Lung Function Tests in Infants and Children

Lung function testing is an essential modality of investigation in children as it provides objective evidence of lung disease/ health. With advances in technology, various tests are available that can aid in the diagnosis of lung disease, assess the progression and response to therapy and document the lung development and evolving lung diseases in infants. This narrative review discusses lung function tests in infants and children. Currently, lung function tests can be performed in every age group, from neonates to the elderly. Spirometry and peak expiratory flow rate (PEFR) are the most employed tests in children more than six years of age. Spirometry helps diagnose and monitoring of both obstructive and restrictive diseases. There is a need for expertise to perform and interpret spirometry correctly. The forced oscillation technique (FOT) or impulse oscillometry (IOS) is done with tidal volume breathing and is feasible even in preschool children. Their utility is mainly restricted to asthma in children at present. Lung function tests can be performed in neonates, infants and children using infant pulmonary function test (PFT) equipment, although their availability is limited. Diffusion capacity for carbon monoxide (DLCO) is a valuable tool in restrictive lung diseases. Lung volumes can be assessed by body plethysmography and multiple washout technique. The latter can also assess lung clearance index. It is essential to perform and interpret the lung function test results correctly and correlate them with the clinical condition for optimum treatment and outcome.

A Case Control Study of Vitamin D Levels in Chronic Obstructive Pulmonary Disease Patients and Healthy Volunteers in South Gujarat, India

Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) programme states that COPD is a common, treatable, and preventable disease that is characterized by a persistent airflow restriction that usually progresses and is connected to an exaggerated chronic inflammatory response in the airways and the lung to harmful particles or gases. The combined severity of a patient's co-morbid illnesses and exacerbations increases. The purpose of the study was to assess the vitamin D status of COPD patients and healthy participants. Methodology: This case-control study was conducted among 75 cases and 75 control at the Surat Municipal Institute of Medical Education and Research General Medicine department. Result: The mean vitamin D of subjects in cases was 32.21 � 12.68 and it was 52.05 � 1.99 in controls. The difference in vitamin D between the two groups was statistically significant (P Value<0.001). Conclusion: COPD patients had lower amounts of vitamin D. As COPD severity increases, vitamin D levels decrease. Along with a rise in COPD exacerbations, vitamin D levels are also decreasing

Pulmonary function tests in subclinical hypothyroidism-a comparative cross-sectional study

Background: Subclinical hypothyroidism (SCH) reflects the earliest stage of thyroid dysfunction with subjects having normal free thyroid hormones T3, T4 with elevated Thyroid-stimulating hormone (TSH) values. Hypothyroidism may depress the central ventilator control and affects respiratory muscle strength which is linearly related to the thyroid hormone levels. In hypothyroidism, the impairment of pulmonary functions may be initiated at the subclinical stage of hypothyroidism. Aim and Objectives: The present study was designed to derive Forced Vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC, Peak expiratory flow rate and FEF 25–75 % in subclinical hypothyroid subjects and to compare the values with that of healthy controls. Materials and Methods: A cross-sectional comparative study was conducted in subjects aged between 25 and 60 years in which 85 subclinical hypothyroid cases were selected after proper exclusion and informed consent. 85 age and sex matched healthy controls were also studied. Statistical package for social sciences version 18 was used for statistical analysis. Results: All spirometric variables were found to be lower in subclinical hypothyroid subjects than in healthy controls and the abnormalities were of mixed pattern-both obstructive and restrictive. All values obtained were statistically significant (P < 0.05). Conclusion: Patients with SCH should be regularly screened with pulmonary function tests as respiratory derangement starts even at this stage. This will help for early diagnosis and treatment, and to prevent future complications.

An Analytical Cross-Sectional Study Comparing Thoracic Dimensions between Chronic Obstructive Pulmonary Disease (COPD) Patients and Healthy Controls

Introduction: Thoracic dimensions play a vital role in thepathogenesis and management of dyspnea among Chronicobstructive pulmonary disease [COPD] patients. COPD maycause changes in the shape of thoracic cage by increasing lungvolume and hyperinflation. Hence it is essential to know thevariations in thoracic dimensions among normal and COPDpatients. Study aimed to compare the thoracic dimensionsAntero posterior [AP] diameter, Transverse diameter andHeight of diaphragm [HDI] between COPD patients andhealthy controls.Material and Methods: The present study was a crosssectional study. The study included 80 subjects diagnosedwith COPD as per GOLD guidelines and 80 healthy controls.Both the groups underwent chest radiographic evaluation withPA and Lateral views.Results: The average AP diameter was significantly greaterin subjects with COPD [10.64cms ± 2.16cms] compared tohealthy controls [9.29cms ± 1.47cms]. The difference wasstatistically significant [p <0.001]. The Mean transversediameter was 22.5cms ± 2.1cms in COPD subjects and amongthe healthy controls [21.83cms ± 2.02cms]. The difference wasstatistically significant (P value 0.041). Also, among COPDmean HDI was 23.35cms ± 2.6cms and among the healthycontrols was 20.57cms ± 0.91cms which was statisticallysignificant [p<0.001].Conclusion: The present study demonstrated that AP,Transverse diameters of thoracic cage, and HDI evaluatedusing Chest X-ray, were increased in COPD subjects comparedto healthy controls.

Assessment of pulmonary function of industrial workers in four different industries of Gujarat

Background: Industrial workers working in various industries have exposure to different kind of pollutants. Exposure to various types of dust causes pneumoconiosis, a rising cause of impairment in factory workers. This study sought to analyze the effect of quantity and quality of dust variety and the duration of exposure on the pulmonary function test of the workers.Methods: Pulmonary function testing (PFT) was done using PC based spirometer in 4 different industries of Ahmedabad and Gandhinagar cities. The PFT values obtained were compared with normal values and the number of workers with impaired PFT was found. Associations were observed between types and amount of exposure with pulmonary impairment.Results: Out of 909 workers, 408 (44.88%) had pulmonary impairment of which 330 (80.88%) presented with restrictive lung function. It was found that maximum restrictive lung functions were found in workers exposed to metallic dust (51.4%) followed by metallic gases (43.8%). Whereas office administrative workers not having any direct exposure were having less impairment (p<0.005). Also, with increased duration of work in the industry, pulmonary impairment was also increasing. (χ2=119.89; p<0.005).Conclusions: Exposure to various types of dust impairs lung functions. The severity increases with the increase in the amount and duration of exposure. Proper protective measures should be taken by the workers and regular check-ups should be done to know any pulmonary impairment. The workers with impairment should be removed from exposure and relocated.

A clinical study of hyperreactive airway disease with wheeze in children aged five to twelve years with special reference to pulmonary function test

Background: Pulmonary function test is the easiest and most cost-effective method to evaluate respiratory functions. PFT can be measured by a simple instrument spirometer. Measuring PFT has been suggested as an important tool in understanding HRAD and its complications and management by all international guidelines.' The objectives of this study were to clinically diagnose the hyperreactive airway disease in children coming to Navodaya Medical College, Raichur, of age group 5 to 12 years. And to perform pulmonary function test before and after the use of a bronchodilator.Methods: PFT was measured in 100 children who came with HRAD with wheeze using Spiro lab III spirometer. The child was given then nebulization with salbutamol and PFT was performed again after 30 min.Results: A total of 100 clinically diagnosed cases of HRAD of age group 5 to 12 years of both the gender was taken into the study, of which more than 44% of the children showed more than 20% improvement in parameters FEV1, PEF, FVC and marginal improvement in EV1/FVC post bronchodilator compared to their prebronchodilator parameters. The young children of both the gender showed better improvement than elder children.Conclusions: Spirometry is the best tool to assess HRAD even in younger children, early diagnosis and regular follow up with PFT helps to understand and prevent the progression of the disease with prompt treatment.

Prevalence of Exercise-Induced Broncho- Constriction in Medical Students

Exercise-Induced Bronchoconstriction (EIB) is a transient acute narrowing of the airway which occurs as a result of exercise. EIB is common in children. The prevalence of EIB has been estimated to be 20% in general individuals without a known diagnosis of asthma. Eighty percent of all asthma individuals experience exercise-related symptoms (ERS). The purpose of this study was to investigate the prevalence of EIB in medical students using an exercise challenge test. Aims And Objectives – To study the prevalence of prevalence of EIB in medical student and to investigate the relationship between EIB and the history of asthma, history of ERS, allergy including rhinitis, atopic dermatitis, hay fever, allergies to food and animals. Methods: This study was done on medical student of NMCH, Jamuhar between January 2019 and March 2019. Medical students underwent exercise challenge test on bicycle -ergometry. Spirometry was performed a few minutes before and immediately after performance of the exercise. The criterion for a positive test was a greater than 10% decrease in FEV1 from the baseline measurement. Results: Total 188 students completed the study, out of which 24 came to be EIB positive. 17 had history of asthma of which 15 came to be EIB positive. 13 had history of ERS of which 11 came to be EIB positive. Conclusion: In our study prevalence of EIB came to be 12.7%. EIB in student having history of asthma came to be 88.2%. EIB in student having history of ERS came to be 84.6%.

Correlation of Body Mass Index with Pulmonary Function Tests in North Indian Females

Introduction: Obesity is becoming one of the serious publichealth problems of modern world with rapidly changinglifestyles involving consumption of high calorie foods withdecreased physical activities. Spirometery is the initialscreening tool for pulmonary diseases. The aim of this studywas to evaluate the prevalence of deranged BMI, pulmonaryfunction tests and correlation between BMI and pulmonaryfunction test.Material and methods: This study was done on 300 femalesubjects in the age group of 18-25 years including 150 fromrural area and 150 from urban area of North Indian populations.Various anthropometric measurements (height, weight) weretaken. BMI was calculated. Parameters of pulmonary functiontests such as FVC, FEV1,FEV1/FVC,FEF25-75%,PEFR weremeasured by spirometer.Results: The mean value of BMI in rural and urban populationis (23.33±4.75) and (22.55±4.57) respectively. On comparingPulmonary function parameters of both the population, allthe parameters were significantly higher in urban populationexcept FEV1/FVC.Conclusion: Prevalence of deranged BMI was significantlyhigher in rural population. Negative correlation found betweenBMI with Pulmonary function tests in both population exceptFEV1 and FVC which showed positive correlation in urbanpopulation.

Correlation between 6-minute walk distance and spirometry parameters in stable chronic obstructive pulmonary disease patients

Background: Six minute walk test (6MWT) is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. It is simple, objective and reproducible test. The present study was designed to assess correlation of six minute walk test with spirometry parameters, in patients with chronic obstructive pulmonary disease.Methods: In this cross sectional study, fifty patients diagnosed with chronic obstructive pulmonary disease (GOLD criteria) coming to tertiary center were recruited according to inclusion and exclusion criteria. All patients underwent spirometric measurement. Spirometric indices including FEV1, FVC, FEV1/FVC and MVV were tested using computerized spirometer. 6MWT was performed following American Thoracic Society (ATS) guidelines. Percent (%) predicted 6MWD was calculated. Correlation between spirometry and 6MWT was assessed.Results: It was found that correlation between 6MWT and spirometry is statistically significant. There is significant strong positive correlation between percent predicted 6MWD and FEV1 (r=0.850 and p= <0.001), whereas there is significant moderate correlation between percent predicted 6MWD and FVC (r=0.554 and p= <0.001), FEV1/FVC (r=0.509 and p= <0.001) and MVV (r=0.615 and p= <0.001).Conclusions: In chronic obstructive pulmonary disease, percent predicted 6mwd significantly correlated with the spirometry parameters (FEV1, FVC, FEV1/FVC, and MVV). 6MWD decreases as there is decline in the pulmonary function. 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.

Study of pulmonary functions with DLco in acute respiratory distress syndrome/ acute lung injury syndrome

Background: The objective of this is to study the lung functions with DLco in ARDS/ALI survivors; to study and analyse the lung functions in different diseases causing ARDS/ ALI survivors and to analyse the effect of treatment strategies on lung functions with DLco in survivors.Methods: All patients who survived ARDS/ALI illness from January 2008 to July 2009 are selected and follow up for pulmonary function at discharge, 3 months and 6 months were performed post illness were recorded and compared.Results: In the study period, 37 cases were enrolled in the prospective cohort study, out of which 9(24.3%) were suffering from ALI according to American European Consensus definition. There was varied infections etiology causing ARDS/ ALI. Pulmonary function test at discharge were showing normal flow rates and volumes (94.6%), mild restriction in some cases (8.4%) as the patients included in the study does not have any past respiratory illness out of 37(100%) patients of ARDS/ALI discharged from Hospital 21(56.8%) had low DLco and 16 (43.2%) had normal DLco.Conclusions: Diffusion defect is found to be more common in the patients who had mixed infections than the patients who had single infection. There was no effect of steroids on the outcome of the patients in terms of diffusion defect.

A clinical study of COPD in elderly with special reference to HRCT chest and PFT

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined as a preventable and treatable lung disease with some significant extra-pulmonary effects. Pulmonary component is characterized by airflow limitation that is not fully reversible, usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles and gases. Elderly patients are more prone to COPD due to the reduction in the immune power along with the muscle weakness of the chest wall and bone weakness. Aim and objectives: To study the COPD in elderly with reference to HRCT chest and PFT, to study the pattern of pulmonary involvement in COPD in elderly. Materials and methods: It was Prospective observational study. Study population was elderly patients (age ≥60 years) detected having COPD (both in-patient and out-patient) attending MGM Hospital for treatment. Detailed history was taken from patient, particularly history of symptoms like fever, cough, shortness of breath, weight loss, night sweat etc. Thorough physical examination of all the systems with special emphasis on respiratory system was done. Results: Total 50 patients were enrolled in the study. Majority of the patients (44%) were in the age group of 60-70 years followed by 32% in the age groups of 70-80 years and 24% patients in the age group of >80 years. The mean age of the patients was 72.76±7.58 years. There was male preponderance (72%) in the study. Majority of the male patients were smokers (61%). Dyspnoea (76%), cough (68%), sputum production (64%) were the common symptoms. Centriacinar emphysema (34%) was mostly observed. FEV1/FVC ratio ranged from 38-89% (mean 62.9+/- 18.52%) preinhalation, ranged from 45% to 90% (mean 69.26±15.08) post-inhalation. Conclusion: HRCT showed regional assessment of compartment involved and has greater sensitivity than chest radiography in early diagnosis of emphysema.

Diabetic: A Comparative Study

Background and Objectives: Type II diabetes mellitus (DM) is particularly common medical disorder and is leading cause of morbidity worldwide. The complication of DM is due to micro or macro vascular damage. The presence of an extensive microvascular circulation and abundant connective tissue in the lungs raises the possibility that lung tissue may be a target organ in diabetic patients and thus pulmonary function test can be affected by DM. This study was designed to compare pulmonary function test between Type II diabetic and non-diabetic individuals; and, with the duration of DM.Material and Methods: This cross sectional comparative study was conducted at King Edward Medical University, Lahore Pakistan. Total sample consist of 91 diabetic and 91 non-diabetic grouped as group A and group B. FEV1, FVC, FEV1/FVC ratio, and PEFR were compared within two groups and with the duration of DM.Results: Total 182 sample with mean age 53.1±5.90 years, with 91(50%) male and 91(50%) female. Group A and B had 91(50%) sample each. Mean value of FVC, FEV1 and PEFR showed statistically significant difference among the both group. Mean of FVC decreases significantly with the increasing duration of DM; although, is not significant with FEV1, FEV1/FVC ratio, and PEFR.Conclusion: Diabetic group showed significantly impaired pulmonary functions test as FEV1, FVC, and PEFR as compare to non-diabetic group.

Effects of yoga and physical exercise on cardio-respiratory parameters.

Background: Yoga includes combination of postural exercise (Asanas),Voluntary breathing exercise (pranayam) & relaxation techniques. The comparative study about effects of regular practice of yoga & physical exercise on cardio-respiratory functions and respiratory pressures (MIP,MEP) is very important to better understand it’s effect on health. Method: 200 healthy volunteers (146M-54F) from age group (17 -26)years were included in the study.They were divided in to two groups. Gr A Yoga group(n=100),Gr B Physical exercise group(n=100). Yoga group practiced some yoga exercises including Asanas,Pranayam & relaxation postures daily one hour for 3 months.While Physical exercise group practiced slow walk,calisthenic exercise & stretching exercises daily 1 hour for 3 months. Following parameters were recorded at start & end of the study. Resting cardiovascular parameters including HR,BP,PP,MAP,RPP & DoP were recorded. Pulmonary parameters (FVC,FEV1,FEV1/FVC,PEFR,MVV) were recorded. Apart from this MIP,MEP & 40mmhg endurance test were also recorded .Result: Yoga group shows significant reduction in Heart rate (p<.01),SBP & DBP (p<.05), MAP(p<.01),while exercise group shows only decreasing trend. FVC & FEV1 inreased significantly after yoga training. FEV1/FVC, PEFR & FEF25-75% shows increasing trend in both the groups,but only exercise group shows significantly raised PEFR & FEF25-75%. MVV was significantly improved in yoga group. MIP,MEP were significantly increased after yoga training. Timing of Respiratory Endurance test was also significantly raised(p<.05) in yoga group. Conclusion: 3 moths Yoga training produces a significant improvement in respiratory pressures (MIP,MEP), spirometric values.

To compare the effects of marble and stone dust on lung volumes and capacity.

Background and objectives: Occupational pulmonary diseases are more widespread and more disabling than any other group of occupational disease in form of pneumoconiosis, silicosis, byssinosis, farmerslung, asbestosis, asthma, allergic alveolitis. Early recognition of disturbed lung functions will be of great clinical, social and preventive importance in industry workers who constantly exposed to air borne pollution. So the present study was conducted to determine the effect of marble and stone dust on marble cutters and stone cutters. Methods: Thirty subjects were marble cutters and thirty were stone cutters . The pulmonary function tests viz forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), peak expiratory volume(PEFR) and maximum ventilatory volume (MVV) were carried out with the help of compurterised medspiror. The data were collected, and conclusions were drawn on the basis of appropriate statistical analysis.Results and interpretation: The results were compared with students `t` test which showed a significant reduction in pulmonary function tests due to marble dust and stone dust. The decrease in FVC and MVV indicates a restrictive impairement whereas decrease in (FEV1), (FEF25-75), (PEFR) indicates an obstructive impairment. Conclusion: The observed changes in pulmonary function tests could be due to mechanical irritation caused by exposed dust and individual’s susceptibility to silica dust. The pulmonary function tests are more decreased in marble cutters as compared to stone cutters which may be due to longer duration of exposure suggesting an urgent need to improve dust control measures and health status of marble as well as stone cutters.

A prospective, open labeled, comparative study to assess the efficacy of montelukast as add on to β2-agonist and inhaled corticosteroid in patients of moderate persistent asthma.

Background: Steroid, bronchodilator and the leukotriene receptor antagonist montelukast have demonstrated efficacy in children with mild persistent asthma, but comparative long-term studies in adult patient with moderate persistent asthma is needed. A randomized and prospective study was undertaken to find out the efficacy of montelukast as add on to β2-agonist and inhaled corticosteroids in patients of moderate persistent asthma. Methods: This was a continuous, longitudinal, prospective study carried out at a tertiary care teaching hospital. Newly diagnosed patients of moderate persistent asthma attending the chest out patient department (OPD) were enrolled. Group I was treated with salbutamol 200 mcg rotacap SOS and formoterol 6 mcg + budesonide 400 mcg rotacap BD. In addition to these medicines group II also received montelukast 10 mg OD. The patients were followed up every two months. Clinical examination and pulmonary function tests (PFT) were carried out at baseline and during each visit. Unpaired ‘t’ test was used for statistical analysis. Results: Comparison of clinical symptoms revealed a better improvement in group II as compare to group I [cough - 83% vs. 33%; breathlessness - 75% vs. 33%; and wheezing - 83% vs. 78%] at the end of one year. A significantly better (p < 0.05) improvement in forced expiratory volume (FEV1) was also observed in group II. Conclusions: Treatment with montelukast leads to better improvement in clinical symptoms and PFT in the patients of moderate persistent asthma.

A study of deterioration of pulmonary function parameters among smokers and recovery among ex-smokers in bus depot workers.

Smoking has deleterious effects on Pulmonary Function Test (PFT) parameters; however, evidences about recovery in ex-smokers are ambiguous. Therefore present study was conducted to quantify relative deterioration of PFT parameters and to assess reversibility of the same. A cross-sectional study was conducted on 84 bus-depot workers consisting of equal number of smokers, ex-smokers and non-smokers. PFT observations were obtained using Medspiror following standard methods and precautions. Comparisons among three groups were performed employing one-way ANOVA and post-hoc tests. There were substantial effects of smoking on PFT parameters (deterioration was up-to half). Partial recovery was found in all the parameters of ex-smokers. Frequency and duration of smoking were negatively correlated with some of the parameters. In conclusion, present study has demonstrated considerable deterioration of PFT parameters in smokers and indications of recovery in ex-smokers. Further detailed study with larger sample size and stricter definition of ex-smokers is recommended.

Effect of flour dust on lung volumes and capacities in flour mill workers.

Background And Objectives: Due to increase in industrialization, air pollution is increasing day by day. The workers working in these industries suffer from various types of air way diseases like Pneumoconiosis, Farmer’s Lung, Chronic bronchitis, pulmonary fibrosis and Asthma. So the present study was undertaken to study the effects of flour dust on the lung functions. Methods: Pulmonary function tests (PFT’s) of flour mill workers were compared with those of controls. We evaluated 100 subjects in the age group of 20-50 years consisting of 50 industrial workers from flour mills from the Amritsar Distt., and 50 healthy non-smoker, non-exposed subjects in the same age group served as controls. The PFT’s were carried out with a computerized spirometer “Med-Spiror”. The various data was collected, compiled, statistically analyzed and valid conclusions were drawn. Results And Interpretation: The present study results showed a significant decrease in the mean values of FVC, FEV1, PEFR, FEF25-75 and MVV and stratification of results showed a dose response of years of exposure in flour mills on lung functions. Conclusion: Flour dust causes chronic bronchial irritation which is responsible for the obstructive type of pulmonary impairment of lung functions.

Role of p53 in antioxidative stress in melanocyte exposed to UV or H2O2 / 中华医学美学美容杂志

Objective To study the effects of UVR or H2O2 on the expression of p53 in human melanocytes,and that of nutlin-3 and PFT-α on the DNA oxidative damage,and to investigate the role of p53 in the antioxidative stress.Methods The effect of UVR,H2O2,nutlin-3 and PFT-α on the expression of p53 of human melanocytes was detected by Western blot analysis,and that of nutlin-3 and PFT-α on UVR or H2O2 DNA damage assessed by single cell electrophoresis (comet assay).Determination of the effect of nutlin-3 on H2O2 DNA damage was detected by γ-H2AX immunofluorescence.Results UVR and H2O2 could induce p53 protein expression,accompanied by increased phosphorylation of p53 on serine 15 residue,and nutlin-3 and PFT-α could induce and inhibit p53 protein in human melanocytes respectively; nutlin-3 decreased the tail moment of DNA oxidative damage of UVR or H2O2 in human melanocytes,but PFT-α increased the tail moment of DNA oxidative damage of UVR or H2O2 in human melanocytes,and there were significant differences among the control and exposed groups; nutlin-3 decreased expression of γ-H2AX.Conclusions p53 plays a very important role in the antioxidative stress in melanocyte exposed to UV or H2O2.

Study On Harmful Effects Of Opium On Liver And Lungs In Chronic Opium Addicts Of Western Rajasthan.

Background: Today opium dependence is widely prevalent in certain states of India, especially Rajasthan, Punjab, Haryana, Madhya Pradesh (MP) etc. In rural areas of western Rajasthan crude opium is consumed with a social acceptance by a notable proportion (8.0%) of adult male population. Later on they become addicted to it. Objective: to observe the changes in some liver and lung function parameters in opium addicted subjects of Barmer city of Western Rajasthan. Methods:The present study was conducted in district hospital of Barmer, Rajasthan. Total fifty (50) adult male subjects with age ranged from 30 to 50 years were participated in this study. Among them 25 were opium addicted and were considered as study group (Group B) and another 25 apparently healthy adult male of same age group were designated as control group (Group A). Opium addicts were consuming about 5–11 gm/day opium for >2 years. Then liver function tests were evaluated by estimating serum aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase and lung function tests by measuring FVC, FEV1 , FEV1/FVC% , PEF, FEF 25-75% of both the groups. Results: In this study AST, ALT and alkaline phosphatase levels were found significantly (p<.05) higher in group B as compared to those of group A. Again, FVC, FEV1, FEV1/ FVC were significantly (p<.05) lower in group B as compared to those of group A. PEF (L/sec) and FEF25-75% were also significantly (p<0.001) lower in group B as compared to those of group A. Conclusion: it is concluded that chronic long term use of opium, increases the risk of hepatic and pulmonary damage.

Plasma oxidant-antioxidants status in asthma and its correlation with pulmonary function tests.

The present study was planned to asses the levels of oxidant and antioxidant in asthmatic patients and to evaluate the existence of correlation between oxidant-antioxidant levels and pulmonary function test. Asthma is a well know chronic inflammatory disorder where disturbances in the oxidative system have been observed. To investigate the oxidative stress plasma malondialdehyde and ascorbic acid (Vitamin C) were measured. FEV1, FEV1% and PEFR values were taken with computerized spirometry. Results revealed statistically significantly reduced PFT values (***P<0.001) in asthmatics. Increase serum MDA (***P<0.001) and decrease vitamin C (***P<0.001) in patients suggestive of oxidative imbalance in asthma was revealed. However no correlation was found between PFT and oxidative stress indicators. The study thus supported the emerging concept of free radical injury in asthma and therefore a thought can be given to whether antioxidant supply could have a beneficial impact on the free radical induced injury and improvement of respiratory reserve in Asthmatics.