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Jang JG, Kim Y, Shin SH, Min KH, Jung KS, Kim YI, Park S, Na JO, Lee H, Yoo KH. The role of FEV 1/FVC in the prediction of acute exacerbation of COPD. Respir Med 2024; 234:107780. [PMID: 39216610 DOI: 10.1016/j.rmed.2024.107780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/06/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Whether the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) can be used as a biomarker to predict the risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is unclear. METHODS To investigate the predictive role of FEV1/FVC for AECOPD, we analyzed data from an observational and multicenter cohort study of 2043 patients with COPD in KOREA. Exposures were post-bronchodilator FEV1/FVC and/or percentage predicted FEV1 (FEV1%pred). The outcome was the development of AECOPD during the first year of follow-up. RESULTS During the first year of follow-up, the proportion of patients who developed AECOPD increased as FEV1/FVC decreased (P < 0.01). FEV1/FVC and FEV1%pred had similar predictive power for AECOPD, with optimal predictive cut-offs of approximately 0.5 for FEV1/FVC and 50 % for FEV1%pred. When the participants were classified into groups based on these cut-offs, compared with a high both-lung function group (FEV1/FVC≥0.5 and FEV1%pred≥50 %), the low-FEV1 group (FEV1/FVC≥0.5 and FEV1%pred<50) had a modestly increased risk of severe AECOPD (adjusted odds ratio[aOR] = 3.12; 95 % confidence interval[CI] = 1.59-6.16), while the risk of severe AECOPD was the highest in the low both-lung function group (FEV1%pred<50 % and FEV1/FVC<0.5) (aOR = 5.16; 95 % CI = 3.34-7.97). CONCLUSIONS FEV1/FVC is a spirometric biomarker predictive of AECOPD. In countries where FEV1%pred is not available for their population, FEV1/FVC could be used as a biomarker for assessing the risk of AECOPD. In countries where accurate FEV1%pred is available, both FEV1%pred and FEV1/FVC could be used to provide additional information to assess the risk of AECOPD. KEY MESSAGE This study showed that FEV1/FVC had similar predictive power for AECOPD compared with percentage predicted FEV1. Furthermore, the use of both FEV1 and FEV1/FVC provides additional information for the risk assessment of AECOPD.
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Affiliation(s)
- Jong Geol Jang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Youlim Kim
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki Suck Jung
- Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
| | - Yu-Il Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Shinhee Park
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Joo Ock Na
- Division of Pulmonology, Department of Internal Medicine, Soonchunhyang University, College of Medicine, Cheonan, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Kouranos V, Ward S, Kokosi MA, Castillo D, Chua F, Judge EP, Thomas S, Van Tonder F, Devaraj A, Nicholson AG, Maher TM, Renzoni EA, Wells AU. Mixed Ventilatory Defects in Pulmonary Sarcoidosis: Prevalence and Clinical Features. Chest 2020; 158:2007-2014. [PMID: 32534908 DOI: 10.1016/j.chest.2020.04.074] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/11/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In cohort studies of pulmonary sarcoidosis, abnormal ventilatory patterns have generally been subdivided into restrictive and obstructive defects. Mixed ventilatory defects have largely been overlooked in pulmonary sarcoidosis, as total lung capacity has seldom been taken into account in historical series. RESEARCH QUESTION This study evaluated the prevalence of mixed disease in pulmonary sarcoidosis and its clinical associations. STUDY DESIGN AND METHODS In patients with pulmonary sarcoidosis (N = 1,110), mixed defects were defined according to American Thoracic Society/European Respiratory Society criteria. Clinical data, pulmonary function variables, and vital status were abstracted from clinical records. Chest radiographs were evaluated independently by two experienced radiologists. RESULTS The prevalence of a mixed ventilatory defect was 10.4% in the whole cohort, rising to 25.9% in patients with airflow obstruction. Compared with isolated airflow obstruction, mixed defects were associated with lower diffusing lung capacity for carbon monoxide levels (50.7 ± 16.3 vs 70.8 ± 18.1; P < .0001), a higher prevalence of chest radiographic stage IV disease (63.5% vs 38.3%; P < .0001), and higher mortality (hazard ratio, 2.36; 95% CI, 1.34-4.15; P = .003). These findings were reproduced in all patient subgroup analyses, including patients with a histologic diagnosis, a clinical diagnosis, incident disease, and prevalent disease. INTERPRETATION Mixed disease is present in approximately 25% of patients with pulmonary sarcoidosis and airflow obstruction and is associated with lower diffusing lung capacity for carbon monoxide levels, a higher prevalence of stage IV disease, and higher mortality than seen in a pure obstructive defect. These observations identify a distinct phenotype associated with a mixed ventilatory defect, justifying future studies of its clinical and pathogenetic significance.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Simon Ward
- Lung Function Department, Royal Brompton Hospital, London, England
| | - Maria A Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Diego Castillo
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England; Interstitial Lung Disease Unit, Hospital de Sant Pau, Barcelona, Spain
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Eoin P Judge
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England
| | - Suzie Thomas
- Lung Function Department, Royal Brompton Hospital, London, England
| | - Frans Van Tonder
- Department of Radiology, Royal Brompton Hospital, London, England; Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Arnand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, England
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, England
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England; NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London, the Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, England
| | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, England.
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Abstract
RATIONALE Current guidelines recommend using forced expiratory volume in 1 second (FEV1) % predicted to categorize the severity of airflow obstruction. There are limitations to using FEV1 % predicted for this purpose, including bias associated with demographic factors and the inability to correct for "lung size." Other methods for grading the severity of airflow obstruction have been proposed to address these limitations. OBJECTIVES Our objectives were to categorize airflow obstruction severity using these methods and then determine which method results in a categorization most closely associated with mortality. METHODS Study subjects were patients aged 40-80 years tested in our pulmonary function test laboratories in the period 2002 to 2013 with airflow obstruction based on an FEV1/forced vital capacity (FVC) less than the lower limit of normal. Categorization of airflow obstruction severity was determined using four methods: FEV1 % predicted; FEV1 % predicted adjusted by FVC % predicted; FEV1/FVC confidence interval approach; and FEV1 z-scores. Receiver operating characteristic curve analysis was used to determine which categorization method best predicts 5-year survival. RESULTS We identified 2,000 patients with airflow obstruction. Important differences in the categorization of airflow obstruction severity were observed using the different methods. More patients were categorized as having severe obstruction using FEV1 % predicted and FEV1 z-scores compared with FEV1 % predicted adjusted by FVC % predicted and FEV1/FVC confidence interval approach. FEV1 % predicted was the best predictor of 5-year survival among the four methods studied. CONCLUSIONS In our study, categorizing airflow obstruction severity using FEV1 % predicted best predicted 5-year survival. This validates the current guideline recommendation that FEV1 % predicted be used to categorize the severity of airflow obstruction.
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Wu TD, Ejike CO, Wise RA, McCormack MC, Brigham EP. Investigation of the Obesity Paradox in Chronic Obstructive Pulmonary Disease, According to Smoking Status, in the United States. Am J Epidemiol 2019; 188:1977-1983. [PMID: 31504124 DOI: 10.1093/aje/kwz185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/05/2019] [Accepted: 08/13/2019] [Indexed: 11/14/2022] Open
Abstract
An obesity paradox in chronic obstructive pulmonary disease (COPD), whereby overweight/obese individuals have improved survival, has been well-described. These studies have generally included smokers. It is unknown whether the paradox exists in individuals with COPD arising from factors other than smoking. Nonsmoking COPD is understudied yet represents some 25%-45% of the disease worldwide. To determine whether the obesity paradox differs between ever- and never-smokers with COPD, 1,723 adult participants with this condition were examined from 2 iterations of the National Health and Nutrition Examination Survey (1988-1994, 2007-2010), with mortality outcomes followed through December 2011. Using Cox proportional hazards models, adjusted for sociodemographic factors, lung function, and survey cycle, ever/never-smoking was found to modify the association between body mass index and hazard of death. Compared with normal-weight participants, overweight/obese participants had lower hazard of death among ever-smokers (for overweight, adjusted hazard ratio (aHR) = 0.56, 95% confidence interval (CI): 0.43, 0.74; for obesity, aHR = 0.66, 95% CI: 0.48, 0.92), but never-smokers did not (overweight, aHR = 1.41, 95% CI: 0.66, 3.03; obesity, aHR = 1.29, 95% CI: 0.48, 3.48). An obesity paradox appeared to be absent among never-smokers with COPD. This, to our knowledge, novel finding might be explained by pathophysiological differences between smoking-related and nonsmoking COPD or by smoking-associated methodological biases.
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Chuang ML, Lin IF. Investigating the relationships among lung function variables in chronic obstructive pulmonary disease in men. PeerJ 2019; 7:e7829. [PMID: 31592356 PMCID: PMC6777488 DOI: 10.7717/peerj.7829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 09/04/2019] [Indexed: 02/02/2023] Open
Abstract
Background In patients with chronic obstructive pulmonary disease (COPD), the independent contributions of individual lung function variables to outcomes may be lower when they are modelled together if they are collinear. In addition, lung volume measurements may not be necessary after spirometry data have been obtained. However, these hypotheses depend on whether forced vital capacity (FVC) can predict total lung capacity (TLC). Moreover, the definitions of hyperinflation and air trapping according to lung function variables overlap and need be clarified. Therefore, the aim of this study was to evaluate the relationships among various lung function parameters to elucidate these issues. Methods Demographic data and 26 parameters of full lung function were measured in 94 men with COPD and analyzed using factor and correlation analyses. Results Factor analysis revealed five latent factors. Inspiratory capacity (IC)/TLC and residual volume (RV)/TLC were most strongly correlated with all other lung volumes. IC/TLC, RV/TLC, and functional residual capacity (FRC)/TLC were collinear and were potential markers of air trapping, whereas TLC%, FRC%, and RV% were collinear and were potential markers of hyperinflation. RV/TLC >0.4 (or IC/TLC <0.4) was comparable with the ratio of forced expiratory volume in one second (FEV1) and FVC <0.7. FVC% and FEV1% were poorly correlated with TLC%. The correlation study showed that TLC%, RV/TLC, and FEV1% could be used to represent individual latent factors for hyperinflation, air trapping, inspiration, expiration, and obstruction. Combined with diffusion capacity%, these four factors could be used to represent comprehensive lung function. Conclusions This study identified collinear relationships among individual lung function variables and thus selecting variables with close relationships for correlation studies should be performed with caution. This study also differentiated variables for air trapping and lung hyperinflation. Lung volume measurements are still required even when spirometry data are available. Four out of 26 lung function variables from individual latent factors could be used to concisely represent lung function.
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Affiliation(s)
- Ming-Lung Chuang
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - I-Feng Lin
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
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Ulubay G, Dilektaşlı AG, Börekçi Ş, Yıldız Ö, Kıyan E, Gemicioğlu B, Saryal S. Turkish Thoracic Society Consensus Report: Interpretation of Spirometry. Turk Thorac J 2019; 20:69-89. [PMID: 30664428 DOI: 10.5152/turkthoracj.2018.180175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022]
Abstract
ÖZET: Günümüzde spirometre ölçümlerinin uygulama ve yorumlama nitelik güvencesi "American Thoracic Society / European Respiratory Society" standartları ile belirlenmiştir. Dünyada olduğu gibi ülkemizde de birçok laboratuvar bu standartları kullanmaktadır. Buna karşın, farklı laboratuvarlardan farklı değerlendirme sonuçları görebilmek mümkündür. Bu rapor, ülkemizdeki solunum fonksiyon testi laboratuvarlarında yapılan değerlendirmelerin standardizasyonunu sağlamak amacı ile hazırlanmıştır.
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Affiliation(s)
- Gaye Ulubay
- Department of Chest Diseases, Başkent University School of Medicine, Ankara, Turkey
| | | | - Şermin Börekçi
- Department of Chest Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Öznur Yıldız
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Esen Kıyan
- Department of Chest Diseases, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Bilun Gemicioğlu
- Department of Chest Diseases, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sevgi Saryal
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
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Abston E, Comellas A, Reed RM, Kim V, Wise RA, Brower R, Fortis S, Beichel R, Bhatt S, Zabner J, Newell J, Hoffman EA, Eberlein M. Higher BMI is associated with higher expiratory airflow normalised for lung volume (FEF25-75/FVC) in COPD. BMJ Open Respir Res 2017; 4:e000231. [PMID: 29071083 PMCID: PMC5652498 DOI: 10.1136/bmjresp-2017-000231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/04/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The obesity paradox in chronic obstructive pulmonary disease (COPD), whereby patients with higher body mass index (BMI) fare better, is poorly understood. Higher BMIs are associated with lower lung volumes and greater lung elastic recoil, a key determinant of expiratory airflow. The forced expiratory flow (25-75) (FEF25-75)/forced vital capacity (FVC) ratio reflects effort-independent expiratory airflow in the context of lung volume and could be modulated by BMI. METHODS We analysed data from the COPDGene study, an observational study of 10 192 subjects, with at least a 10 pack-year smoking history. Data were limited to subjects with BMI 20-40 kg/m2 (n=9222). Subjects were stratified according to forced expiratory volume in 1 s (FEV1) (%predicted)-quintiles. In regression analyses and Cox proportional hazard models, we analysed the association between BMI, the FEF25-75/FVC ratio, the imaging phenotype, COPD exacerbations, hospitalisations and death. RESULTS There was no correlation between BMI and FEV1(%predicted). However, a higher BMI is correlated with a higher FEF25-75/FVC ratio. In CT scans, a higher BMI was associated with less emphysema and less air trapping. In risk-adjusted models, the quintile with the highest FEF25-75/FVC ratio was associated with a 46% lower risk of COPD exacerbations (OR 0.54, p<0.001) and a 40% lower risk of death (HR 0.60, p=0.02), compared with the lowest quintile. BMI was not independently associated with these outcomes. CONCLUSIONS A higher BMI is associated with lower lung volumes and higher expiratory airflows when normalised for lung volume, as quantified by the FEF25-75/FVC ratio. A higher FEF25-75/FVC ratio is associated with a lower risk of COPD exacerbations and death and might quantify functional aspects of the paradoxical effect of higher BMIs on COPD.
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Affiliation(s)
- Eric Abston
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alejandro Comellas
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Robert Michael Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Victor Kim
- Division of Pulmonary and Critical Care Medicine, Temple University, School of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roy Brower
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Spyridon Fortis
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Reinhard Beichel
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
| | - Surya Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Joseph Zabner
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
| | - John Newell
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa, USA
| | - Eric A Hoffman
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, USA
- The Iowa Institute for Biomedical Imaging, University of Iowa, University of Iowa, Iowa City, Iowa, USA
- Department of Radiology, University of Iowa, Iowa, USA
| | - Michael Eberlein
- Department of Medicine, University of Iowa, Iowa City, Iowa, USA
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, Iowa, USA
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Wieshammer S, Dreyhaupt J. Smoking exposure, loss of forced expiratory volume in one second and the risk of lung cancer among patients with malignant disease who present with cardiac or pulmonary symptoms: a cross-sectional study. Tob Induc Dis 2017; 15:16. [PMID: 28286467 PMCID: PMC5343303 DOI: 10.1186/s12971-017-0122-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 02/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smokers with airway obstruction are at a higher risk of lung cancer than smokers without airway obstruction. Inflammation plays a key role in lung carcinogenesis. This single-center study prospectively assessed (i) the relationship between smoking exposure and the loss of forced expiratory volume in 1 s (FEV1) in determining lung cancer risk and (ii) the effect of lung cancer on systemic inflammation. METHODS The study group comprised 475 consecutively enrolled patients with cancer who presented with pulmonary or cardiac symptoms. The effects of smoking exposure and FEV1 loss on the predicted lung cancer risk were assessed using multiple logistic regression analysis. C-reactive protein (CRP) was used as a marker of inflammation. RESULTS The prevalence of lung cancer was 0.23. The lung cancer risk increased with the number of pack years and FEV1 loss (p < 0.01). Moving from the 5th (-22% of the predicted value) to the 95th percentile of FEV1 loss (56% of the predicted value) increased lung cancer risk from 0.07 to 0.23 (Δ = 0.16) at 0 pack years and from 0.39 to 0.73 (Δ = 0.34) at 70 pack years (95th percentile). The values for Δ peaked at 61 pack years (0.34) and then decreased with a further increase in smoking exposure, without reaching the zero mark. Patients with lung cancer were more likely to have a CRP level above the median (4.05 mg/L) than patients with other cancers (adjusted odds ratio = 2.67). CONCLUSIONS Systemic inflammation is more pronounced in patients with lung cancer than in patients with other cancers. The effect of FEV1 loss on the patients' predicted risks of lung cancer increases with increasing smoking exposure. Measurements of FEV1 loss are useful to identify patients facing an increased risk of developing lung cancer.
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Affiliation(s)
- Siegfried Wieshammer
- Department of Cardiology, Pulmonology and Critical Care Medicine, Offenburg Hospital, Weingartenstrasse 70, D-77654 Offenburg, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstrasse 13, D-89075 Ulm, Germany
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Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidiscip Respir Med 2017; 12:3. [PMID: 28194273 PMCID: PMC5299792 DOI: 10.1186/s40248-017-0084-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/02/2017] [Indexed: 11/10/2022] Open
Abstract
From a physiological standpoint, the lung volumes are either dynamic or static. Both subclasses are measured at different degrees of inspiration or expiration; however, dynamic lung volumes are characteristically dependent on the rate of air flow. The static lung volumes/capacities are further subdivided into four standard volumes (tidal, inspiratory reserve, expiratory reserve, and residual volumes) and four standard capacities (inspiratory, functional residual, vital and total lung capacities). The dynamic lung volumes are mostly derived from vital capacity. While dynamic lung volumes are essential for diagnosis and follow up of obstructive lung diseases, static lung volumes are equally important for evaluation of obstructive as well as restrictive ventilatory defects. This review intends to update the reader with the physiological basis, clinical significance and interpretative approaches of the standard static lung volumes and capacities.
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Affiliation(s)
- Mohamed Faisal Lutfi
- Department of Physiology, Faculty of Medicine and Health Sciences, Al-Neelain University, Khartoum, Sudan
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11
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Olujimi OO, Ana GREE, Ogunseye OO, Fabunmi VT. Air quality index from charcoal production sites, carboxyheamoglobin and lung function among occupationally exposed charcoal workers in South Western Nigeria. SPRINGERPLUS 2016; 5:1546. [PMID: 27652119 PMCID: PMC5020008 DOI: 10.1186/s40064-016-3227-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022]
Abstract
Charcoal production is often accompanied with gaseous and particulate emission into the atmosphere and occupationally exposed workers could be affected. This cross sectional comparative study was carried out to assess the levels of carbon monoxide (CO), carbon dioxide (CO2), sulphur dioxide (SO2), nitrogen dioxide (NO2) and particulate matter (PM2.5) generated during the phases of charcoal production and their relationship with certain biomarkers among charcoal workers (subjects) and non-charcoal workers (controls) such as carboxyhaemoglobin (COHb), forced expiratory volume in the first second of expiration (FEV1), peak expiratory flow rate (PEFR) and body mass index (BMI) in Igbo-Ora, Oyo State and Alabata, Ogun State, which are two of the major hubs of charcoal production in South Western Nigeria. Four communities in Igbo-Ora and six communities in Alabata were purposively selected and levels of pollutant gases were assessed using appropriate gas meters, PM2.5 was assessed with Thermo Scientific MIE pDR-1500, FEV1 and PEFR were measured with Piko-1 spirometer while COHb was assessed using non-invasive pulse CO-oximeter (Rad 57). Data were statistically analyzed and results were compared with recommended guidelines. The mean FEV1, PEFR, COHb and BMI for subjects and controls were 2.35 ± 0.73 and 2.69 ± 0.56, 253.72 ± 103.45 and 330.02 ± 94.61 (p < 0.01), 13.28 ± 3.91 and 8.50 ± 3.68 (p < 0.01) and 21.97 ± 2.19 and 23.36 ± 3.74 (p < 0.05) respectively. There was a statistically significant difference between actual and expected values of FEV1 (p < 0.01) and PEFR (p < 0.01) among charcoal workers. There existed a positive correlation between CO and COHb while FEV1 and PEFR correlated negatively with PM2.5. The study showed that charcoal workers are exposed to high levels of CO and PM2.5, contributing to lowered respiratory functions for FEV1 and PEFR and high levels of COHb compared to the control group. Routine respiratory and carboxyheamoglobin assessment of persons involved in charcoal production is also recommended.
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Affiliation(s)
- O O Olujimi
- Department of Environmental Management and Toxicology, Federal University of Agriculture, Abeokuta, Ogun State Nigeria ; Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - G R E E Ana
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O O Ogunseye
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - V T Fabunmi
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Stahr CS, Samarage CR, Donnelley M, Farrow N, Morgan KS, Zosky G, Boucher RC, Siu KKW, Mall MA, Parsons DW, Dubsky S, Fouras A. Quantification of heterogeneity in lung disease with image-based pulmonary function testing. Sci Rep 2016; 6:29438. [PMID: 27461961 PMCID: PMC4962033 DOI: 10.1038/srep29438] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022] Open
Abstract
Computed tomography (CT) and spirometry are the mainstays of clinical pulmonary assessment. Spirometry is effort dependent and only provides a single global measure that is insensitive for regional disease, and as such, poor for capturing the early onset of lung disease, especially patchy disease such as cystic fibrosis lung disease. CT sensitively measures change in structure associated with advanced lung disease. However, obstructions in the peripheral airways and early onset of lung stiffening are often difficult to detect. Furthermore, CT imaging poses a radiation risk, particularly for young children, and dose reduction tends to result in reduced resolution. Here, we apply a series of lung tissue motion analyses, to achieve regional pulmonary function assessment in β-ENaC-overexpressing mice, a well-established model of lung disease. The expiratory time constants of regional airflows in the segmented airway tree were quantified as a measure of regional lung function. Our results showed marked heterogeneous lung function in β-ENaC-Tg mice compared to wild-type littermate controls; identified locations of airway obstruction, and quantified regions of bimodal airway resistance demonstrating lung compensation. These results demonstrate the applicability of regional lung function derived from lung motion as an effective alternative respiratory diagnostic tool.
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Affiliation(s)
- Charlene S Stahr
- Department of Mechanical &Aerospace Engineering, Monash University, Melbourne, VIC, Australia
| | | | - Martin Donnelley
- Robinson Research Institute, University of Adelaide, SA, Australia.,Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Farrow
- Robinson Research Institute, University of Adelaide, SA, Australia.,Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Kaye S Morgan
- School of Physics and Astronomy, Monash University, Melbourne, VIC, Australia
| | - Graeme Zosky
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Richard C Boucher
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen K W Siu
- School of Physics and Astronomy, Monash University, Melbourne, VIC, Australia
| | - Marcus A Mall
- Department of Translational Pulmonology Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - David W Parsons
- Robinson Research Institute, University of Adelaide, SA, Australia.,Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Stephen Dubsky
- Department of Mechanical &Aerospace Engineering, Monash University, Melbourne, VIC, Australia.,4Dx Limited, Melbourne, VIC, Australia
| | - Andreas Fouras
- Department of Mechanical &Aerospace Engineering, Monash University, Melbourne, VIC, Australia.,4Dx Limited, Melbourne, VIC, Australia
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Wieshammer S, Dreyhaupt J, Müller D, Momm F, Jakob A. Venous thromboembolism and persistent pulmonary hypertension in cancer patients: a cross-sectional study. Thromb J 2016; 14:3. [PMID: 26858584 PMCID: PMC4745153 DOI: 10.1186/s12959-016-0077-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer patients are at increased risk for venous thromboembolism (VTE). OBJECTIVE This monocenter cross-sectional study prospectively assessed the association between a history of ≥1 VTE episode and the presence of pulmonary hypertension (PH) among cancer patients presenting with pulmonary or cardiac symptoms. METHODS A consecutive series of 583 patients underwent a diagnostic work-up for heart and lung disease. PH was diagnosed if a patient's peak systolic pressure gradient across the tricuspid valve was ≥35 mmHg, as measured by echocardiography. Using multiple logistic regression analysis, the association between VTE and PH was assessed, following adjustments for age, the presence of severe airway obstruction, atrial fibrillation and left heart diseases. RESULTS The prevalence values for PH (n = 90) and a history of VTE (n = 72) were 15.4 and 12.3 %, respectively. The median time interval between the first VTE episode and referral was 43 months. The odds of PH was higher in the subgroup with VTE (19/72; 26.4 %) than that without VTE (71/511; 13.9 %) in the unadjusted analysis [odds ratio (OR) 2.2, 95 % confidence interval (CI) 1.2, 4.0] and the adjusted model [OR 2.4, 95 % CI 1.2, 4.5]. The risk of PH did not depend on the time interval between VTE and referral. Older age and the presence of severe airway obstruction, atrial fibrillation, and left heart diseases were also associated with an increased odds of PH. CONCLUSION In cancer patients presenting with cardiac or pulmonary symptoms, previous VTE is associated with an increased risk of persistent PH.
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Affiliation(s)
- Siegfried Wieshammer
- Department of Cardiology, Pulmonology and Critical Care Medicine, Offenburg Hospital, Weingartenstrasse 70, D-77654 Offenburg, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, D-89075 Ulm, Germany
| | - Dirk Müller
- Department of Cardiology, Pulmonology and Critical Care Medicine, Offenburg Hospital, Weingartenstrasse 70, D-77654 Offenburg, Germany
| | - Felix Momm
- Department of Radiation Oncology, Offenburg Hospital, D-77654 Offenburg, Germany
| | - Andreas Jakob
- Department of Medical Oncology, Offenburg Hospital, D-77654 Offenburg, Germany
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15
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Beshir S, Shaheen WA, Elserougy S, Aziz HM. Serum autoantibodies in silicosis and non-silicosis cement workers. Am J Ind Med 2015; 58:238-44. [PMID: 25564983 DOI: 10.1002/ajim.22413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2014] [Indexed: 12/26/2022]
Abstract
AIM To study serum autoantibodies and immunoglobulin levels in cement workers. METHODS Blood samples for numerous antibodies were collected from 30 silicosis and 42 non-silicosis cement workers. Spirometry of the silicosis workers was also studied. RESULTS Serum IgA mean level showed a significant increase in the silicosis group compared to the non-silicosis group. Elevated titers of serum anti-smooth muscle antibodies (ASMA) and anti-glomerular basement membrane (anti-GBM) were detected only in the silicosis group. The duration of exposure showed a significant positive correlation with serum IgA, ASMA and anti-GBM, and a significant negative correlation with serum IgG. Serum anti-GBM showed a significant positive correlation with IgG while the inverse titer (1/titer) of anti-GBM showed highly significant positive correlations with serum IgA and ASMA. The percent predicted FVC was the ventilatory function most closely associated with immunological parameters in silicosis group. CONCLUSION Serum IgA, ASMA, and anti-GBM are the principal immunologic parameters associated with silicosis.
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Affiliation(s)
- Safia Beshir
- Department of Environmental and Occupational Medicine; National Research Center; Cairo Egypt
| | - Weam A. Shaheen
- Department of Environmental and Occupational Medicine; National Research Center; Cairo Egypt
| | - Safaa Elserougy
- Department of Environmental and Occupational Medicine; National Research Center; Cairo Egypt
| | - Hisham M. Aziz
- Department of Environmental and Occupational Medicine; National Research Center; Cairo Egypt
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17
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Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are common diseases which cause patients and society considerable difficulties. These are costly diseases which cause substantial morbidity and death. Health care policy makers have made improving outcomes in asthma and COPD a priority. Application of guideline recommended approaches to asthma and COPD care in the real-life setting has been emphasized but outcomes have not improved. Failure to improve outcomes may not be because of inconsistent applications of guideline recommendations, but rather because there are difficulties implementing the Expert Panel Report III (EPR 3) method for categorizing asthma severity and the Global Initiative for Obstructive Lung Disease (GOLD) method for diagnosing COPD. As these serve as the foundation for treatment recommendations for these diseases, alternative approaches should be considered for categorizing asthma severity and identifying COPD patients. Claims-based algorithms provide an intriguing option for identifying persistent asthma patients and symptomatic COPD patients in administrative databases. These methods could be used as the basis for pragmatic research, both retrospective and prospective, on assessing outcomes of guideline recommended treatment approaches in asthma and COPD. Important questions urgently need to be answered about how guideline recommended approaches regarding use of long-acting inhaled β-agonist/inhaled corticosteroid (LABA/ICS) in asthma and long-acting inhaled anti-muscarinic agent (LAMA) and LABA/ICS in COPD affect outcomes in real-life situations.
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Affiliation(s)
- Gene L Colice
- The George Washington University School of Medicine, Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, Washington DC, USA
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18
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Issues in pulmonary function testing for the screening and diagnosis of chronic obstructive pulmonary disease. Curr Opin Pulm Med 2012; 18:104-11. [PMID: 22262139 DOI: 10.1097/mcp.0b013e32834feae7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review article is to provide an up-to-date summary on the current evidence for or against the use of lung function tests as screening and diagnostic tools for airflow obstruction in chronic obstructive pulmonary disease (COPD), and to consider the relevant issues in context. RECENT FINDINGS COPD is characterized by chronic respiratory symptoms and airflow limitation with only partial reversibility on lung function testing. However, screening on a population basis or of an enriched 'at-risk' subset like chronic smokers is not supported by findings from previous epidemiological studies, screening trials or in currently published clinical management guidelines by professional societies and review bodies. The definition of airflow obstruction and the classification of disease severity of COPD also differ slightly between guidelines and statements from different professional societies. SUMMARY Given the experience from previous screening trials and controversial classification of airflow obstruction by severity, it is impossible to have accurate screening results for COPD based on lung function tests alone. Clinical respiratory symptoms should be taken into consideration in terms of the diagnosis and management of COPD, as well as in any screening trial or programme that is to be attempted or implemented.
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Affiliation(s)
- Bruce H Culver
- Department of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA.
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