Introduction to pulmonary function

Association between obesity and lung function in South African adolescents of African Ancestry

Background

There is a growing body of literature on the increasing prevalence of obesity in adolescents of Sub-Saharan African ancestry. However, limited data is available on the impact of obesity on pulmonary function. This study assessed the relationship between obesity and lung function in South African adolescents of African ancestry.

Methods

This was a cross-sectional study involving 10–14 year old adolescents recruited from middle schools of the Eastern Cape Province of South Africa. Anthropometric measurements were performed. Body mass index (BMI) was converted to percentiles for age and sex and used to classified obesity. Spirometry was performed to assess lung function. Chi-square test of association and binary regression analysis were used to assess the relationship between obesity and airway obstruction. Adjusted linear regression was used to determine the relationship between obesity and lung function parameters.

Results

A total of 540 adolescents were recruited for the study among which 77 (14.3%) were obese. Lung function parameters: forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁) were higher (p < 0.001) in obese than in non-obese adolescents while peak expiratory flow (PEF) % and FEV₁/FVC ratio were lower (p < 0.05) in obese than non-obese adolescents. Obesity was associated (χ2 = 9.614; p < 0.01) with airway obstruction and obese adolescents were over 1.5 times more likely to have pulmonary obstruction (OR: 1.57; p < 0.05) than their non-obese counterparts. Anthropometric measures were positively associated (p < 0.05) with FVC, FEV1, PEF and/or FEV_25-75 but negatively associated with FEV₁/FVC ratio.

Conclusions

Obesity was associated with airway obstruction in South Africa adolescents of African ancestry.

Low thoracic muscle mass index on computed tomography predicts adverse outcomes following lobectomy via thoracotomy for lung cancer

OBJECTIVES

The aim of this study was to determine whether the preoperative thoracic muscle mass is associated with postoperative outcomes in patients undergoing lobectomy via thoracotomy for lung cancer.

METHODS

Consecutive patients undergoing lobectomy were retrospectively reviewed. The thoracic muscle mass index (TMMI) was obtained at the level of the fifth thoracic vertebra on preoperative thoracic computed tomography (CT). Patients were analysed comparatively by being dividing into low and high muscle index groups by the median of sex-specific TMMI. The primary outcomes were the incidence of any or postoperative pulmonary complications. The secondary outcomes were postoperative intensive care unit (ICU) admission, length of stay (LOS) in the ICU, total hospital LOS, readmission and mortality.

RESULTS

The study population consisted of 120 patients (63.6 ± 9.8 years; 74% male). Each groups included 60 patients. Major complications occurred in 28.3% (34/120) and readmission in 18.3% (22/120) of patients. The adjusted multivariable analysis showed that each unit increase in TMMI (cm2/m2) was independently associated with the rates of less any complications [odds ratio (OR) 0.92, P = 0.014], pulmonary complications (OR 0.27, P = 0.019), ICU admission (OR 0.76, P = 0.031), hospitalization for >6 days (OR 0.90, P = 0.008) and readmission (OR 0.93, P = 0.029).

CONCLUSIONS

Low TMMI obtained from the preoperative thoracic CT is an independent predictor of postoperative adverse outcomes in patients following lobectomy via thoracotomy for lung cancer. TMMI measurements may contribute to the development of preoperative risk stratification studies in the future.

Effects of yoga on pulmonary functions among asthmatic patients: A protocol synthesis

OBJECTIVE

This study aimed to synthesize protocol of yoga pranayama's practice through combining yoga pranayama's steps into the new integrated formations of yoga pranayama's steps for adult asthmatic patients as a protocol.

METHOD

Literature review from the last 20 years publication of original trial articles on adult asthmatic subjects from 4 databases: PubMed, Science Direct, EBSCO, and Scopus was conducted. Review and non-trial articles were excluded. Articles were appraised using Joanna Bridge Institute (JBI) critical appraisal tools.

RESULTS

There were 4 out of 252 articles which met the criteria and being included in this study. The synthesized protocol resulting 11 pranayama steps in the new synthesized protocol.

CONCLUSIONS

The regular 13 yoga pranayama steps within 11 pranayama steps based on synthesized protocol takes 30-45min for each session and can be conducted 2-5 times a week for 2-6 months to be able to reveal pulmonary function outcomes.

Utility of Peak Inspiratory Flow in Managing Subglottic Stenosis

Objectives:

To identify the utility of peak inspiratory flow (PIF) in the assessment and management of subglottic stenosis through correlation of clinical presentation with PIF.

Study Design:

Case report.

Methods:

Review of the clinical course of a 31-year-old woman with the diagnosis of granulomatosis with polyangiitis. Repeated PIF measurements at clinic visits were obtained over a 30-month follow-up.

Results:

Twenty-seven PIF measurements were obtained at 31 otolaryngology clinic visits. Correlations were identified between low PIF measurements with the clinical symptom shortness of breath (2.04 ± 0.38 L/s, n = 10), clinically recorded stridor at rest (1.64 ± 0.41 L/s, n = 3), and urgent operative intervention (1.60 ± 0.23 L/s, n = 5). Correlations were identified between high PIF measurement with patient report of normal breathing (3.07 ± 0.35 L/s, n = 16) and clinical observation of absence of stridor at rest (2.81 ± 0.32 L/s, n = 23). There was a statistically significant difference in the patient’s PIF values with patient-documented shortness of breath vs no shortness of breath ( P = .001) and clinician-noted stridor vs no stridor ( P = .017).

Conclusion:

Peak inspiratory flow measurements correlate with degree of airway compromise and are helpful to monitor the degree of airway obstruction and document response to treatment.