Comparison of per cent predicted and percentile values for pulmonary function test interpretation

Design of Growth Trend Map of Children and Adolescents Based on Bone Age

Accurate height prediction has important reference significance for the development of children and adolescents and the selection of athletes. The current mainstream height prediction methods include the B-P (Bayley–Pinneau) method and the TW2 (Tanner–Whitehouse) method. A large number of documents show that the B-P method and the TW2 method have relatively large deviations in the lifelong height prediction results of Chinese children and adolescents. Based on the data collected by the Chinese Adolescent Students' Physical Fitness and Growth and Development Health Project in Zhejiang's primary and secondary schools, this paper proposes a graph of height growth trends based on bone age. The height map of age has more reference value. Aiming at the feasibility of the height data in the statistical results, the interpolation prediction method is used to verify the data, and the height growth trend graph is drawn through the method of fitting. Validation results with actual data show that the average error of the lifetime height prediction of the height growth trend map proposed in this paper is 2.1 cm, which is 1.4 cm lower than the 3.5 cm error predicted by the B-P method and 0.4 cm lower than the 2.5 cm error predicted by the TW2 method.

Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study

Rationale

Oscillometry is an emerging technique that offers some advantages over spirometry as it does not require forced exhalation and may detect early changes in respiratory pathology. Obstructive lung disease disproportionately impacts people experiencing homelessness with a high symptoms burden, yet oscillometry is not studied in this population.

Objectives

To assess lung disease and symptom burden using oscillometry in people experiencing homelessness or at-risk of homelessness using a community-based participatory action research approach (The Bridge Model™).

Methods

Of 80 recruited, 55 completed baseline oscillometry, 64 completed spirometry, and all completed patient-reported outcomes with demographics, health, and respiratory symptom related questionnaires in the Participatory Research in Ottawa: Management and Point-of-Care for Tobacco Dependence project. Using a two-tail t-test, we compared mean oscillometry values for airway resistance (R_5–20), reactance area under the curve (A_x) and reactance at 5 Hz (X₅) amongst individuals with fixed-ratio method (FEV₁/FVC ratio < 0.70) and LLN (FEV₁/FVC ratio ≤ LLN) spirometry diagnosed chronic obstructive pulmonary disease (COPD). We compared mean oscillometry parameters based on participants’ COPD assessment test (CAT) scores using ANOVA test.

Results

There was no significant difference between the pre- and post- bronchodilator values of R_5–20 and A_x for the fixed ratio method (p = 0.63 and 0.43) and the LLN method (p = 0.45 and 0.36). There was a significant difference in all three of the oscillometry parameters, R_5–20, A_x and X₅, based on CAT score (p = 0.009, 0.007 and 0.05, respectively). There was a significant difference in R_5–20 and A_x based on the presence of phlegm (p = 0.03 and 0.02, respectively) and the presence of wheeze (p = 0.05 and 0.01, respectively). Oscillometry data did not correlate with spirometry data, but it was associated with CAT scores and correlated with the presence of self-reported symptoms of phlegm and wheeze in this population.

Conclusions

Oscillometry is associated with respiratory symptom burden and highlights the need for future studies to generate more robust data regarding the use of oscillometry in systematically disadvantaged populations where disease burden is disproportionately higher than the general population.

TrialRegistration: ClinicalTrails.gov—NCT03626064, Retrospective registered: August 2018, https://clinicaltrials.gov/ct2/show/NCT03626064

One-year follow-up of chest CT findings in patients after SARS-CoV-2 infection

BACKGROUND

Knowledge about the 1-year outcome of COVID-19 is limited. The aim of this study was to follow-up and evaluate lung abnormalities on serial computed tomography (CT) scans in patients with COVID-19 after hospital discharge.

METHODS

A prospective cohort study of patients with COVID-19 from the First Affiliated Hospital, Zhejiang University School of Medicine was conducted, with assessments of chest CT during hospitalization and at 2 weeks, 1 month, 3 months, 6 months, and 1 year after hospital discharge. Risk factors of residual CT opacities and the influence of residual CT abnormalities on pulmonary functions at 1 year were also evaluated.

RESULTS

A total of 41 patients were followed in this study. Gradual recovery after hospital discharge was confirmed by the serial CT scores. Around 47% of the patients showed residual aberration on pulmonary CT with a median CT score of 0 (interquartile range (IQR) of 0-2) at 1 year after discharge, with ground-glass opacity (GGO) with reticular pattern as the major radiologic pattern. Patients with residual radiological abnormalities were older (p = 0.01), with higher rate in current smokers (p = 0.04), higher rate in hypertensives (p = 0.05), lower SaO2 (p = 0.004), and higher prevalence of secondary bacterial infections during acute phase (p = 0.02). Multiple logistic regression analyses indicated that age was a risk factor associated with residual radiological abnormalities (OR 1.08, 95% CI 1.01-1.15, p = 0.02). Pulmonary functions of total lung capacity (p = 0.008) and residual volume (p < 0.001) were reduced in patients with residual CT abnormalities and were negatively correlated with CT scores.

CONCLUSION

During 1-year follow-up after discharge, COVID-19 survivors showed continuous improvement on chest CT. However, residual lesions could still be observed and correlated with lung volume parameters. The risk of developing residual CT opacities increases with age.

Impact of COVID-19: urging a need for multi-domain assessment of COVID-19 inpatients

Aim

To retrospectively analyse data obtained from the multi-domain assessment of hospitalized COVID-19 patients, to describe their health status at discharge, and to investigate whether subgroups of patients, more specific ICU patients and older adults (> 70 years), had more (or less) risk to experience specific impairments.

Findings

The results of the assessment show that physical, functional, cognitive, nutritional, and psychological impairments are highly prevalent in the group of COVID-19 patients, both in ICU and non-ICU patients, adults and older adults.

Message

The high prevalence of physical, cognitive, psychological, and functional impairments in hospitalized COVID-19 patients, both ICU and non-ICU patients, indicates that assessment of impairments is imperative.

Objective

To retrospectively analyse data obtained from the multi-domain assessment of hospitalized COVID-19 patients, to describe their health status at discharge, and to investigate whether subgroups of patients, more specific ICU patients and older adults (> 70 years), had more (or less) risk to experience specific impairments.

Methods

Retrospective case series in the University Hospitals Leuven, Belgium of confirmed COVID-19 patients ‘after surviving an ICU-stay’, ‘aged ≥ 70 years’, or ‘aged < 70 years with a length of hospitalization > 7 days’. Exclusion criteria were ‘unwilling to cooperate’, ‘medically unstable’, or ‘palliative care policy’. Following tests were used: ‘Five Times Sit To Stand Test’, ‘hand grip dynamometry’, ‘Barthel index’, ‘Swallowing screening’, ‘Montreal Cognitive Assessment’, ‘Hospital Anxiety and Depression Scale’, and ‘Nutritional Risk Screening 2002’.

Results

One or more tests were obtained in 135/163 patients (83.3%). Physical impairments were present in 43.2–82.8% of the patients. Median BI was 10/20 indicating limited self-dependency. Swallow impairments were present in 3/53 (5.7%) and 24/76 (31.6%) had risk of malnutrition. Impaired memory was seen in 26/43 (60.5%) and 22/47 (46.8%) had elevated anxiety/depression scores. Older adults had more physical, functional, and cognitive impairments. ICU patients had a lower hand grip force.

Conclusion(s)

The high prevalence of physical, cognitive, psychological, and functional impairments in hospitalized COVID-19 patients, both ICU and non-ICU patients, indicates that assessment of impairments is imperative. These results imply that rehabilitation and follow-up is essential for these patients. This paper proposes a short, workable assessment composed with known outcome measures to assess different domains of COVID-19 patients.

Development and validation of a nomogram to predict pulmonary function and the presence of chronic obstructive pulmonary disease in a Korean population

BACKGROUND

Early suspicion followed by assessing lung function with spirometry could decrease the underdiagnosis of chronic obstructive pulmonary disease (COPD) in primary care. We aimed to develop a nomogram to predict the FEV₁/FVC ratio and the presence of COPD.

METHODS

We retrospectively reviewed the data of 4241 adult patients who underwent spirometry between 2013 and 2019. By linear regression analysis, variables associated with FEV₁/FVC were identified in the training cohort (n = 2969). Using the variables as predictors, a nomogram was created to predict the FEV₁/FVC ratio and validated in the test cohort (n = 1272).

RESULTS

Older age (β coefficient [95% CI], - 0.153 [- 0.183, - 0.122]), male sex (- 1.904 [- 2.749, - 1.056]), current or past smoking history (- 3.324 [- 4.200, - 2.453]), and the presence of dyspnea (- 2.453 [- 3.612, - 1.291]) or overweight (0.894 [0.191, 1.598]) were significantly associated with the FEV₁/FVC ratio. In the final testing, the developed nomogram showed a mean absolute error of 8.2% between the predicted and actual FEV₁/FVC ratios. The overall performance was best when FEV₁/FVC < 70% was used as a diagnostic criterion for COPD; the sensitivity, specificity, and balanced accuracy were 82.3%, 68.6%, and 75.5%, respectively.

CONCLUSION

The developed nomogram could be used to identify potential patients at risk of COPD who may need further evaluation, especially in the primary care setting where spirometry is not available.

Prediction of lung function using handgrip strength in healthy young adults

Positive association between physical activity and spirometry has been reported to be possibly attributed to handgrip strength (HGS), particularly in the elderly. However, the nature of the association between HGS and lung function in young adults is still unclear. This study investigated the prediction of lung function using HGS in young adults. A cross-sectional analytical study was carried out on four hundred (400) apparently healthy medical students who are aged 16-30 years. Handgrip strength (dominant and nondominant) and lung function (FEV1 , FVC and PEFR) of these students were assessed using Jamar dynamometer and a portable spirometer, respectively. Data were analyzed using inferential statistics. Independent t-test showed that the mean values of HGS and lung function of the males were significantly higher than the females (P < 0.0005). The relationship between HGS and lung function indices was significant (P < 0.0005) in all the participants but strongest for FEV1 (r = 0.64). The regression analysis showed that in addition to gender and height, HGS was a significant (P < 0.0005) predictor of lung function. Regression equations were also proposed for the prediction of these lung function indices using HGS, gender and height. This study is the first to report HGS as a significant predictor of pulmonary function in healthy young adults living in a low-resource country. Hence, its use could enhance medical practice in being an indicator of lung function status in healthy young adults.

Peak lung function during young adulthood and future long-term blood pressure variability: The Coronary Artery Risk Development in Young Adults (CARDIA) study

BACKGROUND AND AIMS

Long-term blood pressure variability (BPV) is associated with cardiovascular events independent of mean blood pressure (BP); however, little is known about its predictors.

METHODS

Using data from the CARDIA study, we investigated the association between peak lung-function and long-term BPV in 2917 individuals (mean age 24.8 years, 45.3% males, 58.6% whites) who were not taking antihypertensive medications. Lung-function was measured using forced vital capacity (FVC) and forced expiratory volume in 1-s (FEV1) at years 0, 2, 5, 10 and 20 and the maximum score attained was considered as peak lung-function. Variability independent of the mean (VIM) and coefficient of variation (CV) of BP were calculated to quantify BPV since achieving peak lung-function across 9 visits over 30 years.

RESULTS

In a multivariate linear regression models, individuals in the 2nd (-0.64 mmHg; 95% CI: -1.06, -0.19), 3rd (-0.96; -1.47, -0.45), and 4th (-0.85: -1.53, -0.17) quartiles of FVC had lower VIM of systolic BP than the those in quartile 1 (p-trend = 0.005). CV of systolic BP was also lower by -0.58 (-0.98, -0.19), -0.92 (-1.42, -0.43), and -0.74 (-1.40, -0.08) percentage points, in the three progressively higher quartiles of FVC compared to quartile 1 (p-trend = 0.008). Similar findings were observed when the outcome was diastolic BPV. There was no association of FEV1 and FEV1-to-FVC ratio with BPV.

CONCLUSIONS

These findings suggest that smaller lung volume or restrictive lung disease during young adulthood, which result in lower peak FVC, may independently increase the risk of higher long-term BPV during middle adulthood.

Chronic low-level arsenic exposure reduces lung function in male population without skin lesions

OBJECTIVES

The respiratory effects of chronic low-level arsenic exposure from groundwater have been investigated in West Bengal, India.

METHODS

The participants (834 non-smoking adult males) were subdivided in two groups: an arsenic-exposed group (n = 446, mean age 35.3 years) drinking arsenic-contaminated groundwater (11-50 μg/L) and a control group of 388 age-matched men drinking water containing <10 μg/L of arsenic. Arsenic in water samples was measured by atomic absorption spectroscopy. The prevalence of respiratory symptoms was documented by structured, validated questionnaire. Pulmonary function test (PFT) was assessed by portable spirometer.

RESULTS

Compared with control, the arsenic-exposed subjects had higher prevalence of upper and lower respiratory symptoms, dyspnea, asthma, eye irritation and headache. Besides, 20.6% of arsenic-exposed subjects had lung function deficits (predominantly restrictive and combined types) compared with 13.6% of control (p < 0.05). A positive association was observed between arsenic concentration in drinking water and the prevalence of respiratory symptoms, while a negative association existed between arsenic level and spirometric parameters.

CONCLUSIONS

The findings suggest that even low-level arsenic exposure has deleterious respiratory effects.