SARS-CoV-2 IgM turned negative in 72% (41 of 57 patients), 85% (44 of 52 patients) and 87% (48 of 55 patients) at 1-month, 2-months and 3-months after discharge, respectively.

CONCLUSION

Infection by SARS-CoV-2 caused some mild impairments of survivors within the first three months of their discharge and the duration of SARS-CoV-2 antibody was limited, which indicates the necessity of long-term follow-up of survivors of COVID-19.

Respiratory Symptoms and Diminished Lung Functions Associated with Occupational Dust Exposure Among Iron Ore Mine Workers in Iran

Background:

Dust exposure at quarry mines is inevitable and can result in poor air quality. This research aimed to assess pulmonary symptoms and lung functions of dust-exposed workers at an iron-ore mine in eastern Iran.

Methods:

An environmental cross-sectional study sampled 174 dust-exposed mine workers and 93 unexposed administrative employees as the reference group. A standardized questionnaire on respiratory symptoms was completed in accordance with recommendations of the American Thoracic Society(ATS). Calibrated spirometer measured Pulmonary Function Tests (PFTs). Data were analyzed via SPSS-21, integrating independent samples t-test, Chi-square and linear or logistic-regression models.

Results:

There was no significant variation between dust-exposed and reference groups in terms of age, weight, height, work experience and the number of smokers (P>0.05). Mean levels of exposure to inhalable and respirable mineral-dust were 15.09±2.34 and 3.45±2.57 mg/m³ respectively. Pulmonary capacities of dust-exposed group were considerably decreased as compared to others (Forced Vital Capacity [FVC] 86.55±13.77 vs. 105.05±21.5; Forced Expiratory Volume in 1 second [FEV1] 88.06±16.8 vs. 105.81±21.55; FEV1/FVC 103.03±18.17 vs. 93.3±12.49; and Peak Expiratory Flow [PEF] 89.82±22.58 vs. 98.09±20.60) (P<0.001); with a higher prevalence of cough (P=0.041), wheezing (P=0.032), and dyspnea (P=0.035) among formers. Age along with exposure to respirable-dust significantly reduced FVC, FEV1 and FEV1/FVC. Cigarette consumption attenuated FVC and FEV1 on an average of 5 to 9 units.

Conclusion:

Controlled occupational dust-exposure is a definitive pre-requisite to reduce respiratory problems among quarry workers, with an explicit consideration towards mineral- mine workers. Modifiable accomplices like smoking and non-compliance of PPEs usage should be amicably resolved.

COVID-19: Reduced Lung Function and Increased Psycho-emotional Stress

The COVID-19 outbreak causing reduced lung function and increased psycho-emotional stress in the community worldwide. Therefore, it is of interest to document such viral outbreak related emotional stress data in the community with known molecular and patho-physiological parameters of the affected individuals. We provide a concise, coherent, critical, precise, specific and direct narration of such events from a community research viewpoint using known molecular data in this editorial.

Post-tuberculosis health-related quality of life, lung function and exercise capacity in a cured pulmonary tuberculosis population in the Breede Valley District, South Africa

BACKGROUND

Pulmonary tuberculosis (PTB) remains a major concern worldwide. Albeit curable, PTB continues to negatively affect patients' health-related quality of life (HRQoL) and functioning even after cure.

OBJECTIVES

To describe the demographics, respiratory symptoms, pulmonary airflow patterns, HRQoL and exercise capacity of cured PTB patients, in the Breede Valley district of South Africa.

METHODS

A cross-sectional study conducted at five primary health care facilities included adult patients diagnosed with PTB, who had completed anti-tuberculosis treatment. Post-treatment bronchodilator lung function, HRQoL and 6-min walk distance (6MWD) were measured.

RESULTS

Three hundred and twenty-four patients were screened. Specific challenges resulted in 45 patients being included (male n = 25 [56%]; mean population age 39.9 [± 10.2]). HRQoL was assessed using the short-form 12v2, part of the burden of lung disease core questionnaire. In general, self-reported physical scores (physical health component summary score = 45) were higher than mental scores (mental health component summary score = 39). The mean 6MWD was 294.5 m (± 122.7) m (range 110 m - 600 m), which is well below normal reference values. Forty-eight percent (48%) of the sample presented with abnormal lung function, including obstructive (n = 9; 21%), restrictive (n = 11; 25%) and mixed (n = 1; 2%).

CONCLUSIONS

This pilot study suggests that most cured PTB patients have decreased HRQoL, exercise capacity and abnormal lung function. This study is the first to describe the combination of these three outcomes in a South African population.

CLINICAL IMPLICATIONS

Clinicians must recognise that holistic management of PTB patients is required after cure.

Effect of wearing cotton towel Ihram and plain Ihram on lung function among Hajj Pilgrims

Objectives:

Hajj is the world’s largest gathering to Makkah, Saudi Arabia. Wearing cotton made Ihram is a basic and an essential component of Hajj. The aim of this study was to investigate the lung functions among Hajj pilgrims who were wearing cotton towel ihram (ihram with fibers) compared to those who were wearing plain cotton ihram (ihram without fibers).

Methods:

Ninety male, non-smoker, Hajj pilgrim volunteers with age ranged 20-60 years were selected. Forty five of them wore cotton towel ihram and 45 wore plain ihram. A day before leaving for Hajj and wearing ihram (6^th Dhu-al-Hijjah) lung function base line parameters of Hajj pilgrims were determined. Hajj Pilgrims continuously wear ihram from 7-10^th Dhu-al-Hijjah. In the afternoon of 10^th Dhu-al-Hijjah, after removal of ihram, all parameters were repeated and at the completion of Hajj when all pilgrims return to their homes at Riyadh, all parameters were recorded again.

Results:

Before wearing Ihram, anthropometric and lung function baseline parameters were recorded, no significant difference was found between the study population. After wearing Ihram on the 7^th Dhu-al-Hijjah and its removal on the 10^th Dhu-al-Hijjah significant decline in the lung function test parameters was observed among Hajj pilgrims who were wearing cotton towel ihram. Forced Vital Capacity (FVC) 4.30±1.18 vs. 5.03±1.41 (p=0.01); Forced Expiratory Flow 25% (FEF-25%) 4.39±1.94 vs. 5.69±2.84 (p=0.03); Forced Expiratory Flow-50% (FEF-50%) 2.93±1.65 vs. 4.07±2.08 (p=0.01); Forced Expiratory Flow-75% (FEF-75%) 1.02±0.70 vs. 1.66±0.94 (p=0.002) compared to those who were wearing plain ihram.

Conclusions:

Lung function test parameters were decreased among the Hajj pilgrims who were wearing cotton towel ihram compared to those who were wearing plain cotton ihram. The pattern of impairment of lung function shows an obstructive peripheral airway lung involvement. It is suggested to conduct further large sample size studies to confirm the present study observations and reach at better conclusions.

Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults

Background

Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB.

Methods

The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008–2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed.

Results

Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV₁) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error=49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the non-PTB group.

Conclusion

FEV₁ tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

Impact of lung-function measures on cardiovascular disease events in older adults with metabolic syndrome and diabetes

BACKGROUND

Individuals with metabolic syndrome (MetS) and diabetes (DM) are more likely to have decreased lung function and are at greater risk of cardiovascular disease (CVD).

HYPOTHESIS

Lung-function measures can predict CVD events in older persons with MetS, DM, and neither condition.

METHODS

We followed 4114 participants age ≥ 65 years with and without MetS or DM in the Cardiovascular Health Study. Cox regression examined the association of forced vital capacity (FVC) and 1-second forced expiratory volume (FEV₁ ; percent of predicted values) with incident coronary heart disease and CVD events over 12.9 years.

RESULTS

DM was present in 537 (13.1%) and MetS in 1277 (31.0%) participants. Comparing fourth vs first quartiles for FVC, risk of CVD events was 16% (HR: 0.84, 95% CI: 0.59-1.18), 23% (HR: 0.77, 95% CI: 0.60-0.99), and 30% (HR: 0.70, 95% CI: 0.58-0.84) lower in DM, MetS, and neither disease groups, respectively. For FEV₁ , CVD risk was lower by 2% (HR: 0.98, 95% CI: 0.70-1.37), 26% (HR: 0.74, 95% CI: 0.59-0.93), and 31% (HR: 0.69, 95% CI: 0.57-0.82) in DM. Findings were strongest for predicting congestive heart failure (CHF) in all disease groups. C-statistics increased significantly with addition of FEV₁ or FVC over risk factors for CVD and CHF among those with neither MetS nor DM.

CONCLUSIONS

FEV₁ and FVC are inversely related to CVD in older adults with and without MetS, but not DM (except for CHF); however, their value in incremental risk prediction beyond standard risk factors is limited mainly to metabolically healthier persons.

Impact of High-Intensity-NIV on the heart in stable COPD: a randomised cross-over pilot study

BACKGROUND

Although high-intensity non-invasive ventilation has been shown to improve outcomes in stable COPD, it may adversely affect cardiac performance. Therefore, the aims of the present pilot study were to compare cardiac and pulmonary effects of 6 weeks of low-intensity non-invasive ventilation and 6 weeks of high-intensity non-invasive ventilation in stable COPD patients.

METHODS

In a randomised crossover pilot feasibility study, the change in cardiac output after 6 weeks of each NIV mode compared to baseline was assessed with echocardiography in 14 severe stable COPD patients. Furthermore, CO during NIV, gas exchange, lung function, and health-related quality of life were investigated.

RESULTS

Three patients dropped out: two deteriorated on low-intensity non-invasive ventilation, and one presented with decompensated heart failure while on high-intensity non-invasive ventilation. Eleven patients were included in the analysis. In general, cardiac output and NTproBNP did not change, although individual effects were noticed, depending on the pressures applied and/or the co-existence of heart failure. High-intensity non-invasive ventilation tended to be more effective in improving gas exchange, but both modes improved lung function and the health-related quality of life.

CONCLUSIONS

Long-term non-invasive ventilation with adequate pressure to improve gas exchange and health-related quality of life did not have an overall adverse effect on cardiac performance. Nevertheless, in patients with pre-existing heart failure, the application of very high inspiratory pressures might reduce cardiac output.

TRIAL REGISTRATION

The trial was registered in the Deutsches Register Klinischer Studien (DRKS-ID: DRKS00007977 ).

Respiratory Effects of Simultaneous Exposure to Respirable Crystalline Silica Dust, Formaldehyde, and Triethylamine of a Group of Foundry Workers

BACKGROUND

Foundry workers are occupationally exposed to hazardous substances such as silica dusts and toxic gases. The aim of this study was to examine the effects of simultaneous exposure to complex mixtures of silica dust, formaldehyde, and triethylamine on lung function parameters.

STUDY DESIGN

A cross-sectional study.

METHODS

This study was conducted on 55 male workers of core making unit of a foundry plant (the case group) and 55 workers in a food industry were enrolled as a control group in 2015. Workers were monitored for personal exposure to crystalline silica respirable dust, according the NIOSH method No.7602. The concentrations of formaldehyde and triethylamine were measured using a PID instrument. Lung function tests were performed according to the ERS/ATS standards.

RESULTS

The mean concentrations of personal exposure to silica dust, formaldehyde, and triethylamine in the core making workers were 0.23 mg/m3, 2.85 ppm, and 5.55 ppm and respective exposures of control subjects were less than the LOD (limit of detection). There were significant associations between exposure to silica dust and decreases in FVC (Forced vital capacity) values (P<0.05). The findings showed a statistically significant synergistic effect of silica dust and triethylamine on FVC values (P<0.05).

CONCLUSIONS

The mean exposure of all studied substances was higher than occupational exposure limits. Synergistic effects of exposure to silica dust and triethylamine on some lung function parameters were observed. Simultaneous exposure of foundry workers to silica dust and triethylamine could impair lung function.

The Effect of Wood Aerosols and Bioaerosols on the Respiratory Systems of Wood Manufacturing Industry Workers in Golestan Province

BACKGROUND

Occupational exposure to dust leads to acute and chronic respiratory diseases, occupational asthma, and depressed lung function. In the light of a lack of comprehensive studies on the exposure of Iranian workers to wood dusts, the objective of this study was to monitor the occupational exposure to wood dust and bioaerosol, and their correlation with the lung function parameters in chipboard manufacturing industry workers.

MATERIALS AND METHODS

A cross-sectional study was conducted on chipboard workers in Golestan Province; a total of 150 men (100 exposed cases and 50 controls) were assessed. Workers were monitored for inhalable wood dust and lung function parameters, i.e., FVC, FEV1, FEV1/FVC, and FEF25-75%. The workers' exposure to bioaerosols was measured using a bacterial sampler; a total of 68 area samples were collected. The analysis was performed using the Mann-Whitney, Kruskal-Wallis, and regression statistical tests.

RESULTS

The geometric mean value and geometric standard deviation of inhalable wood dust for the exposed and control groups were 19 ± 2.00 mg/m3 and 0.008 ± 0.001 mg/m3, respectively. A statistically significant correlation was observed between the lung parameters and cumulative exposure to inhalable wood dust, whereas a statistically significant correlation was not observed between the lung parameters and bioaerosol exposure. However, the exposure of Iranian workers to bioaerosols was higher, compared to their foreign coworkers.

CONCLUSION

Considering the high level of exposure among workers in this study along with their lung function results, long-term exposure to wood dust may be detrimental to the workers' health and steps to limit their exposure should be considered seriously.

The Lung Function Impairment in Non-Atopic Patients With Chronic Rhinosinusitis and Its Correlation Analysis

Objectives

Chronic rhinosinusitis (CRS) is common disease in otorhinolaryngology and will lead to lower airway abnormality. However, the only lung function in CRS patients and associated factors have not been much studied.

Methods

One hundred patients with CRS with nasal polyps (CRSwNP group), 40 patients with CRS without nasal polyps (CRSsNP group), and 100 patients without CRS were enrolled. The difference in lung function was compared. Meanwhile, CRSwNP and CRSsNP group were required to undergo a bronchial provocation or dilation test. Additionally, subjective and objective outcomes were measured by the visual analogue scale (VAS), 20-item Sino-Nasal Outcome Test (SNOT-20), Lund-Mackay score, Lund-Kennedy endoscopic score. The correlation and regression methods were used to analyze the relationship between their lung function and the above parameters.

Results

The forced expiratory volume in 1 second (FEV₁) and forced expiratory flow between 25% and 75% of forced vital capacity (FEF_25-75) of CRSwNP group were significantly lower than other groups (P<0.05). On peak expiratory flow, there was no difference between three groups. In CRSwNP group, FEV₁ was negatively correlated with peripheral blood eosinophil count (PBEC) and duration of disease (r=–0.348, P=0.013 and r=–0.344, P=0.014, respectively), FEF_25-75 negatively with VAS, SNOT-20 (r=–0.490, P=0.028 and r=–0.478, P=0.033, respectively) in CRSsNP group. The incidence of positive bronchial provocation and dilation test was lower in CRSwNP group (10% and 0%, respectively), with both 0% in CRSsNP group. The multiple linear regression analysis indicated that change ratio of FEV₁ before and after bronchial provocation or dilation test were correlated with PBEC in CRSwNP group (β=0.403, P=0.006).

Conclusion

CRS leading to impaired maximum ventilation and small airway is associated with the existence of nasal polyp. Lung function impairments can be reflected by PBEC, duration, VAS, and SNOT-20. In CRSwNP patients, PBEC is independent predictor of FEV₁ change ratio.

Spirometry interpretation feasibility among pre-school children according to the European Respiratory Society and American Thoracic Society Guidelines

INTRODUCTION

Spirometry is the most used test to evaluate pulmonary function. Guidelines that defined acceptability and repeatability criteria for its implementation and interpretation among preschoolers were published in 2007. Our objective was to quantify the actual compliance with these criteria among pre-school patients.

METHODS

A review was performed on the baseline spirometry measured in patients aged 2 to 5 years in the Pediatric Respiratory Laboratory of the Pontificia Universidad Católica de Chile, who were admitted due to recurrent or persistent coughing or wheezing. Only those results obtained in patients who took the test for the first time were considered. They were analyzed by international standards.

RESULTS

A total of 93 spirometry results (mean age 57.4 ± 8.6 months, 48 males) were obtained, of which 44 (47%) met all acceptable criteria, 87 (93%) obtained expiratory time of ≥ 0.5seconds, and 67 (72%) of the patients had an end-expiratory flow of ≤10% from peak flow. The variation in the measurement of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) was very low (intraclass correlation coefficient > 0.9).

CONCLUSION

It was possible to meet the acceptability and repeatability criteria for spirometry among pre-school children in our Center, which was similar to previous reports. As in older children, this test is fully recommended for pre-school children who require lung function studies.

Changes in Simple Spirometric Parameters After Lobectomy for Bronchial Carcinoma

Introduction: The purpose of this study was to describe the postoperative changes in lung function after pure open lobectomy for lung carcinoma.

Methods: 30 patients (mean age 64 ± 7 years old, 16 men and 14 women) underwent a left or right lobectomy. They underwent spirometric pulmonary tests preoperatively, and at 1 and 6 months after the operation.

Results: The average preoperative forced expiratory volume in 1 second (FEV1) was 2.55±0.62lt and the mean postoperative FEV1 at 1 and 6 months was 1.97 ± 0.59 L and 2.15±0.66 L respectively. The percentage losses for FEV1 were 22.7% and 15.4% after 1 and 6 months respectively. An average percentage increase of 9.4% for FEV1 was estimated at the time of 6 months in comparison with this of 1 month after the operation. The average preoperative forced vital capacity (FVC) was 3.17 ± 0.81 L and the mean postoperative FVC at 1 and 6 months after the operation was 2.50 ± 0.63 L and 2.72 ± 0.67 L respectively. The percentage losses for FVC were 21.1% and 14.2% after 1 and 6 months respectively. An average percentage increase of 8.7% was observed at the time period of 6 months in comparison with this of 1 month after the operation.

Conclusion: Although, we observed a significant decrease in FEV1 and FVC after the operation, all patients were in excellent clinical status. FEV1 and FVC of 6 months were increased in comparison with the respective values of 1 month after the operation, but did not reach the preoperative values in any patient.

Lung function in sickle cell disease

Although some of the most severe complications of Sickle Cell Disease (SCD) tend to be acute and severe (e.g. acute chest syndrome, stroke etc.), the chronic ones can be equally debilitating. Prominent among them is the effect that the disease has on lung growth and function. For many years the traditional teaching has been that SCD is associated with the development of a restrictive lung defect. However, there is increasing evidence that this is not a universal finding and that at least during childhood and adolescence, the majority of the patients have a normal or obstructive pattern of lung function. The following article reviews the current knowledge on the effects of SCD on lung growth and function. Special emphasis is given to the controversies among the published articles in the literature and discusses possible causes for these discrepancies.

Spirometric standards for healthy children and adolescents of Korean Chinese in northeast China

In China there are 1,923,842 Korean Chinese, who live mostly (92.27%) in the country's three northeast provinces. In spite of this sizeable number, no spirometric data are available at present on them. The present study investigated normal spirometric reference values for the Korean Chinese children and adolescents. Spirometry was performed in 443 healthy Korean Chinese children and adolescents aged 8-18 yr with measurements of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF) and maximum mid-expiratory flow (MMEF). Reference equations for FEV1, FVC, PEF and MMEF were derived by using multiple regression analysis. All of the measured spirometric parameters correlated positively with height and age significantly (P < 0.001). The predicted values of FVC and FEV1 were higher than values obtained by using Caucasian and other Asian equations (P < 0.001). A set of spirometric reference equations has been derived using a relatively large, healthy, non-smoking young Korean Chinese population with a wide range of ages and heights, the results of which differ from those gained from several other reference equations. These reference equations should be used for evaluation of lung function in this population.

Metabolic syndrome, insulin resistance and systemic inflammation as risk factors for reduced lung function in Korean nonsmoking males

The aim of this study was done to assess the association of lung function with insulin resistance (IR), systemic inflammation, and metabolic syndrome (MetS). In 9,581 apparently healthy non-smoking male adults, pulmonary function, fasting glucose, insulin, lipid profiles and serum high-sensitivity C-reactive protein (hs-CRP) levels were measured, and homeostatic model assessment (HOMA) was used to assess IR. The presence of MetS was defined according to the AHA/NHLBI criteria. The prevalence of MetS was 19.3%. The odds ratio of MetS for restrictive ventilatory pattern was 1.55 (95% confidence interval, 1.12-2.14), and that for obstructive ventilatory pattern was 1.39 (0.66-2.94) after adjustment for confounders. When subjects were divided in 4 groups according to quartiles of FVC or FEV(1) (% predicted [pred]), HOMA-IR significantly increased as the FVC or FEV(1) (% predicted [pred]) decreased. Individuals in the lowest FVC or FEV(1) quartile had the highest hs-CRP level. Prevalence of MetS increased as FVC or FEV(1) (% predicted [pred]) quartiles decreased. The abdominal obesity, hs-CRP and HOMA-IR were the independent predictors for the lowest FVC and FEV(1) (% predicted [pred]) even after adjustment for confounders. These results indicate that MetS, IR, and systemic inflammation are important risk factors for reduced lung function in nonsmoking Korean males.

Interleukin-13 and its receptors in idiopathic interstitial pneumonia: clinical implications for lung function

Idiopathic interstitial pneumonia (IIP) is characterized by varying degrees of interstitial fibrosis. IL-13 and IL-4 are strong inducers of tissue fibrosis, whereas IFN-gamma has antifibrotic potential. However, the roles of these substances in IIP remain unknown. IL-13, IL-4, and IFN-gamma were measured in the BAL fluid of 16 idiopathic pulmonary fibrosis (IPF) patients, 10 nonspecific interstitial pneumonia (NSIP) patients, and 8 normal controls. The expression of IL-13 and IL-13Ralpha1/alpha2 in lung tissues was analyzed using ELISA and immunohistochemistry. IL-13 levels were significantly higher in IPF patients than the others (P<0.05). IL-4 levels were higher in both IPF and NSIP patients than in normal controls (P<0.05), and IFN-gamma levels were lower in NSIP patients than in normal controls (P=0.047). IL-13 levels correlated inversely with FVC% (r=-0.47, P=0.043) and DLCO% (r=-0.58, P=0.014) in IPF and NSIP patients. IL-13 was strongly expressed in the smooth muscle, bronchial epithelium, alveolar macrophages and endothelium of IPF patients. IL-13Ralpha1, rather than IL-13Ralpha2, was strongly expressed in the smooth muscle, bronchial epithelium, and endothelium of IPF patients. IL-13 and its receptors may contribute to the pathogenesis of fibrosis in IIP and appear to be related to the severity of the disease.