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Respiratory Medicine Jun 2023Welders are exposed to gas and particle emissions that can cause severe lung disease, such as chronic obstructive pulmonary disease (COPD), a leading cause of mortality...
BACKGROUND
Welders are exposed to gas and particle emissions that can cause severe lung disease, such as chronic obstructive pulmonary disease (COPD), a leading cause of mortality and morbidity worldwide. It is difficult to detect COPD early and therefore mitigating measures may be delayed. The aim of this study was to investigate lung health in welders and evaluate new sensitive methods with potential to assess early onset pulmonary changes in occupational settings.
METHODS
This study assessed the lung health and symptoms in active welders (n = 28) and controls (n = 17). Lung measurements were performed with standard spirometry and new methods: airspace dimension assessment (AiDA), oscillometry, blood serum biomarkers (club cell secretory protein 16, surfactant protein D, matrix metalloproteinases, fibroblast, hepatocyte growth factor, interleukins), and one urine biomarker (desmosine).
RESULTS
According to spirometry measurements, all participants had normal lung function. However, prevalence of cough was significantly higher among welders compared with controls and lung changes were found in welders with the novel methods. Welders had significantly higher respiratory system resistance assessed with oscillometry, serum levels of metalloproteinases 9 and hepatocyte growth factor, compared with controls. Airspace dimensions were on average higher among welders compared with controls, but the difference was not significant. The number of welding years correlated with decreased respiratory system reactance and increased serum levels of matrix metalloproteinases 9, interleukin 6, and hepatocyte growth factor. Airspace dimension assessment indices were correlated with increasing levels of inflammatory markers and matrix metalloproteinases.
CONCLUSIONS
This study indicated the potential to use new and more sensitive methods for identification of changes in lungs when standard spirometry failed to do so.
Topics: Humans; Hepatocyte Growth Factor; Metal Workers; Respiratory Function Tests; Lung; Pulmonary Disease, Chronic Obstructive; Occupational Diseases; Occupational Exposure
PubMed: 37062499
DOI: 10.1016/j.rmed.2023.107244 -
BMC Pulmonary Medicine Apr 2023Studies linking early life exposure to air pollution and subsequent impaired lung health have focused on chronic, low-level exposures in urban settings. We aimed to...
BACKGROUND AND OBJECTIVE
Studies linking early life exposure to air pollution and subsequent impaired lung health have focused on chronic, low-level exposures in urban settings. We aimed to determine whether in utero exposure to an acute, high-intensity air pollution episode impaired lung function 7-years later.
METHOD
We conducted a prospective cohort study of children who lived in the vicinity of a coalmine fire. Respiratory function was measured using the forced oscillation technique (FOT). Z-scores for resistance at 5 Hz (R), reactance at 5 Hz (X) and area under the reactance curve (AX) were calculated. Two sets of analyses were conducted to address two separate questions: (1) whether mine fire exposure (a binary indicator; conceived after the mine fire vs in utero exposed) was associated with the respiratory Z-scores; (2) whether there was any dose-response relationship between fire-related PM exposure and respiratory outcomes among those exposed.
RESULTS
Acceptable lung function measurements were obtained from 79 children; 25 unexposed and 54 exposed in utero. Median (interquartile range) for daily average and peak PM for the exposed children were 4.2 (2.6 - 14.2) and 88 (52-225) µg/m respectively. There were no detectable differences in Z-scores between unexposed and exposed children. There were no associations between respiratory Z-scores and in utero exposure to PM (daily average or peak).
CONCLUSION
There was no detectable effect of in utero exposure to PM from a local coalmine fire on post-natal lung function 7-years later. However, statistical power was limited.
Topics: Child; Humans; Air Pollutants; Particulate Matter; Prospective Studies; Environmental Exposure; Air Pollution; Lung; Respiration
PubMed: 37059986
DOI: 10.1186/s12890-023-02414-7 -
ERJ Open Research Mar 2023https://bit.ly/3WCpWC0.
https://bit.ly/3WCpWC0.
PubMed: 37041988
DOI: 10.1183/23120541.00480-2022 -
Scientific Reports Feb 2023It is increasingly important to study the impact of environmental inhalation exposures on human health in natural or man-made disasters in civilian populations. The...
It is increasingly important to study the impact of environmental inhalation exposures on human health in natural or man-made disasters in civilian populations. The members of the World Trade Center Environmental Health Center (WTC EHC; WTC Survivors) had complex exposures to environmental disaster from the destruction of WTC towers and can serve to reveal the effects of WTC exposure on the entire spectrum of lung functions. We aimed to investigate the associations between complex WTC exposures and measures of spirometry and oscillometry in WTC Survivors and included 3605 patients enrolled between Oct 1, 2009 and Mar 31, 2018. We performed latent class analysis and identified five latent exposure groups. We applied linear and quantile regressions to estimate the exposure effects on the means and various quantiles of pre-bronchodilator (BD) % predicted forced expiratory volume in one second (FEV), forced vital capacity (FVC) and FEV/FVC ratio, as well as the resistance at an oscillating frequency of 5 Hz (R), frequency dependence of resistance R, and reactance area (AX). Compared with Group 5, which had low or unknown exposure and was treated as the reference group, Group 1, the local workers with both acute and chronic exposures, had a lower median of % predicted FVC (-3.6; 95% CI: -5.4, -1.7) and higher (more abnormal) measures of AX at 10th quantile (0.77 cmHO L s; 95% CI: 0.41, 1.13) and 25th quantile (0.80 cmHO L s; 95% CI: 0.41, 1.20). Results suggested heterogeneous exposures to the WTC disaster had differential effects on the distributions of lung functions in the WTC Survivors. These findings could provide insights for future investigation of environmental disaster exposures.
Topics: Humans; September 11 Terrorist Attacks; Inhalation Exposure; Lung; Forced Expiratory Volume; Disasters
PubMed: 36828851
DOI: 10.1038/s41598-023-30030-2 -
PloS One 2023The body posture can influence gas exchange, respiratory mechanics, and mucociliary clearance and different positions can be used as a therapeutic strategy to improve in...
BACKGROUND AND OBJECTIVE
The body posture can influence gas exchange, respiratory mechanics, and mucociliary clearance and different positions can be used as a therapeutic strategy to improve in gas exchange and can also help physiotherapists to assist patients who have difficult or restrictions to stay seated or the ones who stay in the same position for a long period. The objective of this study was to evaluate the effect of different positions on respiratory system impedance in obese and eutrophic subjects, using Impulse Oscillometry System (IOS).
METHODS
The IOS parameters were evaluated in seated (Se), right lateral decubitus (RL), left lateral decubitus (LL), and supine (Su).
RESULTS
Sixty two volunteers were allocated in obese group (OG) or eutrophic group (EG) according to BMI. In seated position, OG showed higher impedance than EG for R5: 0.55 (0.31; 0.93) and 0.33 (0.24; 0.52); R20: 0.39 (0.23; 0.54) and 0.32 (0.03; 0.41); R5-R20: 0.13 (0.02; 0.47) and 0.01 (-0.08; 0.27); X5: -0.20 (-0.51; 0.16) and -0,10 (-0.016; -0.04); Fres: 20.59 (11.54; 36.45 and 10.69 (7.56; 24.7) (p<0.05) and the impedance were higher in the Su for both groups. Compared to Se, there were differences with Su (R5, R5-20, X5), with RL (R20), and with LL (R5, R20) for OG; and with Su (R5, R5-20, X5, Fres), with RL and LL (X5) for EG. Compared to Su, there were differences with RL and LL (R5-20, X5) for OG; and with RL (R5, R5-20, X5, Fres), and LL (R5-20, X5, Fres) for EG. There were no differences between RL and LL for OG and EG.
CONCLUSION
The respiratory system impedance is increased in OG, with greater contribution of peripheral resistance. The higher values of resistance and reactance were obtained in the supine position, in both groups, with lower differences obtained in the right and left lateral decubitus.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Oscillometry; Electric Impedance; Forced Expiratory Volume; Respiratory System; Spirometry
PubMed: 36787314
DOI: 10.1371/journal.pone.0281780 -
The European Respiratory Journal May 2023Impulse oscillometry (IOS) allows an effort-independent evaluation of small airway function in asthma. Unfortunately, well-determined minimal clinically important...
BACKGROUND
Impulse oscillometry (IOS) allows an effort-independent evaluation of small airway function in asthma. Unfortunately, well-determined minimal clinically important differences (MCIDs) for IOS measures are lacking. Here, we provide MCIDs for frequently used IOS measures, namely frequency dependence of resistance (FDR) and area of reactance (AX), in patients with asthma.
METHODS
We performed IOS at baseline and 1 year later in adult patients with mild-to-severe asthma (n=235). In a two-step approach, we first applied a distribution-based method to statistically determine the MCID. Next, we validated the proposed MCID according to patient-reported outcome measures (PROMs): Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire-7 (ACQ-7) and Asthma Control Test (ACT). We used multivariable analyses to investigate the proposed MCIDs as predictors for improvements in PROMs compared with the established MCID of forced expiratory volume in 1 s (FEV).
RESULTS
The proposed MCID was a decline of ≥0.06 kPa·L·s and ≥0.65 kPa·L for FDR and AX, respectively. Patients who had changes beyond the MCIDs for both FDR and AX showed greater improvements in all PROMs than those who had not. The mean improvements in PROMs were beyond the established MCIDs for ACQ-7 and AQLQ, and approximated the MCID for ACT. Multivariable analyses demonstrated the MCIDs for both FDR and AX as independent predictors for the MCIDs of all PROMs. The MCID for FDR was a stronger predictor of all PROMs than the MCID for FEV.
CONCLUSIONS
This study provides MCIDs for IOS-derived measures in adult patients with asthma and emphasises that small airway function is a distinguished end-point beyond the conventional measure of FEV.
Topics: Humans; Adult; Minimal Clinically Important Difference; Oscillometry; Quality of Life; Asthma; Respiratory Function Tests
PubMed: 36758985
DOI: 10.1183/13993003.01793-2022 -
Frontiers in Medicine 2022Impulse oscillometry (IOS) can be used to evaluate airway impedance in patients with obstructive airway diseases. Previous studies have demonstrated that IOS parameters...
BACKGROUND
Impulse oscillometry (IOS) can be used to evaluate airway impedance in patients with obstructive airway diseases. Previous studies have demonstrated that IOS parameters differ between patients with bronchiectasis and healthy controls. This study aims to explore the usefulness of IOS in assessing disease severity and airway reversibility in patients with bronchiectasis.
METHOD
Seventy-four patients with non-cystic fibrosis bronchiectasis who visited our Respiratory Medicine outpatient clinic were consecutively recruited. Spirometry, plethysmography and IOS tests were performed. Patients were stratified into mild, moderate and severe disease according to Reiff, Bhalla, BSI, FACED, and BRICS scores. Airway reversibility was measured by bronchodilation test (BDT) and the result was classified as positive or negative. ROC curves of IOS parameters were used to assess the usefulness of IOS parameters in predicting airway reversibility. Correlations between the IOS, spirometric lung function and bronchiectasis severity parameters were analyzed.
RESULTS
Many IOS parameters, such as airway resistance at 5 Hz (R5), small airways resistance (R5-R20), total airway reactance (X5), resonance frequency (Fres), total airway impedance at 5 Hz (Z5), and peripheral resistance (Rp) increased in patients with bronchiectasis who presented a moderate to severe severity as categorized by the FACED, BSI and Reiff scores. Large airway resistance (R20) and central resistance (Rc) were not significantly different among groups with different bronchiectasis severity. The difference between R5 and R20 (R5-R20) showed 81.0% sensitivity, and 69.8%specificity in predicting the airway reversibility in bronchiectasis with AUC of 0.794 (95%CI, 0.672-0.915).
CONCLUSION
IOS measurements are useful indicators of bronchiectasis severity and may be useful for predicting the airway reversibility.
PubMed: 36687424
DOI: 10.3389/fmed.2022.796809 -
Journal of Investigational Allergology... Apr 2024Background: Static lung hyperinflation (SLH) measured using body plethysmography in patients with asthma is associated with poor outcomes. The severity of SLH may be... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Background: Static lung hyperinflation (SLH) measured using body plethysmography in patients with asthma is associated with poor outcomes. The severity of SLH may be associated with small airway dysfunction (SAD), which can be measured using impulse oscillometry (IOS). Objective: This study aims to determine the correlation between SLH and SAD in patients with severe asthma and assess the improvement in SLH and SAD with treatment.
METHODS
We analyzed data from patients who were enrolled in the Taiwan Severe Asthma Registry, which comprises a prospective observational cohort. Plethysmography and IOS were performed regularly. The relationship between spirometry and IOS parameters was determined. Changes in the clinical outcomes in response to treatment were analyzed.
RESULTS
Of 107 patients with severe asthma, 83 (77.6%) had SLH based on an increased residual volume to total lung capacity ratio (RV/ TLC). Most patients were older women with worse pulmonary function and SAD than those without SLH. SAD, defined as increased airway resistance/reactance, was significantly correlated with SLH. Airway reactance at 5 Hz (X5) ≤-0.21 kPa/(L/s) detected SLH with an area under the receiver operating characteristic curve of 0.84 (P<.0001; sensitivity, 85.2%; and specificity, 83.3%). After 12 months, patients who received add-on biologics (vs those who did not) had significantly reduced exacerbations, fractional exhaled nitric oxide level, and blood eosinophil counts, as well as improved forced expiratory volume in the first second, X5, and a trend toward reduced RV/TLC ratio.
CONCLUSIONS
In severe asthma, airway reactance (X5) could be a novel parameter for assessing SLH.
Topics: Aged; Female; Humans; Asthma; Forced Expiratory Volume; Lung; Respiratory Function Tests; Spirometry; Prospective Studies
PubMed: 36645713
DOI: 10.18176/jiaci.0888 -
The Journal of Allergy and Clinical... May 2023A recent study demonstrated a significant correlation between bronchial biopsy airway remodeling and quantitative computed tomography looking at bronchial wall thickness.
BACKGROUND
A recent study demonstrated a significant correlation between bronchial biopsy airway remodeling and quantitative computed tomography looking at bronchial wall thickness.
OBJECTIVE
To identify clinical associations with bronchial wall thickness in moderate to severe asthma.
METHODS
Ninety-two respiratory physician-diagnosed Global Initiative for Asthma-defined patients with moderate to severe asthma were included in this retrospective cohort study. Blinded to all clinical data, 2 senior thoracic radiologists independently measured airway lumen and total airway area at 4 different bronchopulmonary segments using high-resolution computed tomography imaging. We calculated adjusted odds ratios with regard to the association of bronchial wall thickness with spirometry, oscillometry, exacerbations, and nasal polyps.
RESULTS
The pooled analysis for all 4 bronchopulmonary segments showed that an area under reactance curve greater than or equal to 1.0 kPa/L, an R5-R20 ratio (resistance heterogeneity between 5 and 20 Hz divided by total resistance [R5]) of 25% or more, having 2 or more exacerbations per year, and presence of nasal polyposis exhibited adjusted odds ratios of 3.54 (95% CI, 1.22-10.32), 2.89 (95% CI, 1.03-8.05), 4.17 (95% CI, 1.25-13.90), and 9.85 (95% CI, 2.33-41.74), respectively, in their association with a wall area thickness of 50% or more. These translated into a respective 72%, 65%, 76%, and 90% increased likelihood for a wall area thickness of 50% or more.
CONCLUSIONS
Bronchial wall thickness is associated with peripheral airways resistance and reactance, severe exacerbations, and nasal polyposis in persistent asthma.
Topics: Humans; Retrospective Studies; Asthma; Lung; Bronchi; Spirometry
PubMed: 36639055
DOI: 10.1016/j.jaip.2022.12.040 -
Archives of Razi Institute Jun 2022This study was performed to evaluate the prognostic value of relative changes from admission to discharge (Δ%) of integrated congestion assessment to predict adverse...
This study was performed to evaluate the prognostic value of relative changes from admission to discharge (Δ%) of integrated congestion assessment to predict adverse outcomes in patients with irreversible heart failure (HF) during a one-year follow-up. The study included 122 patients (60% males, median age of 69 years) with decompensated HF. Most of the patients (92%) had a history of arterial hypertension, 53.3% had coronary heart disease, and 40.2% had type 2 diabetes mellitus. All patients underwent assessments, including NT-proBNP, lung ultrasound (LUS) B-line score, liver stiffness by transient elastography, and resistance and reactance by bioimpedance vector analysis (BIVA). The assessments were performed at admission and discharge, and a relative change from admission (delta percentage, Δ%) was calculated. Long-term clinical outcomes were assessed by a structured interview conducted 1, 3, 6, and 12 months after discharge. The cut-offs for the occurrence of the endpoint events were Δ% NT-proBNP of ≥ -25, Δ% liver stiffness of ≥ -44, Δ% B-line score on lung ultrasound of ≥ -73, Δ% BIVA resistance of ≤ 18, and Δ% BIVA reactance of ≤ 40. It was revealed that 55% of endpoint events, including 22 (18%) deaths and 33 (27%) readmissions, occurred within a median of 74 days (interquartile range: 33-147). Patients with an endpoint event had significantly worse values of all studied parameters in contrast to patients without it. There was a significant direct association between Δ% NT-proBNP and Δ% B-lines (r=0.18; =0.04), and a highly reliable inverse association was observed between Δ% liver stiffness and Δ% BIVA reactance (r=-0.4; <0.001). No significant associations were found between the other parameters. Univariate Cox regression analysis demonstrated the independent prognostic value of all congestion markers under study (NT-proBNP, LUS B-lines, liver stiffness, and BIVA reactance) for predicting the combined endpoint. Multivariate Cox regression analysis confirmed the independent prognostic value in predicting the risk of endpoint event for the following parameters: NT-proBNP (hazard rate [HR] 2.5, =0.001), liver stiffness (HR 2.3, =0.012), LUS B-line score (HR 2.2, =0.008). However, it did not find any significant prognostic value for BIVA resistance and reactance. The relative admission-to-discharge change in the integral assessment of congestion had a prognostic value for predicting the risk of adverse outcomes (all-cause mortality and readmission rate) in patients with decompensated HF during a one-year follow-up.
Topics: Aged; Female; Humans; Male; Diabetes Mellitus, Type 2; Heart Failure; Patient Discharge; Prognosis; Prospective Studies
PubMed: 36618279
DOI: 10.22092/ARI.2022.357393.2033