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Bowerman C, Bhakta NR, Brazzale D, Cooper BG, Cooper J, Gochicoa-Rangel L, Haynes J, Kaminsky DA, Lan LTT, Masekela R, McCormack MC, Steenbruggen I, Stanojevic S. Reply to: The Race Arithmetic of the Global Lung Function Initiative Global Reference Equations. Am J Respir Crit Care Med 2024; 209:114-115. [PMID: 37193659 PMCID: PMC10870871 DOI: 10.1164/rccm.202304-0729le] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2023] Open
Affiliation(s)
- Cole Bowerman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nirav R. Bhakta
- Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Danny Brazzale
- Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Brendan G. Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Julie Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Laura Gochicoa-Rangel
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Jeffrey Haynes
- Pulmonary Function Laboratory, Elliot Health System, Manchester, New Hampshire
| | - David A. Kaminsky
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | | | - Refiloe Masekela
- Department of Paediatrics and Child Health, Faculty of Health Sciences, School of Clinical Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Meredith C. McCormack
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | | | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Gochicoa-Rangel L, Martínez-Briseño D, Guerrero-Zúñiga S, Contreras-Morales J, Arias-Jiménez D, Del-Río-Hidalgo R, Hernández-Rocha FI, Ceballos-Zúñiga CO, Silva-Cerón M, Mora-Romero UDJ, Torre-Bouscoulet L, Fernández-Plata R, Pérez-Nieto JE, Vargas MH. Reference equations using segmented regressions for impulse oscillometry in healthy subjects aged 2.7-90 years. ERJ Open Res 2023; 9:00503-2023. [PMID: 38111542 PMCID: PMC10726221 DOI: 10.1183/23120541.00503-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/30/2023] [Indexed: 12/20/2023] Open
Abstract
Background Published reference equations for impulse oscillometry (IOS) usually encompass a specific age group but not the entire lifespan. This may lead to discordant predicted values when two or more non-coincident equations can be applied to the same person, or when a person moves from one equation to the next non-convergent equation as he or she gets older. Thus, our aim was to provide a single reference equation for each IOS variable that could be applied from infancy to old age. Methods This was an ambispective cross-sectional study in healthy nonsmokers, most of whom lived in Mexico City, who underwent IOS according to international standards. A multivariate piecewise linear regression, also known as segmented regression, was used to obtain reference equations for each IOS variable. Results In a population of 830 subjects (54.0% female) aged 2.7 to 90 years (54.8% children ≤12 years), segmented regression estimated two breakpoints for age in almost all IOS variables, except for R5-R20 in which only one breakpoint was detected. With this approach, multivariate regressions including sex, age, height and body mass index as independent variables were constructed, and coefficients for calculating predicted value, lower and upper limits of normal, percentage of predicted and z-score were obtained. Conclusions Our study provides IOS reference equations that include the major determinants of lung function, i.e. sex, age, height and body mass index, that can be easily implemented for subjects of almost any age.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Pulmonary Function Test Laboratory, Institute for Development and Innovation in Respiratory Physiology (INFIRE), Mexico City, Mexico
- These authors contributed equally
| | - David Martínez-Briseño
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- These authors contributed equally
| | - Selene Guerrero-Zúñiga
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Dulce Arias-Jiménez
- Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Pachuca, Mexico
| | | | | | | | - Mónica Silva-Cerón
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Luis Torre-Bouscoulet
- Pulmonary Function Test Laboratory, Institute for Development and Innovation in Respiratory Physiology (INFIRE), Mexico City, Mexico
| | | | | | - Mario H. Vargas
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Orea-Tejeda A, Robles-Hernández R, González-Islas D, Jimenez-Gallardo L, Gochicoa-Rangel L, Castorena-Maldonado A, Hernández-Zenteno R, Montañez-Orozco A, Valderrábano-Salas B. Dynapenia and Sarcopenia in Post-COVID-19 Syndrome Hospitalized Patients Are Associated with Severe Reduction in Pulmonary Function. J Clin Med 2023; 12:6466. [PMID: 37892604 PMCID: PMC10607104 DOI: 10.3390/jcm12206466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND After hospital discharge, post-COVID-19 syndrome has been observed to be associated with impaired diffusing capacity, respiratory muscle strength, and lung imaging abnormalities, in addition to loss of muscle mass/strength, sarcopenia, and obesity impact exercise tolerance, pulmonary functions, and overall prognosis. However, the relationship between lung function and the coexistence of obesity with low muscle strength and sarcopenia in post-COVID-19 patients remains poorly investigated. Therefore, our aim was to evaluate the association between lung function and the coexistence of obesity with dynapenia and sarcopenia in post-COVID-19 syndrome patients. METHODS This cross-sectional study included subjects who were hospitalized due to moderate to severe COVID-19, as confirmed by PCR testing. Subjects who could not be contacted, declined to participate, or died before the follow-up visit were excluded. RESULTS A total of 711 subjects were evaluated; the mean age was 53.64 ± 13.57 years, 12.4% had normal weight, 12.6% were dynapenic without obesity, 8.3% had sarcopenia, 41.6% had obesity, 21.2% had dynapenic obesity, and 3.8% had sarcopenic obesity. In terms of pulmonary function, the dynapenic subjects showed decreases of -3.45% in FEV1, -12.61 cmH2O in MIP, and -12.85 cmH2O in MEP. On the other hand, the sarcopenic subjects showed decreases of -6.14 cmH2O in MIP and -11.64 cmH2O in MEP. The dynapenic obesity group displayed a reduction of -12.13% in PEF. CONCLUSIONS In post-COVID-19 syndrome, dynapenia and sarcopenia-both with and without obesity-have been associated with lower lung function.
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Affiliation(s)
- Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Robinson Robles-Hernández
- Department of Research in Tobacco Smoking and COPD at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas” 2, Mexico City 14080, Mexico;
| | - Dulce González-Islas
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Luz Jimenez-Gallardo
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Laura Gochicoa-Rangel
- Department of Pulmonary Physiology at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Armando Castorena-Maldonado
- Direction for Medical Care in Pneumology at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas” 4, Mexico City 14080, Mexico
| | - Rafael Hernández-Zenteno
- COPD Clinic at Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Alvaro Montañez-Orozco
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
| | - Benigno Valderrábano-Salas
- Heart Failure and Respiratory Distress Clinic, Cardiology Service, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City 14080, Mexico; (A.O.-T.)
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Schönffeldt-Guerrero P, Gochicoa-Rangel L, Aguirre Franco C, Arce SC, Rodríguez Flores C. ALAT 2023 Recommendations for Performing Respiratory Function Studies. Arch Bronconeumol 2023; 59:619-620. [PMID: 37210255 PMCID: PMC10165494 DOI: 10.1016/j.arbres.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | | | | | - Santiago C Arce
- Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Argentina
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5
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Cherrez-Ojeda I, Osorio MF, Robles-Velasco K, Calderón JC, Cortés-Télles A, Zambrano J, Guarderas C, Intriago B, Gochicoa-Rangel L. Small airway disease in post-acute COVID-19 syndrome, a non-conventional approach in three years follow-up of a patient with long COVID: a case report. J Med Case Rep 2023; 17:386. [PMID: 37691104 PMCID: PMC10494419 DOI: 10.1186/s13256-023-04113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be suspected when respiratory symptoms continue, air trapping persists on expiratory CT scans, and imaging findings fail to improve despite objectively better conventional pulmonary function test (PFT) parameters. The forced oscillation technique (FOT) and Multiple breathing washout (MBW) are both very sensitive methods for detecting anomalies in the peripheral airways. CASE PRESENTATION We discuss the case of a 60-year-old Hispanic patient who had severe COVID-19 pneumonia and developed dyspnea, fatigue, and limited daily activity a year later. The PFTs revealed restrictive lung disease, as seen by significant diffusing capacity of the lungs for carbon monoxide (DLCO) decrease, severe desaturation, and poor 6-min walk test (6MWT) performance. The patient was treated with lowering corticosteroids as well as pulmonary rehabilitation (PR). During the 24-month follow-up, the dyspnea and fatigue persisted. On PFTs, 6MWT performance and restricted pattern improved slightly, but MBW discovered significant ventilatory inhomogeneity. FOT revealed substantial peripheral airway obstructive abnormalities. On CT scans, air trapping and ground-glass opacities (GGO) improved somewhat. The patient used a bronchodilator twice a day and low-dose inhaled corticosteroids (160 µg of budesonide and 4.5 µg of formoterol fumarate dihydrate) for nine months. PR sessions were resuming. The restricting parameters were stabilized and the DLCO had normalized after 36 months, with a 6MWT performance of 87% but significant desaturation. The CT scan revealed traction bronchiectasis, low GGO, and persistent air trapping. Without normalization, FOT and MBW scores improved, indicating small airway disease. CONCLUSIONS The necessity of integrating these tests when detecting SAD is emphasized in our paper. This article lays the foundation for future research into the best ways to manage and monitor SAD in post-acute COVID-19 patients.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador.
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.
| | - Maria F Osorio
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
| | - Karla Robles-Velasco
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | | | - Arturo Cortés-Télles
- Departamento de Neumología y Cirugía de Tórax, Hospital Regional de Alta Especialidad de Yucatán, Mérida, Mexico
| | - Jorge Zambrano
- Centro de enfermedades respiratorias, rehabilitación y sueño (CERS), Guayaquil, Ecuador
| | - Cristian Guarderas
- Centro de enfermedades respiratorias, rehabilitación y sueño (CERS), Guayaquil, Ecuador
| | - Belen Intriago
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México, Mexico
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Gochicoa-Rangel L, Jiménez C, Lechuga-Trejo I, Benítez-Pérez RE, Thirion-Romero I, Hernández-Rocha FI, Ceballos-Zúñiga O, Cortes-Telles A, Guerrero-Zuñiga S, Díaz-García R, Hernández-Morales AP, Aguilar-Zanela JL, Torre-Bouscoulet L. [Small airway: from definition to treatment]. Rev Alerg Mex 2023; 70:22-37. [PMID: 37566753 DOI: 10.29262/ram.v70i1.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/14/2023] [Indexed: 08/13/2023] Open
Abstract
The small airway, present since the origins of humanity and described barely a century ago, has recently been discovered as the anatomical site where inflammation begins in some obstructive lung diseases, such as asthma and Chronic Obstructive Pulmonary Disease (COPD), per se. Small airway dysfuction was identified in up to 91% of asthmatic patients and in a large proportion of COPD patients. In subjects without pathology, small airway represent 98.8% (approximately 4500 ml) of the total lung volume, contributing only between 10-25% of the total lung resistance; however, in subjects with obstruction, it can represent up to 90% of the total resistance. Despite this, its morphological and functional characteristics allow its dysfunction to remain undetected by conventional diagnostic methods, such as spirometry. Hence the importance of this review, which offers an overview of the tools available to assess small airway dysfunction and the possible therapies that act in this silent zone.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México
| | - Carlos Jiménez
- Facultad de Medicina de la Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Irma Lechuga-Trejo
- Departamento de Neumopediatría, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México
| | - Rosaura Esperanza Benítez-Pérez
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México
| | - Ireri Thirion-Romero
- Sociedad Latinoamericana de Fisiología Respiratoria (SOLAFIRE), Ciudad de México
| | | | | | - Arturo Cortes-Telles
- Clínica de Enfermedades Respiratorias, Hospital Regional De Alta Especialidad de la Península de Yucatán, Mérida, México
| | - Selene Guerrero-Zuñiga
- Unidad de Medicina del Sueño, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México
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7
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Bowerman C, Bhakta NR, Brazzale D, Cooper BR, Cooper J, Gochicoa-Rangel L, Haynes J, Kaminsky DA, Lan LTT, Masekela R, McCormack MC, Steenbruggen I, Stanojevic S. A Race-neutral Approach to the Interpretation of Lung Function Measurements. Am J Respir Crit Care Med 2023; 207:768-774. [PMID: 36383197 DOI: 10.1164/rccm.202205-0963oc] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale: The use of self-reported race and ethnicity to interpret lung function measurements has historically assumed that the observed differences in lung function between racial and ethnic groups were because of thoracic cavity size differences relative to standing height. Very few studies have considered the influence of environmental and social determinants on pulmonary function. Consequently, the use of race and ethnicity-specific reference equations may further marginalize disadvantaged populations. Objectives: To develop a race-neutral reference equation for spirometry interpretation. Methods: National Health and Nutrition Examination Survey (NHANES) III data (n = 6,984) were reanalyzed with sitting height and the Cormic index to investigate whether body proportions were better predictors of lung function than race and ethnicity. Furthermore, the original GLI (Global Lung Function Initiative) data (n = 74,185) were reanalyzed with inverse-probability weights to create race-neutral GLI global (2022) equations. Measurements and Main Results: The inclusion of sitting height slightly improved the statistical precision of reference equations compared with using standing height alone but did not explain observed differences in spirometry between the NHANES III race and ethnic groups. GLI global (2022) equations, which do not require the selection of race and ethnicity, had a similar fit to the GLI 2012 "other" equations and wider limits of normal. Conclusions: The use of a single global spirometry equation reflects the wide range of lung function observed within and between populations. Given the inherent limitations of any reference equation, the use of GLI global equations to interpret spirometry requires careful consideration of an individual's symptoms and medical history when used to make clinical, employment, and insurance decisions.
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Affiliation(s)
- Cole Bowerman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nirav R Bhakta
- Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California
| | - Danny Brazzale
- Department of Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, Germany
| | - Brendan R Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Julie Cooper
- Lung Function & Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Laura Gochicoa-Rangel
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Jeffrey Haynes
- Pulmonary Function Laboratory, Elliot Health System, Manchester, New Hampshire
| | - David A Kaminsky
- Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | | | - Refiloe Masekela
- Department of Paediatrics and Child Health, Faculty of Health Sciences, School of Clinical Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Baltimore, Maryland; and
| | | | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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8
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Gochicoa-Rangel L, Arce SC, Aguirre-Franco C, Madrid-Mejía W, Gutiérrez-Clavería M, Noriega-Aguirre L, Schonffeldt-Guerrero P, Acuña-Izcaray A, Cortés-Telles A, Martínez-Valdeavellano L, Hernández-Rocha FI, Ceballos-Zúñiga O, Del Rio Hidalgo R, Sánchez S, Meneses-Tamayo E, Chérrez-Ojeda I. Effect of Altitude on Respiratory Functional Status in COVID-19 Survivors: Results from a Latin American Cohort-FIRCOV. High Alt Med Biol 2023; 24:37-48. [PMID: 36757307 DOI: 10.1089/ham.2022.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Laura Gochicoa-Rangel, Santiago C. Arce, Carlos Aguirre-Franco, Wilmer Madrid-Mejía, Mónica Gutiérrez-Clavería, Lorena Noriega-Aguirre, Patricia Schonffeldt-Guerrero, Agustín Acuña-Izcaray, Arturo Cortés-Telles, Luisa Martínez-Valdeavellano, Federico Isaac Hernández-Rocha, Omar Ceballos-Zúñiga, Rodrigo Del Rio Hidalgo, Sonia Sánchez, Erika Meneses-Tamayo, and Iván Chérrez-Ojeda; and on Behalf of the Respiratory Physiology Project in COVID-19 (FIRCOV). Effect of altitude on respiratory functional status in COVID-19 survivors: results from a Latin American Cohort-FIRCOV. High Alt Med Biol 24:37-48, 2023. Persistent symptoms and lung function abnormalities are common in COVID-19 survivors. Objectives: To determine the effect of altitude and other independent variables on respiratory function in COVID-19 survivors. Methods: Analytical, observational, cross-sectional cohort study done at 13 medical centers in Latin America located at different altitudes above sea level. COVID-19 survivors were invited to perform pulmonary function tests at least 3 weeks after diagnosis. Results: 1,368 participants (59% male) had mild (20%), moderate (59%), and severe (21%) disease. Restriction by spirometry was noted in 32%; diffusing capacity of the lung for carbon monoxide (DLCO) was low in 43.7%; and 22.2% walked less meters during the 6-minute walk test (6-MWT). In multiple linear regression models, higher altitude was associated with better spirometry, DLCO and 6-MWT, but lower oxygen saturation at rest and during exercise. Men were 3 times more likely to have restriction and 5.7 times more likely to have a low DLCO. Those who had required mechanical ventilation had lower DLCO and walked less during the 6-MWT. Conclusions: Men were more likely to have lower lung function than women, even after correcting for disease severity and other factors. Patients living at a higher altitude were more likely to have better spirometric patterns and walked farther but had lower DLCO and oxygen saturation.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Ciudad de México, México
| | - Santiago C Arce
- Pulmonary Function Laboratory, Instituto de Investigaciones Médicas A. Lanari, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Aguirre-Franco
- Servicio de Pruebas de Función Pulmonar, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Wilmer Madrid-Mejía
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Ciudad de México, México
| | | | - Lorena Noriega-Aguirre
- Centro de Diagnóstico y Tratamiento de Enfermedades Respiratorias CEDITER, Cd. De Panamá, Panamá
| | | | - Agustín Acuña-Izcaray
- Servicio de Neumonología, Centro Médico Docente La Trinidad y Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - Arturo Cortés-Telles
- Clínica de Enfermedades Respiratorias, HRAE de la Península de Yucatán, Mérida, México
| | | | | | | | | | - Sonia Sánchez
- Centro de Estudios Respiratorios, Asunción, Paraguay
| | - Erika Meneses-Tamayo
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Ciudad de México, México
| | - Iván Chérrez-Ojeda
- Universidad de Especialidades Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Center, Guayaquil, Ecuador
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Cid-Juárez S, Téllez-Navarrete NA, Bautista-Bernal A, León-Gómez P, Salas-Escamilla I, Gochicoa-Rangel L, Pérez-Padilla R. Arterial Blood Gases in Normal Subjects at 2240 Meters Above Sea Level: Impact of Age, Gender, and Body Mass Index. Rev Invest Clin 2023; 75:29-36. [PMID: 36854075 DOI: 10.24875/ric.22000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background The values of arterial blood gases (ABG) change with altitude above sea level; empirical verification is essential because ventilatory acclimatization varies with ethnicity and a population's adaptation. Objective The aim of the study was to describe ABG in a healthy population residing at 2,240 meters above sea level, to identify the mean level of alveolar ventilation (PaCO2), and to know whether a progressive increase in PaCO2 occurs with age and the impact of increasing body mass index (BMI). Methods We conducted a cross-sectional study in a referral center for respiratory diseases in Mexico City. Associations among variables with correlation coefficient and regression models of PaO2, SaO2, and P(A-a)O2 as dependent variables as a function of age, BMI, minute ventilation, or breathing frequency were explored. Results Two hundred and seventeen healthy subjects were evaluated with a mean age of 40 ± 15 years, mean of the PaO2 was 71 ± 6 mmHg, SaO2 94% ± 1.6%, PaCO2 30.2 ± 3.4 mmHg, HCO3 20 ± 2 mmol/L, BE-2.9 ± 1.9 mmol/L, and the value of pH was 7.43 ± 0.02. In a linear regression, the main results were PaO2 = 77.5-0.16*age (p < 0.0001) and with aging P(A-a)O2 tended to increase 0.12 mmHg/year. PaCO2 in women increased with age by 0.075 mmHg/year (p = 0.0012, PaCO2 =26.3 + 0.075*age). SaO2 and PaO2 decreased significantly in women with higher BMI 0.14% and 0.52 mmHg per kg/m2, (p = 0.004 and 0.002 respectively). Conclusion Mean PaCO2 was 30.7 mmHg, implying a mean alveolar ventilation of around 30% above that at sea level.
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Affiliation(s)
- Silvia Cid-Juárez
- National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | | | | | - Pablo León-Gómez
- National Institute of Respiratory Diseases (INER), Mexico City, Mexico
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10
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Zac J, Zac S, Pérez-Padilla R, Remigio-Luna A, Guzmán-Boulloud N, Gochicoa-Rangel L, Guzmán-Valderrábano C, Thirión-Romero I. Lung volumes measurement using novel pressure derived method in participants with obstructive, restrictive and healthy lungs. Physiol Meas 2022; 43. [PMID: 36537615 DOI: 10.1088/1361-6579/aca7ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022]
Abstract
Background.Lung volumes can be measured by body plethysmography (BP), by inert gas dilution during a single-breath or multiple breaths and by radiographic methods based on chest roentgenogram or CT scanning. Our objective was to analyze the concordance between several methods including a new pressure-derived method (PDM) in a variety of pulmonary conditions.Methods. We recruited four groups of adult volunteers at the chronic obstructive pulmonary disease and tobacco clinic of a respiratory referral hospital: patients with lung bullae, with obstructive lung diseases, with restrictive lung diseases and healthy controls; all subjects underwent lung volume measurements according to ATS/ERS standards in random order with each method and then CT scanning. Differences among groups were estimated by Kruskal-Wallis tests. Concordance correlation coefficients (CCC) and Bland-Altman plots were performed.Results. Sixty-two patients were studied including 15 with lung bullae, 14 with obstructive lung diseases, 12 with restrictive lung disease and 21 healthy subjects. Highest concordance was obtained between BP and CT scanning (CCC 0.95, mean difference -0.35 l) and the lowest, with TLC-DLCOsb(CCC 0.65, difference -1.05 l). TLC measured by BP had a moderate concordance with the PDM (CCC = 0.91, mean difference -0.19 l). The PDM on the other hand had the lowest intra-test repeatability (2.7%) of all tested methods.Conclusions. Lung volumes measured by BP and CT had high concordance in the scenario of varied pulmonary conditions including lung bullae, restrictive and obstructive diseases. The new PDM device, had low intra-test variability, and was easy to perform, with a reasonable concordance with BP.
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Affiliation(s)
- Jacob Zac
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | - Salomon Zac
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | - Arantxa Remigio-Luna
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
| | | | - Laura Gochicoa-Rangel
- Respiratory Physiology Department, INER Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Respiratory Physiology Department, INER Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Ireri Thirión-Romero
- Tobacco and COPD Research Unit, Instituto Nacional de Enfermedades Respiratorias INER, Mexico City, Mexico
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11
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Cherrez-Ojeda I, Cortés-Telles A, Gochicoa-Rangel L, Camacho-Leon G, Mautong H, Robles-Velasco K, Faytong-Haro M. Challenges in the Management of Post-COVID-19 Pulmonary Fibrosis for the Latin American Population. J Pers Med 2022; 12:jpm12091393. [PMID: 36143178 PMCID: PMC9501763 DOI: 10.3390/jpm12091393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
This commentary aims to highlight some of the major issues (with possible solutions) that the Latin American region is currently dealing with in managing post-COVID-19 pulmonary fibrosis. Overall, there is little evidence for successful long-term COVID-19 follow-up treatment. The lack of knowledge regarding proper treatment is exacerbated in Latin America by a general lack of resources devoted to healthcare, and a lack of availability and access to multidisciplinary teams. The discussion suggests that better infrastructure (primarily multicenter cohorts of COVID-19 survivors) and well-designed studies are required to develop scientific knowledge to improve treatment for the increasing prevalence of pulmonary fibrosis in Latin America.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Respiralab Research Group, Guayaquil 090512, Guayas, Ecuador
- Correspondence: (I.C.-O.); (M.F.-H.)
| | - Arturo Cortés-Telles
- Departamento de Neumología y Cirugía de Tórax, Hospital Regional de Alta Especialidad de Yucatán, Mérida 97133, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Génesis Camacho-Leon
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL 33143, USA
| | - Hans Mautong
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Respiralab Research Group, Guayaquil 090512, Guayas, Ecuador
| | - Karla Robles-Velasco
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Respiralab Research Group, Guayaquil 090512, Guayas, Ecuador
| | - Marco Faytong-Haro
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Sociology and Demography Department, The Pennsylvania State University, University Park, PA 16802, USA
- Ecuadorian Development Research Lab, Daule 090656, Guayas, Ecuador
- Correspondence: (I.C.-O.); (M.F.-H.)
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12
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González-Islas D, Sánchez-Moreno C, Orea-Tejeda A, Hernández-López S, Salgado-Fernández F, Keirns-Davis C, Galicia-Amor S, Trejo-Mellado E, Gochicoa-Rangel L, Castorena-Maldonado A. Body composition and risk factors associated with sarcopenia in post-COVID patients after moderate or severe COVID-19 infections. BMC Pulm Med 2022; 22:223. [PMID: 35676657 PMCID: PMC9175169 DOI: 10.1186/s12890-022-02014-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/26/2022] [Indexed: 12/13/2022] Open
Abstract
Background Post-COVID-19 syndrome is characterized by diverse symptoms and abnormalities that persist beyond 12 weeks from the onset of acute COVID-19. Severity disease has been associated with more musculoskeletal alterations such as muscle weakness, dyspnea, and distance walking. The aim was to evaluate the impact of invasive mechanical ventilation (IMV) on body composition and investigate risk factors associated with sarcopenia in post-COVID-19 patients three months after moderate or severe COVID-19 infections. Methods Cross-sectional study. 530 patients with PCR-confirmed diagnoses of moderate to severe COVID-19, > 18 years old, oxygen saturation ≤ 93%, PaO2/FiO2 ratio < 300, who required hospitalization and were discharged were included. We excluded those who died before the follow-up visit, declined to participate, or could not be contacted. Results The mean age was 53.79 ± 12.90 years. IMV subjects had lower phase angle and handgrip strength and higher impedance index, frequency of low muscle mass, and low muscle strength than those without IMV. The risk factors of sarcopenia were > 60 years of age, diabetes, obesity, IMV, and prolonged hospital stay. The multivariate model showed that age > 60 years (OR: 4.91, 95% CI: 2.26–10.63), obesity (OR: 3.73, 95% CI: 1.21–11.54), and interaction between prolonged length of hospital stay and IMV (OR: 2.92; 95% CI: 1.21–7.02) were related to a higher risk of sarcopenia. Conclusion Obesity and the interaction between prolonged length of hospital stay and IMV are associated with a higher risk of sarcopenia at 3 months after severe or moderate COVID-19 infection.
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Affiliation(s)
- Dulce González-Islas
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502 Col Sec XVI CP 14080 Del Tlalpan, Mexico City, Mexico
| | - Carlos Sánchez-Moreno
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502 Col Sec XVI CP 14080 Del Tlalpan, Mexico City, Mexico
| | - Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502 Col Sec XVI CP 14080 Del Tlalpan, Mexico City, Mexico.
| | - Samantha Hernández-López
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502 Col Sec XVI CP 14080 Del Tlalpan, Mexico City, Mexico
| | - Fernanda Salgado-Fernández
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502 Col Sec XVI CP 14080 Del Tlalpan, Mexico City, Mexico
| | - Candace Keirns-Davis
- Heart Failure and Respiratory Distress Clinic, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502 Col Sec XVI CP 14080 Del Tlalpan, Mexico City, Mexico
| | - Susana Galicia-Amor
- Pulmonary Rehabilitation Department, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Esperanza Trejo-Mellado
- Pulmonary Rehabilitation Department, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Pulmonary Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Armando Castorena-Maldonado
- Otorhinolaryngology Department, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
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13
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Gochicoa-Rangel L, Rodríguez-Peralta KY, Gutiérrez-Bautista AK, Guzmán-Valderrábano C, Fernández-Plata R, Torre-Bouscoulet L, Martínez-Briseño D. Maximal inspiratory and expiratory flow at moderate altitude: a study of a Latin American population. BMC Pulm Med 2022; 22:147. [PMID: 35439986 PMCID: PMC9020005 DOI: 10.1186/s12890-022-01943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Peak inspiratory and expiratory flows (PIF, PEF) are parameters used to evaluate the mechanics of the respiratory system. These parameters can vary based on whether they are measured using mechanical devices vs. spirometry and based on the barometric pressure at which the measurements are obtained. Our objectives were (1) to report the normal values and variability of PEF and PIF of a Latin American population living at a moderate altitude (2240 m above sea level), (2) to analyze the adjustment of reference values obtained at sea level with those obtained in healthy subjects living at a moderate altitude, and (3) to assess the correlation between PEF obtained by spirometry (PEFs) and PEF obtained by mechanical devices (PEFm). Methods In this prospective and transversal study, men and women with good respiratory health aged between 2.8 and 68 years old were invited to participate. Randomly, they underwent spirometry (to measure PEFs and PIFs) and mechanical flowmetry (to measure PEFm). Results A total of 314 subjects participated, with an average age of 24.3 ± 16.4 years; 59% were Women. The main determinants for the reference equations were age, weight, height and sex at birth. The agreement of the PEFm, PEFs and PIFs values was inconsistent with that reported by other authors, even at the same barometric pressure. The association between PEFm and PEFs was r = 0.91 (p < 0.001), and the correlation coefficient of concordance was 0.84. Conclusions The PEFm, PEFs, and PIFs measurements in individuals living at moderate altitudes are different from those found by other authors in cities with different barometric pressures and ethnicities. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01943-x.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico.,Pulmonary Function Laboratory, Institute for Development and Innovation in Respiratory Physiology S de RL, Mexico City, Mexico
| | - Keylin Yaoska Rodríguez-Peralta
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Ana Karen Gutiérrez-Bautista
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rosario Fernández-Plata
- Department of Hospital Epidemiology and Infectology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Tlalpan 4502, Section XVI, Mexico City, 14080, Mexico
| | - Luis Torre-Bouscoulet
- Pulmonary Function Laboratory, Institute for Development and Innovation in Respiratory Physiology S de RL, Mexico City, Mexico
| | - David Martínez-Briseño
- Department of Hospital Epidemiology and Infectology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Tlalpan 4502, Section XVI, Mexico City, 14080, Mexico.
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Sánchez-Jerónimo P, Silva-Cerón M, López-López M, Hernández-Morales V, Gochicoa-Rangel L. Implementation of an Integrated Total Quality Management System in a Pulmonary Function Laboratory. Qual Manag Health Care 2022; 31:74-79. [PMID: 35132004 DOI: 10.1097/qmh.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES A worldwide objective in the area of health is to offer high-quality services supported by certification strategies that contribute to improving standards for processes commonly used in medicine. However, few pulmonary function test laboratories (PFTLs) follow official standards in their daily operations or are organized around an integrated total quality management system (ITQMS) focused on their established processes. The aim was to determine the feasibility of implementing an ITQMS to accredit the International Organization for Standardization (ISO) 9001:2015 standard in a high-demand PFTL where 13 respiratory function tests are routinely performed together with teaching and research activities. METHODS This project was conducted at the PFTL of the Instituto Nacional de Enfermedades Respiratorias in Mexico City from November 2014 to August 2017 and involved the implementation of an ITQMS guided by ISO 9001:2015 in 5 phases: (1) the establishment of a work team; (2) the elaboration of situational diagnoses; (3) the development of guidelines for the ITQMS; (4) the implementation of the ITQMS model; and (5) the evaluation of the ITQMS. RESULTS Upon completing the 5 phases, an evaluation of the system by an internal audit identified 3 minor cases of nonconformity (NC), while additional observations and an external audit found 5 minor cases of NC. These issues were addressed through a root-cause analysis to establish an action plan for each one. At the end of the process, the institution was granted the ISO 9001:2015 certification for its 3 processes: medical attention in support of diagnoses, teaching, and research. CONCLUSIONS It is possible to implement an ISO quality management system as a routine operating methodology in a high-demand PFTL.
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Affiliation(s)
- Patricia Sánchez-Jerónimo
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias, Tlalpan, Ciudad de México, México
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15
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Gochicoa-Rangel L, Hernández-Morales AP, Salles-Rojas A, Madrid-Mejía W, Guzmán-Valderrábano C, González-Molina A, Salas-Escamilla I, Durán-Cuellar A, Silva-Cerón M, Hernández-Morales V, Reyes-García A, Alvarado-Amador I, Lozano-Martínez L, Enright P, Pensado-Piedra LE, Torre-Bouscoulet L. Gas Exchange Impairment During COVID-19 Recovery. Respir Care 2021; 66:1610-1617. [PMID: 34465571 PMCID: PMC9993571 DOI: 10.4187/respcare.09114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Persistent impairment of pulmonary function and exercise capacity has been known to last for months or even years in the survivors who recovered from other coronavirus pneumonia. Some reports showed that subjects with coronavirus disease 2019 pneumonia after being discharged could have several sequelae, but there are few studies on gas exchange and exercise capacity complications in these subjects. AIMS To describe residual gas exchange abnormalities during recovery from coronavirus disease 2019 pneumonia. METHODS In an observational study, ∼90 d after onset of disease, we scheduled almost 200 subjects for an out-patient visit with pulmonary function testing and computed tomography of the lungs. Lung mechanics by using body plethysmography, gas exchange with diffusing lung capacity for carbon monoxide determined by the single-breath technique (DLCOsb) and diffusing lung capacity for nitric oxide determined by the single-breath technique (DLNOsb), and exercise ability by using the 6-min walk test (6MWT) were measured in the subjects. The results were compared between those who required invasive mechanical ventilation and those who did not. RESULTS A total of 171 subjects were included, the majority (96%) had signs of residual pneumonia (such as an excess of high attenuation areas) on computed tomography of the lungs. The DLCOSB results were below the lower limit of the normal range in 29.2% of the subjects; during the 6MWT, 67% experienced oxygen desaturation ([Formula: see text]) > 4%; and, in 81 (47%), the dropped below 88%. Subjects who required invasive mechanical ventilation (49.7%) were more likely to have lower lung volumes, more gas exchange abnormality, less exercise capacity and more radiologic abnormality. CONCLUSIONS Subjects who recovered from severe COVID-19 pneumonia continued to have abnormal lung function and abnormal radiologic findings.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico.
| | | | - Antonio Salles-Rojas
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Wilmer Madrid-Mejía
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Amaury González-Molina
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Isabel Salas-Escamilla
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Adela Durán-Cuellar
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Mónica Silva-Cerón
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Víctor Hernández-Morales
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Alejandro Reyes-García
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Irlanda Alvarado-Amador
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Luis Lozano-Martínez
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Paul Enright
- Pulmonary Function Test Laboratory, Institute for Development and Innovation in Respiratory Physiology, Mexico City, Mexico
| | - Lya Edith Pensado-Piedra
- Department of Image, National Institute of Respiratory Diseases "Ismael Cosío Villegas," Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Pulmonary Function Test Laboratory, Institute for Development and Innovation in Respiratory Physiology, Mexico City, Mexico
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16
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Madrid WA, Guzmán-Valderrábano C, Martínez-Briseño D, Torre-Bouscoulet L, Juan DHRS, Gochicoa-Rangel L. Offline exhaled nitric oxide in children: chemiluminescence vs. electrochemical devices. Bol Med Hosp Infant Mex 2021; 78:404-410. [PMID: 34571514 DOI: 10.24875/bmhim.20000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Exhaled nitric oxide (eNO) is a noninvasive marker of airway inflammation that has been used in children, using the "offline" technique. To the extent of our knowledge, no article reported in literature compares the concordance and correlation between the two different technologies used to measure eNO at tidal volume offline. This study aimed to report the concordance and correlation of the eNO measured "offline" at tidal volume, using chemioluminiscence (cl) vs electrochemical devices (eq). Methods A cross-sectional, observational, and prospective study was conducted in the National Institute of Respiratory Diseases (Instituto Nacional de Enfermedades Respiratorias), Mexico City. Healthy children and those with a lung disease between 1 and 11 years of age were included. The exhaled air sample at tidal volume was obtained by attaching a mask connected to a Mylar® bag. Results We studied 36 children. The mean ± standard deviation (SD) age of the study population was 6 ± 2.6 years; 25% of the subjects included were healthy, and the rest had a lung disease. The concordance correlation coefficient between the two measuring devices was 0.98 (p < 0.001), with a mean difference of 1.46 ± 3.5 ppb and 95% limits of agreement from -5.3 ppb to 8.3 ppb. The linear regression model equation for the estimation of eNO was eNOcl = (eNOeq·1.0718) - 0.1343 (r2 = 0.97). Conclusions The measurement of eNO at tidal volume by the offline method can be analyzed by electrochemical devices, and the results are interchangeable with those analyzed by chemiluminescence technology.
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Affiliation(s)
- Wilmer A Madrid
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.,Departmento de Pulmonología, Pedia-Hero. Mexico City, Mexico
| | - David Martínez-Briseño
- Departmento de Epidemiología y Estadística, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
| | - David H Ramírez-San Juan
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.,Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
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Pérez-Padilla R, Gochicoa-Rangel L, Thirión-Romero I. Measuring Lung Volumes in an Office With a New Device Body-Box Free. Chest 2021; 159:2143-2144. [PMID: 34099122 DOI: 10.1016/j.chest.2021.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022] Open
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18
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Salles-Rojas A, Guzmán-Valderrábano C, Madrid WA, González-Molina A, Silva-Cerón M, Rodríguez-Hernández C, Salas-Escamilla I, Castorena-Maldonado A, López-García CA, Torre-Bouscoulet L, Gochicoa-Rangel L. Masking the 6-Minute Walking Test in the COVID-19 Era. Ann Am Thorac Soc 2021; 18:1070-1074. [PMID: 33315525 PMCID: PMC8456738 DOI: 10.1513/annalsats.202009-1088rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Antonio Salles-Rojas
- National Institute of Respiratory Diseases Ismael Cosío VillegasMexico City, Mexico
| | | | - Wilmer A. Madrid
- National Institute of Respiratory Diseases Ismael Cosío VillegasMexico City, Mexico
| | | | - Mónica Silva-Cerón
- National Institute of Respiratory Diseases Ismael Cosío VillegasMexico City, Mexico
| | | | | | | | | | - Luis Torre-Bouscoulet
- Institute for Development and Innovation in Respiratory PhysiologyMexico City, Mexico
| | - Laura Gochicoa-Rangel
- National Institute of Respiratory Diseases Ismael Cosío VillegasMexico City, Mexico
- Institute for Development and Innovation in Respiratory PhysiologyMexico City, Mexico
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19
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Madrid-Mejía W, Gochicoa-Rangel L, Padilla JRP, Salles-Rojas A, González-Molina A, Salas-Escamilla I, Durán-Cuellar A, Silva-Cerón M, Guzmán-Valderrábano C, Lozano-Martínez L. Improvement in Walking Distance Lags Raise in Lung Function in Post-COVID Patients. Arch Bronconeumol 2021; 58:261-263. [PMID: 34054195 PMCID: PMC8150358 DOI: 10.1016/j.arbres.2021.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Key Words
- 6-MWD, 6-minute walk distance
- 6-MWT, 6-minute walk test
- COVID-19, coronavirus disease-2019
- DLCO, diffusing lung capacity for carbon monoxide
- FEV1, forced expiratory volume in the first second
- FT, pulmonary function tests
- FVC, forced vital capacity
- HHR, heart rate recovery
- IMV, invasive mechanical ventilation
- LLN, lower limit of normal
- MEP, maximal expiratory pressure
- MERS, Middle East respiratory syndrome
- MIP, maximal inspiratory pressure
- SARS, severe acute respiratory syndrome
- SpO2, oxygen blood saturation measured by pulse oximeter
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Affiliation(s)
- Wilmer Madrid-Mejía
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - José Rogelio Pérez Padilla
- COPD and Tobacco Research Department. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Antonio Salles-Rojas
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Amaury González-Molina
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Isabel Salas-Escamilla
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Adela Durán-Cuellar
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Mónica Silva-Cerón
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Luis Lozano-Martínez
- Department of Respiratory Physiology. National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
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20
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Abstract
Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2 that has caused an unprecedented pandemic with a high rate of morbidity and mortality worldwide. Although most cases are mild, there are a considerable number of patients who develop pneumonia or even acute respiratory distress syndrome (ARDS). After having recovered from the initial disease, many patients continue with various symptoms (fatigue, dry cough, fever, dyspnea, anosmia, and chest pain, among others.), which has led to consider the possible existence of "post-COVID-19 syndrome". Although the definition and validity of this syndrome are not clear yet, several studies report that individuals who have recovered from COVID-19 may have persistent symptoms, radiological abnormalities, and compromised respiratory function. Current evidence suggests that there is a large number of pulmonary sequelae after COVID-19 pneumonia (interstitial thickening, ground glass opacities, crazy paving pattern, and bronchiectasis, among others.). Likewise, it seems that pulmonary function tests (spirometry, DLCO, 6MWT, and measurement of maximum respiratory pressures), in addition to high-resolution computed axial tomographies (CAT scan), are useful for the assessment of these post-COVID-19 pulmonary sequelae. This review aims to describe the possible pulmonary sequelae after COVID-19 pneumonia, as well as to suggest diagnostic procedures for their correct assessment and follow-up; thus, allowing proper management by a multidisciplinary medical team.
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21
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Chávez-Alderete J, Gochicoa-Rangel L, Del-Río-Hidalgo R, Guerrero-Zúñiga S, Mora-Romero U, Benítez-Pérez R, Rodríguez-Moreno L, Torre-Bouscoulet L, Vargas MH. Salivary concentrations of cytokines and other analytes in healthy children. Cytokine 2020; 138:155379. [PMID: 33271384 DOI: 10.1016/j.cyto.2020.155379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Blood has been the usual biological fluid for measuring analytes, but there is mounting evidence that saliva may be also useful for detecting cytokines in a noninvasive way. Thus, in this study we aimed to determine concentration of cytokines and other analytes in saliva from a population of healthy children. METHODS We collected un-stimulated whole saliva samples from clinically healthy children, and concentration of 17 cytokines and 12 other analytes were measured in supernatants. All values were adjusted by albumin content and were log-transformed before multivariate statistical analysis. RESULTS We included 114 children (53.5% females) between 6.0 and 11.9 years old. The highest concentrations (medians, pg/µg albumin) were seen for visfatin (183.70) and adiponectin (162.26) and the lowest for IL-13 and IL-2 (~0.003). Albumin concentration was associated with age (rS = 0.39, p < 0.001). In the multivariate analysis, five analytes (C peptide, ghrelin, GLP-1, glucagon, leptin) inversely correlated with age and positively with height-for-age. Age was also positively associated with PAI-1, while height-for-age was also positively associated with insulin and visfatin. Finally, BMI-for-age had a positive correlation with GM-CSF and insulin. CONCLUSIONS Herein, we provided concentration values for 29 analytes in saliva from healthy children that may be useful as preliminary reference framework in the clinical research setting.
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Affiliation(s)
- Jaime Chávez-Alderete
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria, Mexico City, Mexico
| | - Rodrigo Del-Río-Hidalgo
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Selene Guerrero-Zúñiga
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Uri Mora-Romero
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Rosaura Benítez-Pérez
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria, Mexico City, Mexico
| | - Luis Rodríguez-Moreno
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria, Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria, Mexico City, Mexico
| | - Mario H Vargas
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
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22
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Larenas-Linnemann D, Gochicoa-Rangel L, Macías-Weinmann A, Soto-Ramos M, Luna-Pech JA, Elizondo-Ríos A, Del Río-Navarro BE, Hernández-Colín DD, García-Maldonado S, Zepeda B, Martínez-Infante EA, Vázquez JC. [Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma 2020]. ACTA ACUST UNITED AC 2020; 67 Suppl 2:S1-S25. [PMID: 33017878 DOI: 10.29262/ram.v67i0.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The fractional exhaled nitric oxide (FeNO) is related to the level of eosinophilic inflammation in the airways and the levels of interleukin-13, as such it could be a diagnostic and monitoring tool in asthma. A working group was convened between pulmonologists, respiratory physiology experts, and allergists to establish criteria for the use of FeNO in asthma in Mexico. Through a simplified Delphi method and group discussion, seven key points regarding the use of FeNO were agreed upon. We agree that the measurement of FeNO serves for the diagnosis of asthma in specialized clinics, both in children and adults, as well as to determine the level of corticosteroid treatment. In severe asthma, we recommend FeNO for endotyping, for detecting poor therapeutic adherence, undertreatment, and the risk of crisis. We suggest FeNO can be used to determine the level of corticosteroid treatment and to identify patients at risk of loss of lung function. We also recommend it in adults to improve the selection of biological therapy and, in this context, we only suggest it in selected cases for children.
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23
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Muñoz-Torrico M, Cid-Juárez S, Gochicoa-Rangel L, Torre-Bouscolet L, Salazar-Lezama MA, Villarreal-Velarde H, Pérez-Padilla R, Visca D, Centis R, D'Ambrosio L, Spanevello A, Saderi L, Sotgiu G, Migliori GB. Functional impact of sequelae in drug-susceptible and multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2020; 24:700-705. [DOI: 10.5588/ijtld.19.0809] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Evidence on the impact of tuberculosis (TB) treatment on lung function is scarce. The aim of this study was to evaluate post-treatment sequelae in drug-susceptible and drug-resistant-TB (DR-TB) cases in Mexico and Italy.METHODS: At the end of TB treatment
the patients underwent complete clinical assessment, functional evaluation of respiratory mechanics, gas exchange and a 6-minute walking test. Treatment regimens (and definitions) recommended by the World Health Organization were used throughout.RESULTS: Of 61 patients, 65.6% had
functional impairment, with obstruction in 24/61 patients (39.4%), and 78% with no bronchodilator response. These effects were more prevalent among DR-TB cases (forced expiratory volume in 1 s/forced vital capacity [FEV1/FVC] < lower limit of normality, 14/24 vs. 10/34; P
= 0.075). DR-TB patients showed moderately severe (FEV1 < 60%) and severe obstruction (FEV1 < 50%) (P = 0.008). Pre- and post-bronchodilator FEV1 and FEV1/FVC (% of predicted) were significantly lower among DR-TB cases. Plethysmography
abnormalities (restriction, hyperinflation and/or air trapping) were more frequent among DR-TB cases (P = 0.001), along with abnormal carbon monoxide diffusing capacity (DLCO) (P = 0.003).CONCLUSION: The majority of TB patients suffer the consequences of post-treatment
sequelae (of differing levels), which compromise quality of life, exercise tolerance and long-term prognosis. It is therefore important that lung function is comprehensively evaluated post-treatment to identify patient needs for future medication and pulmonary rehabilitation.
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Affiliation(s)
- M. Muñoz-Torrico
- Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - S. Cid-Juárez
- Physiology Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - L. Gochicoa-Rangel
- Physiology Department, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | | | - M. A. Salazar-Lezama
- Dirección médica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - H. Villarreal-Velarde
- Tuberculosis Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City
| | - R. Pérez-Padilla
- Clínica para dejar de fumar y EPOC, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - D. Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - R. Centis
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, ICS Maugeri, IRCCS, Tradate, Italy
| | | | - A. Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici (ICS) Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - L. Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - G. Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - G. B. Migliori
- Servizio di Epidemiologia, Clinica delle Malattie Respiratorie, ICS Maugeri, IRCCS, Tradate, Italy, Blizard Institute, Queen Mary University of London, London, UK
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24
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Yilmaz O, Gochicoa-Rangel L, Blau H, Epaud R, Lands LC, Lombardi E, Moore PE, Stein RT, Wong GWK, Zar HJ. Brief report: International perspectives on the pediatric COVID-19 experience. Pediatr Pulmonol 2020; 55:1598-1600. [PMID: 32356583 PMCID: PMC7267574 DOI: 10.1002/ppul.24800] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022]
Abstract
The 2019 novel coronavirus (SARS-CoV-2) is endangering human health worldwide; scarcity of published pediatric cases and current literature and the absence of evidence-based guidelines necessitate international sharing of experience and personal communication. On 31 March 2020 the International Committee of the American Thoracic Society Pediatrics Assembly recorded an online podcast, during which pediatric pulmonologists worldwide shared their experience on the novel coronavirus disease (COVID-19) in children. The aim was to share personal experience in organizing pediatric care in different health care settings globally, protecting health care workers, and isolation practices. This manuscript summarizes the common themes of the podcast which centered around three main topics: more benign clinical disease and progression in pediatric cases compared to adults, a strong need for strategies to protect health care workers, and social or economic disparities as a barrier to successful pandemic control.
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Affiliation(s)
- Ozge Yilmaz
- Department of Pediatric Allergy and Pulmonology, Medical Faculty, Celal Bayar University, Manisa, Turkey
| | - Laura Gochicoa-Rangel
- Department of Pulmonary Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Hannah Blau
- Pulmonary Institute at Schneider Children's Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Epaud
- Department of Pediatrics, CHI Créteil, Service de Pédiatrie, INSERM U955 (IMRB), équipe GEIC2O, UPEC, Créteil, France
| | - Larry C Lands
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Meyer Children's Hospital, Florence, Italy
| | - Paul E Moore
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Renato T Stein
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gary W K Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Heather J Zar
- Department of Paediatrics and Child Health, SA MRC Unit on Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
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25
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Gochicoa-Rangel L, Torre-Bouscoulet L, Salles Rojas A, Guzmán-Valderrábano C, Silva-Cerón M, Benítez-Pérez RE, Salas-Escamilla I, Madrid-Mejía W, Grosso-Espinosa JM. Functional Respiratory Evaluation in the COVID-19 Era: The Role of Pulmonary Function Test Laboratories. Rev Invest Clin 2020; 73. [PMID: 33053579 DOI: 10.24875/ric.20000250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022]
Abstract
The pandemic character of coronavirus disease-19 (COVID-19) requires strategy changes designed to guarantee the safety of patients and health-care professionals. We are greatly concerned by the limitations in the operation of pulmonary function test (PFT) laboratories, since there is a high risk of disease progression in patients with chronic pulmonary diseases, and we are now faced by the influx of a new group of individuals in the recovery phase of post-COVID-19-syndrome that requires evaluation and follow-up of their respiratory function. To reestablish the operation of PFT laboratories limiting the risk of cross-contamination, we herein present the consensus reached by a group of experts in respiratory physiology, most of whom work in PFT laboratories in several Latin American countries, on the applicable recommendations for severe acute respiratory syndrome coronavirus 2 pneumonia survivors when undergoing PFT. We present the safety and hygiene measures that must be adopted in laboratories or centers where PFT is conducted in adults and/or children. These recommendations answer the following questions: which PFT is most recommended in subjects that have recovered from COVID-19; what quality control and safety measures should PFT laboratories implement during this pandemic? And how should we approach non-COVID-19 patients requiring PFT?
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Affiliation(s)
- Laura Gochicoa-Rangel
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Laboratory of Pulmonary Function Tests, Instituto de Desarrollo e Innovación en Fisiología Respiratoria, Mexico City, Mexico
| | - Antonio Salles Rojas
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Mónica Silva-Cerón
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rosaura E Benítez-Pérez
- Department of Continuous Education, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Isabel Salas-Escamilla
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Wilmer Madrid-Mejía
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Juan M Grosso-Espinosa
- Laboratory of Pulmonary Function Tests, Instituto de Desarrollo e Innovación en Fisiología Respiratoria, Mexico City, Mexico
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26
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Martínez-Briseño D, Gochicoa-Rangel L, Torre-Bouscoulet L, Cid-Juárez S, Fernández-Plata R, Martínez-Valdeavellano L, Chapela-Lara S, Del Río-Hidalgo R, Pérez-Padilla R. Comparing Spirometric Reference Values From Childhood to Old Age Estimated by LMS and Linear Regression Models. Arch Bronconeumol 2020; 57:172-178. [PMID: 32127230 DOI: 10.1016/j.arbres.2019.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/25/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Proper reference values for lung function testing are essential for achieving adequate interpretations. The LMS procedure (lambda, mu, sigma) permits continuous analyses of entire populations avoiding gaps in the transition between childhood and adulthood. It also allows more precise calculations of average values, dispersion, and 5th percentiles, which are usually considered the lower limit of normality. The objective of this study was to compare our results fitted with the LMS method with standard multiple linear regression, and with those from international Global Lung Function Initiative (GLI) equations. METHODS Data from 9835 healthy residents of the metropolitan area of Mexico City aged 8-80 years were compiled from several studies: EMPECE, PLATINO, adult Mexican workers and two unpublished studies. The LMS procedure and multiple linear regression models were fit to obtain reference equations using R software. RESULTS Residuals from the LMS models had a median closer to zero, and smaller dispersion than those from the linear model, but differences although statistically significant were very small and of questionable practical relevance. For example, for females and ln(FEV1), median residual was -0.001 with p25 of -0.08 and p75 of 0.08 for LMS, compared with 0.004 (-0.08, 0.09) [p<0.05] for the linear model. Average spirometric values for a given height for our population, were higher than those predicted by the GLI study. CONCLUSION Continuous reference equations for the Mexican population calculated using the LMS technique showed slightly better fit than linear regression models.
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Affiliation(s)
- David Martínez-Briseño
- Department of Epidemiology and Social Sciences in Health, National Institute of Respiratory Diseases "Ismael Cosío Villegas", 4502 Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | | | - Silvia Cid-Juárez
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rosario Fernández-Plata
- Department of Epidemiology and Social Sciences in Health, National Institute of Respiratory Diseases "Ismael Cosío Villegas", 4502 Mexico City, Mexico
| | - Luisa Martínez-Valdeavellano
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Sofía Chapela-Lara
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rodrigo Del Río-Hidalgo
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Department of Research in Smoking and COPD, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico.
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27
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Gochicoa-Rangel L, Ramírez-José MC, Troncoso-Huitrón P, Silva-Cerón M, Guzmán-Valderrábano C, Lechuga-Trejo I, Cid-Juárez S, Torre-Bouscoulet L. Shorter corridors can be used for the six-minute walk test in subjects with chronic lung diseases. Respir Investig 2020; 58:255-261. [PMID: 32111517 DOI: 10.1016/j.resinv.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/23/2019] [Accepted: 12/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The main limitation of the six-minute walk test (6-MWT) is that not all pulmonary function testing facilities have an indoor flat, 30-m-long corridor. Therefore, this study aimed 1) to evaluate the correlation and agreement of the distances walked in 30-m- vs. 15-m-long corridors by subjects with chronic lung diseases (CLD group) and 2) to compare the levels of oxygen saturation (nSpO2), blood pressure (BP), heart rate recovery at minute one post-exercise (HRR1), and Borg scale scores for dyspnea and fatigue between the two distances walked. METHODS A prospective, cross-sectional study was conducted at the National Institute of Respiratory Diseases in Mexico City. Subjects with chronic lung diseases and healthy adults were invited to participate. The distance of the 6-MWT was randomly assigned based on whether the first test was in the 15-m or 30-m corridor. RESULTS Ninety individuals were included; the correlation in meters walked between the two corridors was r = 0.96 in CLD; the 95% limits of agreement for the 6-MWT ranged from -73 to +37 m. Most subjects walked further in the 30-m corridor (82%); however, the percent predicted values for the CLD group were 3.5% lower for the 15-m corridor than the 30-m corridor. Only 10.5% of the subjects with CLD would have been falsely classified as having a normal 6-MWT (false negative). No significant differences in the nSpO2, Borg scale, BP or HRR1 were found between the two 6-MWT corridor lengths. CONCLUSION The 6-MWT can be performed using a 15-m corridor in subjects with CLD, and the results for the distance walked, HRR1, nSpO2, and Borg scale scores are similar to between the 15-m and 30-m corridors.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico; Laboratorio de Función Pulmonar, Insituto de Desarrollo e Innovación en Fisiología Respiratoria S. de R.L, Av. Baja California 67-301, Romar Sur, Alcaldia Cuauhtémoc, Ciudad de México, 06760, Mexico.
| | - María C Ramírez-José
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico
| | - Prysila Troncoso-Huitrón
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico
| | - Mónica Silva-Cerón
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico
| | - Carlos Guzmán-Valderrábano
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico
| | - Irma Lechuga-Trejo
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico
| | - Silvia Cid-Juárez
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Tlalpan 4502, Sección XXI, Alcaldía Tlalpan, Ciudad de México, 14080, Mexico
| | - Luis Torre-Bouscoulet
- Laboratorio de Función Pulmonar, Insituto de Desarrollo e Innovación en Fisiología Respiratoria S. de R.L, Av. Baja California 67-301, Romar Sur, Alcaldia Cuauhtémoc, Ciudad de México, 06760, Mexico.
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28
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Fernández-Soto JR, Navarrete-Rodríguez EM, Del-Río-Navarro BE, Saucedo-Ramírez OJ, Del-Río-Chivardi JM, Meneses-Sánchez NA, Gochicoa-Rangel L, Sienra-Monge JJ. Asma: uso adecuado de dispositivos para inhalación. Bol Med Hosp Infant Mex 2020; 76:5-17. [PMID: 30657469 DOI: 10.24875/bmhim.18000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Inhaled therapy is considered the cornerstone of asthma treatment. However, despite being the ideal form of drug delivery, it is recognized that only 70% of patients have an adequate attachment to their treatment and only 39-67% of physicians can explain the optimal inhaler technique. Inhaled therapy has very specific characteristics. Pulmonary deposit of an inhaled medication through the respiratory tract is more complex than when administered orally and depends on several factors inherent to both the medication and the administration. For successful inhaled therapy, the drug needs to be converted into particles of an appropriate size, which can enter beyond the oropharynx and larynx, and be deposited in the lungs. There are multiple devices for the administration of drugs in the lower respiratory tract, each one with a similar efficacy as long as it is used with the correct technique. The decision of which device should be used is made based on the age of the patient, the ability to coordinate between the inhalation and activation of the device, and the presence of acute symptoms. The choice of the device must be evaluated individually.
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Affiliation(s)
- José R Fernández-Soto
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez. Ciudad de México, México
| | | | - Blanca E Del-Río-Navarro
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez. Ciudad de México, México
| | - Omar J Saucedo-Ramírez
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez. Ciudad de México, México
| | - Jaime M Del-Río-Chivardi
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez. Ciudad de México, México
| | - Néstor A Meneses-Sánchez
- Servicio de Alergia e Inmunología, Hospital Infantil de México Federico Gómez. Ciudad de México, México
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Ciudad de México, México
| | - Juan J Sienra-Monge
- Jefatura de Pediatría Ambulatoria, Hospital Infantil de México Federico Gómez. Ciudad de México, México
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Fernández-Plata R, Pérez-Padilla R, Del Río-Hidalgo R, García-Sancho C, Gochicoa-Rangel L, Rodríguez-Hernández C, Torre-Bouscoulet L, Martínez-Briseño D. Quality of Pulmonary Function Tests in Participants with Down Syndrome. Arch Bronconeumol 2019; 55:513-518. [DOI: 10.1016/j.arbres.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/17/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
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Cid-Juárez S, Thirión-Romero I, Torre-Bouscoulet L, Gochicoa-Rangel L, Martínez-Briseño D, Hernández-Paniagua IY, Delgadillo-Ruiz O, Guerrero-Zúñiga S, Del Río-Hidalgo R, Cortés-Medina D, Bapo-López PE, León-Gómez P, Bautista-Bernal A, Pérez-Padilla R. Inspiratory Capacity and Vital Capacity of Healthy Subjects 9–81 Years of Age at Moderate-High Altitude. Respir Care 2019; 64:153-160. [DOI: 10.4187/respcare.06284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Torre-Bouscoulet L, Arroyo-Hernández M, Martínez-Briseño D, Muñoz-Montaño WR, Gochicoa-Rangel L, Bacon-Fonseca L, Pérez-Padilla R, Vergara E, García-Sancho C, Lozano-Ruiz F, Fernández-Plata R, Guzmán-Barragán A, Arrieta O. Longitudinal Evaluation of Lung Function in Patients With Advanced Non-Small Cell Lung Cancer Treated With Concurrent Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2018; 101:910-918. [DOI: 10.1016/j.ijrobp.2018.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/27/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
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Torre-Bouscoulet L, Muñoz-Montaño WR, Martínez-Briseño D, Lozano-Ruiz FJ, Fernández-Plata R, Beck-Magaña JA, García-Sancho C, Guzmán-Barragán A, Vergara E, Blake-Cerda M, Gochicoa-Rangel L, Maldonado F, Arroyo-Hernández M, Arrieta O. Abnormal pulmonary function tests predict the development of radiation-induced pneumonitis in advanced non-small cell lung Cancer. Respir Res 2018; 19:72. [PMID: 29690880 PMCID: PMC5937833 DOI: 10.1186/s12931-018-0775-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/10/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiation pneumonitis (RP) is a frequent complication of concurrent chemoradiotherapy (CCRT) and is associated with severe symptoms that decrease quality of life and might result in pulmonary fibrosis or death. The aim of this study is to identify whether pulmonary function test (PFT) abnormalities may predict RP in non-small cell lung cancer (NSCLC) patients. METHODS A prospective multi-institutional study was conducted with locally advanced and oligometastatic NSCLC patients. All participants were evaluated at baseline, end of CCRT, week 6, 12, 24, and 48 post-CCRT. They completed forced spirometry with a bronchodilator, body plethysmography, impulse oscillometry, carbon monoxide diffusing capacity (DLCO), molar mass of CO2, six-minute walk test and exhaled fraction of nitric oxide (FeNO). Radiation pneumonitis was assessed with RTOG and CTCAE. The protocol was registered in www.clinicaltrials.gov (NCT01580579), registered April 19, 2012. RESULTS Fifty-two patients were enrolled; 37 completed one-year follow-up. RP ≥ Grade 2 was present in 11/37 (29%) for RTOG and 15/37 (40%) for CTCAE. Factors associated with RP were age over 60 years and hypofractionated dose. PFT abnormalities at baseline that correlated with the development of RP included lower forced expiratory volume in one second after bronchodilator (p = 0.02), DLCO (p = 0.02) and FeNO (p = 0.04). All PFT results decreased after CCRT and did not return to basal values at follow-up. CONCLUSIONS FEV1, DLCO and FeNO prior to CCRT predict the development of RP in NSCLC. This study suggests that all patients under CCRT should be assessed by PFT to identify high-risk patients for close follow-up and early treatment.
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Affiliation(s)
- L Torre-Bouscoulet
- Subdirección de Investigación Clínica, INER, Calz. de Tlalpan 4502, Tlalpan, Sección XVI, C.P. 14080, Ciudad de México, México
- Departamento de Fisiología Respiratoria INER, México city, México
| | - W R Muñoz-Montaño
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - D Martínez-Briseño
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | | | - R Fernández-Plata
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | - J A Beck-Magaña
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - C García-Sancho
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | - A Guzmán-Barragán
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias (INER), México city, Mexico
| | - E Vergara
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - M Blake-Cerda
- Departamento de Radio-Oncología, INCAN, México city, Mexico
| | - L Gochicoa-Rangel
- Subdirección de Investigación Clínica, INER, Calz. de Tlalpan 4502, Tlalpan, Sección XVI, C.P. 14080, Ciudad de México, México
- Departamento de Fisiología Respiratoria INER, México city, México
| | - F Maldonado
- Departamento de Radio-Oncología, INCAN, México city, Mexico
| | - M Arroyo-Hernández
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico
| | - O Arrieta
- Unidad Funcional de Oncología Torácica, Instituto Nacional de Cancerología (INCAN), Av. San Fernando No. 22, Col. Sección XVI, Tlalpan, 14080, Ciudad de México, CP, Mexico.
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Ciudad de México, México.
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Arroyo Hernandez M, Bouscoulet LT, Bacon L, Lozano-Ruiz F, Gochicoa-Rangel L, García-Sancho C, Vergara E, Martínez Briseño D, Guzmán-Barragán A, Fernández Plata R, Blake Cerda M, Maldonado F, Arrieta O. MA 20.12 Longitudinal Evaluation of Pulmonary Function in Patients with Advanced NSCLC Treated with Concurrent Chemo-Radiotherapy. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cid-Juárez S, Pérez-Padilla R, Torre-Bouscoulet L, Enright P, Gochicoa-Rangel L, Cortés-Medina D, Bapo-López PE, Tafolla-Manzo MV, Díaz SMG. Maximum Voluntary Ventilation in a Population Residing at 2,240 Meters Above Sea Level. Respir Care 2017; 62:1588-1593. [DOI: 10.4187/respcare.04939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gochicoa-Rangel L, del Río-Hidalgo R, Hernández-Ruiz J, Rodríguez-Moreno L, Martínez-Briseño D, Mora-Romero U, Cid-Juárez S, García-Sancho C, Torre-Bouscoulet L. Validating Reference Equations for Impulse Oscillometry in Healthy Mexican Children. Respir Care 2017; 62:1156-1165. [DOI: 10.4187/respcare.05247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Guerrero Zúñiga S, Sánchez Hernández J, Mateos Toledo H, Mejía Ávila M, Gochicoa-Rangel L, Miguel Reyes JL, Selman M, Torre-Bouscoulet L. Small airway dysfunction in chronic hypersensitivity pneumonitis. Respirology 2017; 22:1637-1642. [PMID: 28748646 DOI: 10.1111/resp.13124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/22/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Lung biopsies from patients with hypersensitivity pneumonitis (HP) have demonstrated small airway (SA) involvement, but there is no information concerning SA function in HP, and it is unknown whether pharmacological treatment could modify its function. SA function in patients with chronic HP using ultrasonic pneumography (UPG) and impulse oscillometry (IOS) was explored. We also compared initial results with those obtained after 4 weeks of standardized treatment with azathioprine and prednisone. METHODS The study group consisted of adults with recent diagnoses of HP. All patients completed UPG, IOS, spirometry, body plethysmography, single-breath carbon monoxide diffusing capacity (DLCO ) and the 6-min walk test (6MWT). The fraction of exhaled nitric oxide (FENO ) was obtained to assess eosinophilic airway inflammation. Measurements were taken at diagnosis and after 4 weeks of treatment. RESULTS A total of 20 consecutive patients (16 women) with chronic HP participated in the study. Median age was 50 years (interquartile range (IQR): 42-54). At diagnosis, the UPG phase 3 slope was abnormally high, consistent with maldistribution of ventilation. For IOS, all patients had low reactance at 5 Hz (X5) and elevated reactance area (AX) reflecting low compliance, and only eight (40%) patients had elevated R5 (resistance at 5 Hz (total)) and R5-20 (resistance at 5 Hz-resistance at 20 Hz (peripheral)) attributed to SA resistance. In contrast, FENO parameters were within normal limits. After treatment, forced vital capacity (FVC), the 6-min walk distance and the distribution of ventilation showed significant improvement, although DLCO did not. CONCLUSION Patients with chronic HP have SA abnormalities that are partially revealed by the UPG and IOS tests. Lung volumes, but not gas exchange, improved after treatment with azathioprine and prednisone.
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Affiliation(s)
- Selene Guerrero Zúñiga
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Julia Sánchez Hernández
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Heidegger Mateos Toledo
- Interstitial Lung Diseases Clinic, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Mayra Mejía Ávila
- Interstitial Lung Diseases Clinic, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico
| | | | - Moisés Selman
- Research Unit, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Department of Respiratory Physiology, National Institute of Respiratory Diseases, Mexico City, Mexico.,Research Unit, National Institute of Respiratory Diseases, Mexico City, Mexico
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Gochicoa-Rangel L, Vargas MH, Alonso-Gómez JL, Rodríguez-Moreno L, Martínez-Briseño D, Baños-Mejía O, Torre-Bouscoulet L. Respiratory impedance in patients with Duchenne muscular dystrophy. Pediatr Pulmonol 2016; 51:1072-1079. [PMID: 27129130 DOI: 10.1002/ppul.23434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 01/09/2016] [Accepted: 02/23/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Impulse oscillometry (IOS) evaluates non-effort-dependent respiratory mechanics, and thus it may be useful to evaluate patients with Duchenne muscular dystrophy (DMD). OBJECTIVES We aimed (1) to describe the behavior of IOS parameters in patients with DMD, and compare it to those from a control group; (2) to determine whether resistances and reactances differ in relation to the severity of DMD; and (3) to compare IOS parameters with spirometry and maximal inspiratory (MIP) and expiratory (MEP) pressures. METHODS Children and adolescents (<20 years old) with biopsy-confirmed DMD and age-paired subjects were cross-sectionally evaluated. All results were transformed to z scores with respect to the healthy subjects (reference population). RESULTS Anthropometric characteristics did not differ between the 31 patients and 69 controls included in the study. Compared with controls, patients with DMD had higher IOS resistances and lower reactances. As expected, FEV1 and FVC were lower in patients and always declined as age increased. By contrast, MIP and MEP were lower-than-normal in youngest patients, tended to improve around puberty initiation, and declined thereafter. In general, there was a poor correlation between IOS parameters and spirometric variables or respiratory pressures, excepting for X20 Hz, which had an inverse correlation with FEV1 . Interestingly, IOS resistances were higher in patients with less disability (lower Vignos score; better FVC), but tended to be normalized in advanced stages of the disease. CONCLUSION This study showed that IOS is feasible in children and adolescents with DMD and yields information about respiratory function not achievable with the usual forced techniques. Pediatr Pulmonol. 2016;51:1072-1079. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080, México DF, México.,Centro de Evaluación del Paciente Asmático Infantil, Centro Médico Santa Teresa, Texcoco, Estado de México, México
| | - Mario H Vargas
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", México DF, México
| | - José Luis Alonso-Gómez
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080, México DF, México
| | - Luis Rodríguez-Moreno
- Centro de Evaluación del Paciente Asmático Infantil, Centro Médico Santa Teresa, Texcoco, Estado de México, México
| | - David Martínez-Briseño
- Departamento de Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", México DF, México
| | - Omar Baños-Mejía
- Departamento de Rehabilitación Pulmonar, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", México DF, México
| | - Luis Torre-Bouscoulet
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080, México DF, México.
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Gochicoa-Rangel L, Pérez-Padilla R, Vázquez-García JC, Silva-Cerón M, Cid-Juárez S, Martínez-Briseño D, Enright PL, Jensen R, Torre-Bouscoulet L. Long-Term Stability of a Portable Carbon Monoxide Single-Breath Diffusing Capacity Instrument. Respir Care 2016; 62:231-235. [PMID: 27677305 DOI: 10.4187/respcare.04983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The 2005 American Thoracic Society/European Respiratory Society guidelines for single-breath diffusing capacity of the lung for carbon monoxide (DLCO) recommend a weekly biological control test and/or DLCO simulator to detect instrument error drift. Very little has been published regarding the results of such a quality assurance program. Our aim was to analyze the long-term stability of a portable DLCO instrument. METHODS We used a new EasyOne Pro system and checked its accuracy using a DLCO simulator with 2 reference gases (concentration A: carbon monoxide [CO] = 0.1% and helium = 6.52%; concentration B: CO = 0.08% and helium = 7.21%) during the first 3 y of use in our large clinical laboratory. To detect instrument drift, a healthy woman (MSC), age 43 y old at baseline, tested herself every week during this period of time. RESULTS More than 6,000 spirometry and 5,000 DLCO maneuvers were done using this instrument for patients during these 3 y. There were no failures in the daily volume and flow checks or the CO and helium calibration checks performed automatically by the instrument. The differences between the simulator DLCO and the measured DLCO were -0.91 ± 1.33 mL/min/mm Hg and -0.61 ± 1.45 mL/min/mm Hg for concentration A and concentration B, respectively. The results of the 110 biological control tests were: mean 30.8 ± 1.7 mL/min/mm Hg (95% CI 30.5-31.1), coefficient of variation of 5.4% in DLCO, and repeatability of 2.5 mL/min/mm Hg. Only 4 measurements were outside ±3 mL/min/mm Hg (3.6%). Her mean alveolar volume was 4.2 ± 0.25 L with coefficient of variation of 6.2%; her inspired volume was 3.05 ± 0.14 L, and coefficient of variation = 4.5%. CONCLUSIONS Measurements of DLCO were stable over the 3-y period without any need for manual recalibration of the instrument. The biological control was as good as the DLCO simulator to evaluate this kind of device in a long-term laboratory quality control program.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México, Distrito Federal, México
| | - Rogelio Pérez-Padilla
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México, Distrito Federal, México
| | - Juan Carlos Vázquez-García
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México, Distrito Federal, México
| | - Mónica Silva-Cerón
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México, Distrito Federal, México
| | - Silvia Cid-Juárez
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México, Distrito Federal, México
| | - David Martínez-Briseño
- Departamento de Investigación en Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México
| | - Paul L Enright
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - Robert Jensen
- Department of Medicine, Pulmonary Division, University of Utah, Salt Lake, Utah
| | - Luis Torre-Bouscoulet
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," México, Distrito Federal, México.
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Vazquez-Garcia JC, Perez-Padilla R, Casas A, Schonffeldt-Guerrero P, Pereira J, Vargas-Dominguez C, Velazquez-Uncal M, Martinez-Briseno D, Torre-Bouscoulet L, Gochicoa-Rangel L. Reference Values for the Diffusing Capacity Determined by the Single-Breath Technique at Different Altitudes: The Latin American Single-Breath Diffusing Capacity Reference Project. Respir Care 2016; 61:1217-23. [DOI: 10.4187/respcare.04590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gochicoa-Rangel L, Pérez-Padilla JR, Rodríguez-Moreno L, Montero-Matamoros A, Ojeda-Luna N, Martínez-Carbajal G, Hernández-Raygoza R, Ruiz-Pedraza D, Fernández-Plata MR, Torre-Bouscoulet L. Altitude Above Sea Level and Body Mass Index as Determinants of Oxygen Saturation in Children: The SON@ Study. Rev Invest Clin 2015; 67:366-371. [PMID: 26950741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Altitude above sea level and body mass index are well-recognized determinants of oxygen saturation in adult populations; however, the contribution of these factors to oxygen saturation in children is less clear. OBJECTIVE To explore the contribution of altitude above sea level and body mass index to oxygen saturation in children. METHODS A multi-center, cross-sectional study conducted in nine cities in Mexico. Parents signed informed consent forms and completed a health status questionnaire. Height, weight, and pulse oximetry were recorded. RESULTS We studied 2,200 subjects (52% girls) aged 8.7 ± 3.0 years. Mean body mass index, z-body mass index, and oxygen saturation were 18.1 ± 3.6 kg·m-2, 0.58 ± 1.3, and 95.5 ± 2.4%, respectively. By multiple regression analysis, altitude proved to be the main predictor of oxygen saturation, with non-significant contributions of age, gender, and body mass index. According to quantile regression, the median estimate of oxygen saturation was 98.7 minus 1.7% per km of altitude above sea level, and the oxygen saturation fifth percentile 97.4 minus 2.7% per km of altitude. CONCLUSIONS Altitude was the main determinant of oxygen saturation, which on average decreased 1.7% per km of elevation from a percentage of 98.7 at sea level. In contrast with adults, this study in children found no association between oxygen saturation and obesity or age.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Centro Médico Santa Teresa, Texcoco, Edo. de México, Mexico
| | - José Rogelio Pérez-Padilla
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Luis Rodríguez-Moreno
- Centro Médico Santa Teresa, Texcoco, Edo. de México, Mexico
- Laboratorio de Función Pulmonar S de RL, Mexico City, Mexico
| | - Arturo Montero-Matamoros
- Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, Tepic, Nayarit, Mexico
| | - Nancy Ojeda-Luna
- Respirar, Centro de Atención Pulmonar del Sureste, Mérida, Yucatán, Mexico
| | | | - Roberto Hernández-Raygoza
- Hospital de Pediatría, Unidad Médica de Alta Especialidad, Centro Médico de Occidente, IMSS, Guadalajara, Jalisco, Mexico
| | | | | | - Luis Torre-Bouscoulet
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Laboratorio de Función Pulmonar S de RL, Mexico City, Mexico
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Martínez-Briseño D, Fernández-Plata R, Gochicoa-Rangel L, Torre-Bouscoulet L, Rojas-Martínez R, Mendoza-Alvarado L, García-Sancho C, Pérez-Padilla R. Socioeconomic Status and Longitudinal Lung Function of Healthy Mexican Children. PLoS One 2015; 10:e0136935. [PMID: 26379144 PMCID: PMC4574937 DOI: 10.1371/journal.pone.0136935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 08/10/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Our aim was to estimate the longitudinal effect of Socioeconomic status (SES) on lung function growth of Mexican children and adolescents. Materials and Methods A cohort of Mexican children in third grade of primary school was followed with spirometry twice a year for 6 years through secondary school. Multilevel mixed-effects lineal models were fitted for the spirometric variables of 2,641 respiratory-healthy Mexican children. Monthly family income (in 2002 U.S. dollars [USD]) and parents’ years completed at school were used as proxies of SES. Results Individuals with higher SES tended to have greater height for age, and smaller sitting height/standing height and crude lung function. For each 1-year increase of parents’ schooling, Forced expiratory volume in 1 sec (FEV1) and Forced vital capacity (FVC) increased 8.5 (0.4%) and 10.6 mL (0.4%), respectively (p <0.05) when models were adjusted for gender. Impact of education on lung function was reduced drastically or abolished on adjusting by anthropometric variables and ozone. Conclusions Higher parental schooling and higher monthly family income were associated with higher lung function in healthy Mexican children, with the majority of the effect likely due to the increase in height-for-age.
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Affiliation(s)
- David Martínez-Briseño
- Epidemiology and Social Science in Health, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Rosario Fernández-Plata
- Epidemiology and Social Science in Health, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Epidemiology and Social Science in Health, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Epidemiology and Social Science in Health, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Rosalba Rojas-Martínez
- Population Health Research Center, National Institute of Public Health (INSP), Mexico City, Mexico
| | - Laura Mendoza-Alvarado
- Population Health Research Center, National Institute of Public Health (INSP), Mexico City, Mexico
| | - Cecilia García-Sancho
- Epidemiology and Social Science in Health, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Epidemiology and Social Science in Health, National Institute of Respiratory Diseases (INER), Mexico City, Mexico
- * E-mail:
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Gochicoa-Rangel L, Rojas-Cisneros F, Miguel-Reyes JL, Guerrero-Zúñiga S, Mora-Romero U, Maldonado-Mortera AK, Torre-Bouscoulet L. Variability of FeNO in healthy subjects at 2240 meters above sea level. J Clin Monit Comput 2015; 30:445-9. [PMID: 26174797 DOI: 10.1007/s10877-015-9737-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
Fraction of exhaled nitric oxide (FeNO) is a marker of eosinophilic airway inflammation. Altitude above sea level can affect measurements of this index, but there is only limited information regarding the diurnal variation (ante meridiem vs. post meridiem) and reproducibility of FeNO on consecutive days at moderate altitudes. To evaluate the diurnal variability of FeNO and assess its reproducibility over five consecutive days in healthy individuals living at 2240 m, and to compare the FeNO readings taken with two different analyzers. Healthy non-smoking adults were measured using NIOX MINO(®) or NOA 280i(®) devices. One group (n = 10) had readings taken morning and afternoon for five consecutive days with the NIOX MINO(®) equipment; while the second group (n = 17) was measured on only one morning but by both the electrochemical analyzer (NIOX MINO(®)) and the chemiluminescence method (NOA 280i(®)). The study group consisted of 27 subjects aged 28.7 ± 6 years. Morning and afternoon FeNO measurements were 15.2 ± 7.5 ppb and 15.2 ± 7.9 ppb (p = 0.9), respectively. The coefficient of variation (CV) of these measurements (a.m. vs. p.m.) was 10.7 %, and the coefficient of repeatability (CR), 4.2 ppb. The concordance correlation coefficient (CCC) between the two measures (morning vs. afternoon) was 0.91. The CV and CR of the five morning readings were 15.4 % and 4.3 ppb, respectively; while those of the five afternoon measures were 13.6 % and 3.5 ppb, respectively. The CCC between the NIOX MINO(®) equipment and the NOA-280i(®) device was 0.8, with 95 % limits of agreement of -8.35 to 0.29 ppb. In adults living at 2240 m above sea level, FeNO measurements show minimal diurnal variation, and readings are reproducible (<15 %) over a period of at least five consecutive days; however, the FeNO measurements obtained with the NIOX MINO(®) and NOA 280i(®) devices are not interchangeable due to the wide limits of agreement recorded.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Fermín Rojas-Cisneros
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - José Luis Miguel-Reyes
- Clínica de Asma, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Selene Guerrero-Zúñiga
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Uri Mora-Romero
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Ana Karen Maldonado-Mortera
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Luis Torre-Bouscoulet
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico.
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Torre-Bouscoulet L, Velázquez-Uncal M, García-Torrentera R, Gochicoa-Rangel L, Fernández-Plata R, Enright P, Pérez-Padilla R. Spirometry quality in adults with very severe lung function impairment. Respir Care 2015; 60:740-3. [PMID: 25587163 DOI: 10.4187/respcare.03457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Some technologists worry that patients with very severe lung disease are unable to complete several spirometry maneuvers, which require considerable effort. METHODS We retrospectively selected all spirometry tests with an FEV1 < 35% predicted done by adult subjects sent to our pulmonary function laboratory during a 3-y period. We determined the rates and correlates of poor quality test sessions. RESULTS Approximately 90% of the tests done by the 558 subjects with very severe lung-function impairment (of > 30,000 subjects tested during the 3-y period) had adequate quality spirometry. Subjects with airway obstruction were less likely to meet FVC repeatability goals. A poor spirometry quality grade was associated with a very low FVC and a low body mass index, but not older age. CONCLUSIONS Severe lung disease should not be used as an excuse for not meeting spirometry quality goals.
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Affiliation(s)
- Luis Torre-Bouscoulet
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Tlalpan
| | - Mónica Velázquez-Uncal
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Tlalpan
| | - Rogelio García-Torrentera
- Department of Respiratory Therapy, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Tlalpan
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Tlalpan
| | - Rosario Fernández-Plata
- Department of Epidemiology and Social Sciences, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Tlalpan, México
| | | | - Rogelio Pérez-Padilla
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas," Tlalpan
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Miguel-Reyes JL, Gochicoa-Rangel L, Pérez-Padilla R, Torre-Bouscoulet L. Functional respiratory assessment in interstitial lung disease. Rev Invest Clin 2015; 67:5-14. [PMID: 25857578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interstitial lung diseases are a heterogeneous group of disorders that affect, to a greater or lesser degree, the alveolus, peripheral airway, and septal interstitium. Functional assessment in patients suspected of having an interstitial lung disease has implications for diagnosis and makes it possible to objectively analyze both response to treatment and prognosis. Recently the clinical value of lung-diffusing capacity and the six-minute walking test has been confirmed, and these are now important additions to the traditional assessment of lung function that is based on spirometry. Here we review the state-of-the-art methods for the assessment of patients with interstitial lung disease.
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Affiliation(s)
- José Luis Miguel-Reyes
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., México
- Asthma Clinic, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., México
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., México
| | - Rogelio Pérez-Padilla
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., México
| | - Luis Torre-Bouscoulet
- Department of Respiratory Physiology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., México
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Torre-Bouscoulet L, Mejía-Alfaro R, Salas-Escamilla I, Durán-Cuéllar A, Velázquez-Uncal M, Cid-Juárez S, Silva-Cerón M, Guerrero-Zúñiga S, Mora-Romero U, Gochicoa-Rangel L. Prueba de caminata de 6 minutos: recomendaciones y procedimientos. ACTA ACUST UNITED AC 2015. [DOI: 10.35366/60426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gochicoa-Rangel L, Larios-Castañeda PJ, Miguel-Reyes JL, Briseño DM, Flores-Campos R, Sáenz-López JA, Torre-Bouscoulet L. PIKO-6® vs. forced spirometry in asthmatic children. Pediatr Pulmonol 2014; 49:1170-6. [PMID: 24500941 DOI: 10.1002/ppul.22996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/04/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND The PIKO-6® is an electronic device that measures forced expiratory volume at seconds 1 (FEV1) and 6 (FEV6) of a forced vital capacity (FVC) maneuver. This device could aid in diagnosing obstructive respiratory diseases. OBJECTIVES To determine the concordance of FEV1, FEV6, and the FEV1/FEV6 quotient achieved with PIKO-6® versus spirometric values from asthmatic patients, and compare results with measures from healthy children. METHODS A cross-sectional study with asthmatic and healthy 6-to-14-year-old children, all of whom performed a forced spirometry as well as a PIKO-6® test. RESULTS The study included 82 subjects (58 asthmatics, 24 healthy children). Except for the functional parameters, the basal characteristics of the two groups were similar. The concordance correlation coefficient (CCC) for FEV1 was 0.938 (P < 0.001), with 95% limits of agreement of -0.591 to 0.512 L, and an average of differences of -0.040 L. For FEV6, CCC was 0.927 (P < 0.001), and the 95% limits of agreement were -0.751 to 0.598 L with an average of differences of -0.077 L. The concordance analysis and the FEV1 and FEV6 associations were better in children with controlled asthma and healthy subjects, as well as in the post-bronchodilator results. CONCLUSIONS The concordance between PIKO-6® and spirometry was lower in patients with partially controlled or uncontrolled asthma compared to controlled or healthy children. The broad limits of agreement show that the FEV1, FEV6, and FEV1/FEV6 obtained with the PIKO-6® are not interchangeable with spirometry results. Longitudinal evaluations of asthma patients are necessary to assess the utility of PIKO-6®.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas,", México, Distrito Federal, Mexico
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Gochicoa-Rangel L, Torre-Bouscoulet L, Martinez-Briseno D, Rodriguez-Moreno L, Cantu-Gonzalez G, Vargas MH. Values of Impulse Oscillometry in Healthy Mexican Children and Adolescents. Respir Care 2014; 60:119-27. [DOI: 10.4187/respcare.03374] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gochicoa-Rangel L, Vargas-Domínguez C, García-Mujica ME, Bautista-Bernal A, Salas-Escamilla I, Pérez-Padilla R, Torre-Bouscoulet L. Quality of spirometry in 5-to-8-year-old children. Pediatr Pulmonol 2013; 48:1231-6. [PMID: 23401425 DOI: 10.1002/ppul.22765] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 12/28/2012] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Although spirometry quality standards for children were proposed by American Thoracic Society/European Respiratory Society (ATS/ERS) in 2007, there is limited information on the percentage of children that fulfill these criteria during routine clinical testing, especially among 5-to-8-year-olds. AIMS OF THE STUDY to report the percentage of children that met the current 2007 ATS/ERS quality criteria; explore factors potentially associated with poor quality spirometry; and ascertain the repeatability of forced expiratory volume at 0.5 sec (FEV0.5 ), and at 1 sec (FEV1 ), as well as forced vital capacity (FVC). METHODS We evaluated the quality of spirometries without bronchodilator use performed at our laboratory in 2008 by 5-to-8-year-old children. FEV1 , FEV0.5 , FVC, back-extrapolated volume (BEV), forced expiratory time (FET), number of acceptable maneuvers, and repeatability, were computed and the percentage of tests that met the quality criteria standards was calculated. Based on our results, we propose a quality scoring system for spirometry for children that grades on a scale from A-to-F. RESULTS Three hundred seventy-six spirometries were reviewed. Mean age was 6.7 years; (53% males); 68% fulfilled the 2005 and 2007 ATS/ERS quality standards; >90% reached a repeatability ≤150 and ≤100 ml, or 10%, in FVC or FEV1 ; 87.2% reached FET ≥3 sec; 88% had a BEV ≤80 ml. The 90 percentile repeatability was 120 ml for FVC and FEV1 . Quality improved with age. CONCLUSIONS Our results support the proposal that a FET ≥3 sec, a BEV ≤80 ml, and repeatability in FEV1 and FVC ≤100 ml, or 10%, be taken into account as elements in quality control for spirometry in children.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, México, D.F., Mexico
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Martínez-Briseño D, Fernández-Plata R, Gochicoa-Rangel L, Torre-Bouscoulet L, Rojas-Martínez R, Mendoza L, García-Sancho C, Pérez-Padilla R. Longitudinal lung function growth of Mexican children compared with international studies. PLoS One 2013; 8:e77403. [PMID: 24143231 PMCID: PMC3797091 DOI: 10.1371/journal.pone.0077403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 09/02/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Our aim was to compare the longitudinal lung function growth of Mexican children and adolescents with the collated spirometric reference proposed for international use and with that of Mexican-Americans from the National Health State Examination Survey III (NHANES) III study. Materials and Methods A cohort of Mexican children in third year of primary school was followed with spirometry twice a year through secondary school. Multilevel mixed-effects lineal models separated by gender were fit for the spirometric variables of 2,641 respiratory-healthy Mexican children expressed as Z-scores of tested reference equations. Impact of adjustment by sitting height on differences with Mexican-American children was observed in a subsample of 1,987 children. Results At same gender, age, and height, Mexican children had increasingly higher forced expiratory volume in 1 s (FEV1) and Forced vital capacity (FVC) than the children from the collated reference study (mean Z-score, 0.68 for FEV1 and 0.51 for FVC) and than Mexican-American children (Z-score, 0.23 for FEV1 and 0.21 for FVC) respectively. Differences with Mexican-Americans were not reduced by adjusting by sitting height. Conclusions For reasons that remain unclear, the gender-, age-, and height-adjusted lung function of children from Mexico City is higher than that reported by several international studies.
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Affiliation(s)
| | | | | | | | | | - Laura Mendoza
- National Institute of Public Health (INSP), Mexico City, Mexico
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