Comparative study of effect of stress on peak expiratory flow rate and body mass index in medical and non-medical students

Background: This study was done to compare the effect of stress on peak expiratory flow rate (PEFR) and body mass index (BMI) in medical and non-medical students. Aim and Objective: The aim of the study was to compare the effects of stress on PEFR and BMI in medical and non-medical students. Materials and Methods: In this study, stress, PEFR, and BMI comparison were made between 200 medical and non-medical students of S.N.M.C, Agra and Agra College, respectively, aged between 17 and 21 years. To estimate the prevalence of stress, we used perceived stress scale, PEFR was measured using Rossmax Portable Peak Flow Meter, which having a range of 60–800 l/min. BMI was calculated using formula, Quetelet Index. Cutoff for the subjects was taken as 25 as per the revised WHO standards. Results: In this study, moderate and high perceived level of stress was more common in medical students as compared to non-medical students and the result was found to be statistically significant (P < 0.0001). PEFR was 400 ± 102 in medical students and 420 ± 86.77 was in non-medical students. By applying unpaired t-test, significant changes were observed in PEFR among both groups (P < 0.05). BMI was 22.5 ± 3.12 in medical students and 22.6 ± 1.98 in non-medical students. By applying unpaired t-test, insignificant changes were observed in BMI among both groups (P ? 0.05). Conclusion: From the results obtained from our study, incidence of stress was greater in medical students and that of highly perceived grades. Significant changes were observed for PEFR and insignificant change was observed for BMI among both groups.

Gender differences in peak expiratory flow rate and timed vital capacity by computerized spirometry in medical students

Background: Throughout the human life span, airway behavior and the clinical manifestations of airway disease show gender differences which are related to other factors such as biological and sociocultural factors. Similar studies have been conducted in various parts of India and showed wide variations even within the state with similar socioeconomic and cultural factors. Even physical activity too has influenced pulmonary function tests (PFT). The most of the studies on PFT were carried out in the Southern part of Karnataka and no previous studies on this topic were done in Bidar. Aim and Objectives: The aim of the study was to study the gender differences in peak expiratory flow rate (PEFR) and timed vital capacity among medical students of BRIMS, Bidar. Materials and Methods: After obtaining ethical clearance from institute, the study was conducted on healthy 18� years aged 200 males and 200 female undergraduate medical students in Department of Physiology, BRIMS, Bidar. After recording basic physical characteristics, lung parameters that are forced vital capacity (FVC), forced expiratory volume in the 1st s (FEV1), FEV3, and PEFR were recorded using Micro Quark, a PC-based spirometer, connected through serial port (RS232). Statistical analysis was done using independent sample t-test with the help of SPSS 25 version. P < 0.05 was considered the level of significance. Results: Results revealed that there was statistically significant decrease in the mean values of FVC(L), FEV1(L), FEV3(L), and PEFR (L/min) in female subjects compared to male subjects (P < 0.01). Even there was statistical significant decrease in FEV1/FVC ratio in female subjects compared to male subjects (P < 0.05). Conclusion: Our study concluded that the values of FVC, FEV1, FEV3, FEV1/FVC, and PEFR were observed to be higher in male undergraduate subjects when compared with female subjects of BRIMS, Bidar.

Comparison of the effect of recumbent body positions on dynamic lung function parameters in healthy adults

Background: Pulmonary function parameters can be altered with the change in body position. Therefore, physiological basis behind such consequent influence is essential to be understood. Pulmonary function tests are generally conducted in the erect sitting posture as it is more feasible and comfortable. However, bedridden patients are unable to do so and only few studies are found on recumbent postures. Thus, to comfort such patients in breathing, need arises to meet this requisite investigation to conclude the best recumbent body posture. Aim and Objectives: To compare and assess forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow of during 25�% expiration (FEF25�%, and peak expiratory flow rate (PEF) in the Supine, Crook-lying and Fowler抯 position. Materials and Methods: The present research was carried out on 128 healthy adults to measure FVC, FEV1, FEV1/FVC ratio, FEF25�% and PEF using a computer-based spirometer in the Supine, Crook-lying and Fowler抯 position. One-way Analysis of Variance with Tukey HSD post-hoc test was utilized between each body postures by evaluation of their mean values. Results: This study consisted of 128 subjects (males 57, females 71) with mean age of 21.62 � 1.75 years, mean weight 59.71 � 9.97 kg, mean height 164.68 � 9.30 cm and Body mass index 21.91 � 2.38 kg/m2. Fowler抯 posture showed significantly (P < 0.05) higher value in all spirometric parameters as compared to other two postures. Outcome of the study showed all spirometric parameters value- greater in the Fowler抯 posture than that of Supine or Crook-lying posture. Conclusion: The implication of this research is that it will meet the need of selection of the most suitable substitute posture for better pulmonary functioning in bedridden people.

Effect of age, gender, and body mass index on peak expiratory flow rate and other pulmonary function tests in healthy individuals in the age group 18–60 years

Background: Normal ageing and increasing body mass index (BMI) are related to decline in lung functions in adults in both genders. Females are more likely than age and height-matched males to show smaller lung size and diffusion surface, lower maximal expiratory flow rate, and reduced airway diameter. Lung mechanics and respiratory muscle strength, thoracic compliance, airway resistance, and elastic recoil of the lungs determine the pulmonary function tests (PFTs), and these tests are known to differ with age, sex, socio-economic status, cultural factors, and geographical region of the subject and are related to weight, height and BMI of the individuals. Aim and Objectives: The present study is planned to assess the peak expiratory flow rate (PEFR) and other PFTs and to evaluate the effect of age, gender and BMI on these lung functions. Materials and Methods: This study consists of 200 healthy individuals of age group 18–60 years. A sample was stratified into 5 age groups, and on the basis of BMI, the subjects were categorized as underweight, normal, overweight, and obese. Anthropometric measurements were recorded using standard procedures. PEFR was recorded using Wright’s peak-flow meter and forced vital capacity (FVC), Forced Expiratory Volume in 1 s (FEV1), FEV1/FVC, FEF25–75%, FEF2–1.2, slow vital capacity (SVC), and maximum voluntary ventilation (MVV) were analyzed using Expirograph (Helios 401, RMS, India). Chi-square test was used for analysis of categorical variables. For comparison of two groups, unpaired t-test was used and to assess the relation between the variables, Pearson’s co-relation was used. One way ANOVA was used to compare the difference between the means of more than two groups and Tukey post hoc analysis was done for multiple comparisons. Results: There was highly significant difference in the mean values of PEFR and other PFTs (P < 0.000) among the 5 age groups and a significant difference between younger and older age groups. PEFR, FVC, FEV1, FEV1/FVC, FEF25–75%, FEF0.2–1.2, SVC, and MVV were negatively correlated with age (r = ?0.514, ?0.535, ?0.568, ?0.255, ?0.566, ?0.516, ?0.304, ?0.523, respectively). Females showed reduced mean values of PEFR, FVC, FEV1, FEF25–75%, FEF0.2–1.2, SVC, MVV when compared to males (P < 0.000), and the differences in the mean values were significantly high. Highly significant difference was seen in the mean values of PEFR and other PFTs among the categories of BMI (P < 0.000). The mean values of FVC, FEV1, FEV1/FVC, FEF25–75%, FEF0.2–1.2, MVV were lower among underweight compared to their mean values among individuals with normal BMI. There was negative correlation between PEFR, FVC, FEV1, FEF25–75%, FEF0.2–1.2, SVC, MVV, and BMI (r = ?0.327, ?0.254, ?0.238, ?0.269, ?0.254, ?0.236, ?0.195, respectively). Conclusions: PFTs aid in the prompt and accurate diagnosis of respiratory disorders, such as asthma, chronic obstructive pulmonary disease allowing for efficient management by encompassing a thorough understanding of the disease and exercise respiratory training regimens even in otherwise healthy individuals. The present study showed that PEFR and other PFTs decrease with advancing age and BMI and females showed reduced lung functions compared to males.

Estimativa da taxa de pico de fluxo expiratório em jovens indianos / Estimation of peak expiratory flow rate in young Indians

INTRODUÇÃO: O pico de fluxo expiratório (PFE) é comumente usado para monitorar a progressão de doenças respiratórias, pois fornece boas informações sobre o estado das vias aéreas. Uma boa quantidade de pesquisas está sendo feita em todo o mundo para estabelecer uma equação de previsão local. A força-tarefa conjunta da Sociedade Torácica Americana e da Sociedade Respiratória Europeia promoveu pesquisas a esse respeito. Na Índia, os dados derivados da população caucasiana ainda são usados para o PFE. OBJETIVO: Estudar a relação dos parâmetros do PFE e os dados antropométricos como idade, altura, peso, índice de massa corporal (IMC), área de superfície corporal (ASC) e estabelecer uma equação de regressão para jovens adultos indianos. MÉTODOS: PFE foi feito em 1000 sujeitos de 15-25 anos da região metropolitana de Mumbai. O coeficiente de correlação de Pearson foi usado para entender a relação dos parâmetros antropométricos e PFE. A análise de regressão multivariada foi feita para estabelecer uma equação de predição. (Alfa 5%) RESULTADOS: Idade e todos os parâmetros antropométricos foram correlacionados com PFE. O pico de fluxo expiratório médio da população masculina foi de 515 ml / seg, enquanto a feminina foi de 399 ml / seg. Para o PFE, a maior correlação foi observada com a ASC seguida de altura, peso e idade, enquanto o IMC apresentou o menor coeficiente de correlação. TPFE teve a melhor significância com a idade, ASC, altura e IMC. Teve menos significado com o peso. No sexo feminino, a TPFE teve a melhor significância com altura, peso, IMC e idade. CONCLUSÃO: Existem diferenças de gênero na TPFE. Portanto, equações específicas de gênero são necessárias para a estimativa da TPFE

INTRODUCTION: Peak expiratory flow rate (PEFR) is commonly used to monitor the progression of respiratory diseases as it gives good information about the status of airways. A good amount of research is going across the world to establish a local prediction equation. The joint task force of the American thoracic society and European Respiratory Society has promoted research in this regard. In India, data derived from the Caucasian population are still used for PEFR. OBJECTIVE: To verify the relationship between PEF levels and the variables age, sex, anthropometric and body surface area, and establish the regression equation for young Indian adults. METHODS: A cross-sectional observational study was conducted in 15-25 years aged 1000 subjects from the Metropolitan region of Mumbai. Pearson's correlation coefficient was used to understand the relation of anthropometric parameters and PEFR. Multivariate regression analysis was done for establishing a prediction equation (Alpha 5%). RESULTS: Age and all anthropometric parameters were correlated with PEFR. The mean PEFR of the male population was 515 ml/sec, whereas, for females, it was 399 ml/sec, for PEFR highest correlation was observed with BSA (.696) followed by weight (.667), height (.630), age (.504) whereas BMI shown lowest correlation coefficient (.445). PEFR had the best significance with age, BSA, Height, and BMI. It had less significance with weight. In females, PEFR had the best significance with Height, weight, BMI, and Age. CONCLUSION: Gender-wise differences exist in PEFR. Hence gender-specific equations are needed for the estimation of PEFR.

Independência funcional e espirometria em pacientes adultos pós-unidade de terapia intensiva / Functional independence and spirometry in adult post-intensive care unit patients

RESUMO Objetivo: Relatar a independência funcional e o grau de comprometimento pulmonar em pacientes adultos 3 meses após a alta da unidade de terapia intensiva. Métodos: Este foi um estudo de coorte retrospectiva conduzido em uma unidade de terapia intensiva multiprofissional para pacientes adultos em um único centro. Incluíram-se pacientes admitidos à unidade de terapia intensiva entre janeiro de 2012 e dezembro de 2013 que, 3 meses mais tarde, foram submetidos à espirometria e responderam ao questionário Medida de Independência Funcional. Resultados: Os pacientes foram divididos em grupos segundo sua classificação de independência funcional e espirometria. O estudo incluiu 197 pacientes, que foram divididos entre os grupos maior dependência (n = 4), menor dependência (n = 12) e independente (n = 181). Na comparação dos três grupos com relação à classificação pela Medida de Independência Funcional, pacientes com maior dependência tinham escores Acute Physiology and Chronic Health Evaluation II e Sequential Organ Failure Assessment mais altos quando da admissão à unidade de terapia intensiva, idade mais avançada, mais dias sob ventilação mecânica e tempo mais longo de permanência na unidade de terapia intensiva e no hospital. A maioria dos pacientes apresentava comprometimento pulmonar, sendo o padrão obstrutivo o mais frequentemente observado. Na comparação da independência funcional com a função pulmonar, observou-se que, quanto pior a condição funcional, pior a função pulmonar, observando-se diferenças significantes em relação ao pico de fluxo expiratório (p = 0,030). Conclusão: Em sua maioria, os pacientes que retornaram ao ambulatório 3 meses após a alta tinham boa condição funcional, porém apresentavam comprometimento pulmonar relacionado com o grau de dependência funcional.

ABSTRACT Objective: To relate functional independence to the degree of pulmonary impairment in adult patients 3 months after discharge from the intensive care unit. Methods: This was a retrospective cohort study conducted in one adult intensive care unit and a multi-professional post-intensive care unit outpatient clinic of a single center. Patients admitted to the intensive care unit from January 2012 to December 2013 who underwent (3 months later) spirometry and answered the Functional Independence Measure Questionnaire were included. Results: Patients were divided into groups according to the classification of functional independence and spirometry. The study included 197 patients who were divided into greater dependence (n = 4), lower dependence (n = 12) and independent (n = 181) groups. Comparing the three groups, regarding the classification of the Functional Independence Measure, patients with greater dependence had higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment values at intensive care unit admission with more advanced age, more days on mechanical ventilation, and longer stay in the intensive care unit and hospital. The majority of patients presented with pulmonary impairment, which was the obstructive pattern observed most frequently. When comparing functional independence with pulmonary function, it was observed that the lower the functional status, the worse the pulmonary function, with a significant difference being observed in peak expiratory flow (p = 0.030). Conclusion: The majority of patients who returned to the outpatient clinic 3 months after discharge had good functional status but did present with pulmonary impairment, which is related to the degree of functional dependence.

Effect Of Abdominal Muscle Exercises On Peak Expiratory Flow Rate In Obese Individuals

Background: Expiration is a passive process with active muscle contraction being used more during forceful activities such as coughing or sneezing. The abdominal muscles are major muscles of diaphragm. So it improves the efficiency of expiration. In obese individuals there is deposition of fat around the rib cage and the chest wall. Studies have shown that there is a decrease in the functional residual capacity and expiratory reserve volume in obese individuals. The expiratory flow limitation is important determinant of breathlessness in obese individuals. Abdominal and thoracic fat have direct effects on downward movement of diaphragm and chest wall. Abdominal muscles are powerful expiratory muscles whose actions help to force the diaphragm back to its resting position. Aim: This present study was done to determine the effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals. Methods: In this experimental study 30 obese subjects with decreased peak expiratory flow rate who fulfilled the inclusion and exclusion criteria having a Body mass index of more than 30kg/cm2 were selected for abdominal muscle exercise program for 4 weeks, 2 sets of each exercise, thrice a week for 10 repetitions for each set. The pre and post peak expiratory flow rate were measured by peak expiratory flow meter. Statistical analysis was done using one sample t and Wilcoxon test. Results: There was a significant increase in post peak expiratory flow rate compared to pre peak expiratory flow rate. Conclusion: This study showed that there is significant effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals.

Rectus Sheath Block and Subcutaneous Bupivacaine Infiltration for Post-operative Pain Relief in Midline Laparotomy

Background: The aim of the study was assessment of post-operative outcomes of rectus sheath block and comparison ofoutcomes between rectus sheath block and sub cutaneous bupivacaine.Materials and Methods: This study enrolled 58 patients who were scheduled to undergo laparotomy. Group I – 30 patientsreceived rectus sheath block using bupivacaine by placing catheters in between the muscle and posterior rectus sheath.Group II – 28 patients received bupivacaine infiltration by placing catheters in the subcutaneous plane. Visual analog scale(VAS) score, peak expiratory flow rate (PEFR), rescue analgesia, and complications were noted and follow-up of thesepatients was done.Results: Both the groups were comparable, hemoglobin concentration and anesthesiologists grades (statisticallyinsignificant). The majority of the patients from rectus sheath block group had VAS scores <5 comparing to subcutaneousinfiltration group which was statistically very significant (P ≤ 0.001). There was a statistically significant improvement ofpost-operative PEFR values in Group I as compared to Group II (P < 0.001). In Group I, 20 patients showed VAS scoreof 1 (no pain) at rest as compared only four patients in Group II. Rate of infection was more common in group receivingsubcutaneous infiltration.Conclusion: The patients from rectus sheath block group showed a statistically significant decrease in post-operative painin terms of VAS scores compared to that of subcutaneous bupivacaine infiltration group. There was statistically significantdecreased use of opioids as rescue analgesic in the rectus sheath group compared to that of the subcutaneous bupivacaineinfiltration group.

Study on peak expiratory flow rate and its influencing factors in healthy school children in Kancheepuram district of Tamil Nadu, India

Background: The Peak Expiratory Flow Rate (PEFR) is useful to screen and monitor the severity of asthma in children. Many studies have documented that age, height and weight are some of the main factors that affect the PEFR. Thus, the present study was done to find the PEFR values among the school children and to find the factors that influences the PEFR values in our geographical area.Methods: It was a cross sectional study conducted in school children belong the rural area of Kancheepuram district, Tamil Nadu, India. A total of 378 students of both the gender at the age group of 5-10 years were selected for the study. The PEFR was measured by making the participant seated comfortably. One peak flow meter was used for 25 children and mouthpiece was changed for each student.Results: The PEFR value among and male and female participants was analyzed statistically (Table 2). The mean value of male and female study population was 169.53'37.38 and 146.24'33.01 respectively. The difference in the mean values were statistically significant (p=0.001) and found to be high in male participants. The Pearson correlation r between PEFR with height is 0.463, thus showing a positive correlation with the p?0.001 which is statistically significant. The Pearson correlation r between PEFR and chest circumference is 0.335 thus indicating a positive correlation between PEFR and chest circumference.Conclusions: From the present study, the normal values of PEFR has been deduced for the healthy school children in our geographical area. Further, it was found that the height and chest circumference are influencing factors for PEFR. Further regression equation has been derived that can help us to find the approximate PEFR values with the help of height and chest circumference of the children.

Role of peak expiratory flow rate and chest radiography in children above 5 years of age with acute asthma

Background: Asthma is a heterogeneous disease characterized by cough, wheeze and shortness of breath that vary in intensity and time with variable expiratory airflow limitation, associated with chronic airway inflammation. Aim of the study was to assess the usefulness of Peak Expiratory Flow Rate [PEFR] and oxygen saturation in determining severity of acute asthma, to measure objective change in PEFR and oxygen saturation following bronchodilator therapy and the role of chest X-rays in acute asthma.Methods: A prospective study of 50 children above 5 years with acute asthma who presented to the emergency department in a tertiary care hospital were included. PEFR and oxygen saturation before and after bronchodilator therapy was measured. Indication for chest X-rays, its clinical correlation and change in standard treatment of acute asthma based on X-ray reports was noted.Results: The mean PEFR and PEFR % of expected was lower in severe asthma when compared to moderate asthma and was statistically significant (p<0.001). The % of expected PEFR before salbutamol therapy was 48.78'14.36, which improved significantly to 67.13'14.22 after treatment (p<0.001). Oxygen saturation before and after salbutamol therapy was 94.96 ' 4.11 and 96.96'2.87 respectively with the change being significant (p value <0.001). Chest X-rays were performed in 12 (24%) children as per standard guidelines, of which 1(9%) was abnormal showing right basal consolidation. Chest X-ray correlated with clinical findings in 1 child and the findings on chest X-ray altered the ongoing treatment by addition of antibiotic.Conclusions: PEFR and oxygen saturation is useful in the emergency department to objectively assess the severity of acute asthma and the response to initial bronchodilator therapy. Chest X-rays are not routinely indicated in the standard treatment of acute asthma.

Prognostic Prediction of Cardiopulmonary Exercise Test Parameters in Heart Failure Patients with Atrial Fibrillation / Previsão Prognóstica dos Parâmetros do Teste de Esforço Cardiopulmonar em Pacientes com Insuficiência Cardíaca e Fibrilação Atrial

Abstract Background: Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients. Objective: To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection. Methods: Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant. Results: There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group. Conclusion: Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.

Resumo Fundamento: A fibrilação atrial (FA) está associada ao aumento da mortalidade em pacientes com insuficiência cardíaca (IC). Objetivo: Avaliar se o risco de pacientes com FA pode ser estratificado com precisão em relação aos pontos de corte do teste de esforço cardiopulmonar (TECP) para seleção do transplante cardíaco (TC). Métodos: Avaliação prospectiva de 274 pacientes consecutivos com IC com fração de ejeção do ventrículo esquerdo ≤ 40%. O endpoint primário foi um composto de morte cardíaca ou TC urgente no seguimento de 1 ano. O endpoint primário foi analisado através de vários parâmetros do TECP para a maior área sob a curva e para o valor preditivo positivo (VPP) e negativo (VPN) em pacientes com FA e ritmo sinusal (RS) para detectar se os atuais pontos de corte para a seleção de TC podem estratificar com precisão o grupo com FA. Diferenças estatísticas com valor de p < 0,05 foram consideradas significativas. Resultados: Havia 51 pacientes no grupo de FA e 223 no grupo RS. O endpoint primário foi maior no grupo FA (17,6% vs. 8,1%, p = 0,038). O valor de corte de pVO2 para a seleção do TC mostrou um VPP de 100% e um VPN de 95,5% para o endpoint primário no grupo FA, com um VPP de 38,5% e um VPN de 94,3% no grupo RS. O valor de corte da inclinação VE/VCO2 apresentou valores mais baixos de VPP (33,3%) e valor semelhante de VPN (92,3%) aos resultados de pVO2 no grupo FA. Conclusões: Apesar do fato de a FA apresentar um pior prognóstico para os pacientes com IC, o atual ponto de corte de pVO2 para a seleção de TC pode estratificar com precisão esse grupo de alto risco.

Assessment of ventilatory function in patients with spinocerebellar ataxia type 2 / Avaliação da função ventilatória em pacientes com ataxia espinocerebelar tipo 2

Abstract Subclinical ventilatory dysfunction is observed in individuals with spinocerebellar ataxias (SCA). No studies have correlated ventilatory dysfunction to clinical and functional decline in SCA2. Objective: To evaluate the relationship between the values of peak expiratory flow (PEF), maximum inspiratory pressure (MIP), and presence of respiratory complaints with age, disease duration, age at onset of symptoms, balance scores, independence in basic (ADL) and instrumental (IADL) Activities of Daily Living (ADLs), and severity of ataxia (SARA) in individuals with SCA2. Methods: Cross-sectional study evaluating age, disease duration, age at onset of symptoms, scores in the Berg Balance Scale and in the SARA, Functional Independence Measure and Lawton's scale, values of PEF and MIP, and the presence of respiratory complaints. Results: The study included 36 individuals with SCA2, with a mean age of 42.5±2.4 years, disease duration of 7.6±8.2 years, age 33.7±11.5 years at onset of symptoms, and 9.9±10.3 points in the SARA scale. The lowest PEF values correlated with the longer disease duration (p=0.021). The lowest values of PEF and MIP correlated with greater balance impairment (p=0.019 and p=0.045, respectively), increased degree of dependence in the ADL (p=0.006 and p=0.050, respectively) and IADL (p=0.003 and p=0.001, respectively) scales, and highest severity of ataxia (p=0.00 and p=0.017, respectively). Respiratory complaints were observed in 12 (33.3%) individuals and were not related to age, disease duration, age at onset of symptoms, balance, independence, ataxia severity, or PEF and MIP values. Conclusion: Ventilatory dysfunction, even when asymptomatic, is related to balance impairment, independence, and ataxia severity in individuals with SCA2.

Resumo Disfunção ventilatória subclínica tem sido observada em indivíduos com ataxias espinocerebelares (SCA). Não existem estudos relacionando disfunção ventilatória ao declínio clínico e funcional na SCA2. Objetivo: Avaliar a relação dos valores de Pico de Fluxo Expiratório (PFE), Pressão Inspiratória Máxima (PIMAX) e presença de queixas respiratórias com idade, tempo de doença, idade de início dos sintomas, escore de equilíbrio, independência para atividades básicas (AVD) e instrumentais (AIVD) de vida diária e gravidade da ataxia (SARA) em indivíduos com SCA2. Métodos: Estudo transversal, considerando: idade, tempo de doença, idade de início dos sintomas, escores nas Escalas SARA, Equilíbrio de Berg, Medida da Independência Funcional e de Lawton, valores de PFE, PIMAX e queixas respiratórias. Resultados: Foram avaliados 36 indivíduos com SCA2 com média de 42,5±2,4) anos de idade, 7,6±8,2 anos de tempo de doença, 33,7±11,5 anos de idade de início dos sintomas e 9,9±10,3 pontos na escala SARA. Os menores valores de PFE estiveram relacionados ao maior tempo de doença (p=0,021). Os menores valores de PFE e PIMAX estiveram relacionados ao maior comprometimento do equilíbrio (p=0,019; p=0,045, respectivamente), maior dependência para ADV (p=0,006; p=0,050, respectivamente) e AIVD (p=0,003; p=0,001, respectivamente) e maior gravidade da ataxia (p=0,006; p=0,017, respectivamente). Foram observadas queixas respiratórias em 12 (33,3%) indivíduos que não estiveram relacionadas à idade, idade de início dos sintomas, tempo de doença, equilíbrio, independência, gravidade da ataxia, ou valores de PFE e PIMAX. Conclusão: A disfunção ventilatória, mesmo quando assintomática, está relacionada ao comprometimento do equilíbrio, à independência e à gravidade da ataxia em indivíduos com SCA2.

Comparative study of seasonal variability in peak expiratory flow rate amongst school children in rural and urban areas

Background: Peak Expiratory Flow (PEF) is a value test for lung function and can be conveniently measured by using relatively inexpensive and portable Peak Flow Meter, identifying and assessing the degree of airflow limitation of individuals. While PEFR is obviously related to factors like age, weight, height, race, gender, it may also be additionally affected by seasons and climate. The purpose of study being to observe seasonal variation in PEFR amongst school going children and to observe peak expiratory flow rate in school going children in urban and rural areas.Methods: This prospective and comparative study was carried out on total 600 children; with 300 each from rural and urban schools, of age group 10-14 years, both sexes. Peak expiratory flow meter was used for the measurements in the seasons of summer (April to June) and winter (December to February) of the year. The results thus obtained were compiled and analysed.Results: The mean PEFR value (Litres/min) during summers in the rural children was 243.50(S.D.=16.050) while during winters was 253.63(S.D.=16.934), highly significant (p<0.001); mean PEFR summers in the urban children was 241.50(S.D.=20.530)and during winters was 249.93(S.D.=21.685), again highly significant (p<0.001).In both rural and urban groups PEFR values increased with increase in height and weight of the children which was found to be highly significant (p<0.001). Girls representation proportion in rural vs urban schools being 49% vs 45%; whereas boys being 51% vs 55% respectively.Conclusions: Peak expiratory flow rate decreased during summer season of the year in both rural and urban school attending children. In both the groups PEFR values had a direct correlation with height and weight of the children. Rural schools showed more girl student representation than their urban counterparts indicating more awareness for girl child education amongst rural population.

Association between Asian dust exposure and respiratory function in children with bronchial asthma in Nagasaki Prefecture, Japan

BACKGROUND@#Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children.@*METHODS@#The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR.@*RESULTS@#AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined.@*CONCLUSIONS@#Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.

A Study of Peak Expiratory Flow Rate (PEFR) in 6-12 years Age Group in Relation to Height in Eastern India

Background: Bronchial Asthma is a common cause of mortality and morbidity in the developing world like India. Objective: The purpose of the present study was to establish a nomogram for PEFR in 6-12 yrs age group in relation to height in Eastern India, a first of its kind study from Eastern India. Setting: 1003 randomly selected healthy school children in Kolkata. Study Design: Prospective cross sectional study. Methods: Mini Wright peak flow meter was used to measure PEFR in resting condition and standing position. The best value of three attempts was recorded and compared to height, weight, sex and age separately. Multiple regression analysis was used to determine the influence of various variables. Results: Height ranged from 95 cm to155 cm and PEFR ranged from 115 L/min to 335 L/min irrespective of sex. Mean PEFR was 241.5 L/min in all sexes whereas the median, 25th percentile and 75th percentile values were 244.1 L/min, 186 L/min and 290 L/min respectively. PEFR values increased in a linear pattern with increase in height in both sexes. Using multiple regression analysis we can estimate the PEFR values with height alone in both sexes with more than 95% accuracy. Conclusion: PEFR values depend on height, weight, age and sex, the former being the most important parameter

Assessing The Impact On Pefr Among Smokers And Passive Smokers–A Comparative Study

Objective: The purpose of this study was to monitor the intensity and difference in Peak Expiratory Flow Rate (PEFR) between smokers and passive smokers. Methods: A total of 1000 participants were enrolled in two groups as smokers and passive smokers who are living closely with smokers. Their PEFR values were measured with Wright’s mini peak flow meter. The influence of smoking on the lung function among smokers and passive smokers were assessed with a suitable statistical test. Results: Among the study participants, most of the smokers were in the age group of 31 to 60 and 31 to 50 in passive smokers. Based on the lung function smokers (31%) and passive smokers (19.2%) were in the red zone, PEFR was decreased in both smokers as well as passive smokers, and the magnitude of decline was higher in passive smoking elderly individuals. The impact of passive smoking was significantly observed in all the categories of smoking history they are living with. Conclusion: Smokers and passive smokers have equally deleterious effects on PEFR. Where passive smoking emerged as the main variable to influence airway obstruction in smokers that caused a greater reduction in PEFR.

Exercise Induced Bronchoconstriction In Medical Students

INTRODUCTION: Exercise induced bronchoconstriction (EIB) is transient narrowing of lower respiratory tract airways after exercise. It affects about 5 to 20 % of healthy individuals and 80% of Asthmatics. Obesity has been considered as one of the risk factor to the development of EIB. Symptoms of EIB are nonspecific and can be seen in a variety of disorders and studies have shown a lack of diagnosis specificity and sensitivity based on symptoms. AIM: The aim of this study was to evaluate frequency of EIB in Medical students of Govt. Medical College Miraj. We also tried to find out association of body mass index (BMI) with EIB. We also tried to find out correlation of subjective feeling of breathlessness (symptom of EIB) with actual findings of spirometry tests used to asses EIB. METHOD: This cross-sectional observational study was conducted on 80 male medical students. Exercise challenge test was conducted for participants. Pre and post-test values of Forced expiratory volume in one second (FEV1) and Peak expiratory flow rate (PEFR) were compared and students with ≥ 10% decrease in post-test FEV1 & PEFR were considered positive cases of exercise induced bronchoconstriction. Statistical analysis was done by using software, IBM-SPSS VER 20. RESULT:In our study frequency of EIB in medical students was 6.4%. Decrease in post-test FEV1 and PEFR values were statistically significant with Pvalue < 0.001. Our findings show that there was no association between BMI and EIB. Our study results also reveal strong correlation between subjective feeling of breathlessness measured in terms of visual analogue scale (VAS) and objective spirometry tests used to assess EIB. CONCLUSION: EIB is one of the major problems to be addressed as increasing frequency of EIB in healthy population could pose a threat when people attempt exercise training for their health benefits. Proper care with physician's consultation can minimize undue risks associated with EIB in healthy people.

Pulmonary functions in car air conditioner users and non-air conditioner users in tertiary care centre, South Tamilnadu, India

Background: Air conditioners are used extensively these days of the modern lifestyle. Inhalation of cold dry air while using Air conditioners causes bronchoconstriction due to which alteration may occur in pulmonary function. This study was aimed to compare the Pulmonary Function tests of Car AC users and non AC users. Methods: The Study included 52 employees not exposed to car air conditioner as a control (group I) and 52 employees exposed to car air conditioner  with minimum exposure of 1 hour per day for 6 months as a subject (group II). Pulmonary function tests were performed using computerised spirometer. Statistical analysis was done by unpaired t test.Results: Age, Height and weight are not statistically significant between study group and control group. Forced vital capacity, forced expiratory volume in 1 second, Ratio of Forced vital capacity and Forced expiratory volume in 1 second, Inspiratory reserve volume, Expiratory reserve volume, Maximum voluntary ventilation are decreased in car air conditioner users compared to non-users, but was not significant. Forced expiratory flow (FEF), Peak expiratory flow rate (PEFR) values shows statistically significant decreased in car air conditioner users.Conclusions: The present study shows hyper-responsive airways on exposure to cold air which leads to bronchoconstriction. The significant decrease in PEFR, FEF suggest that upper airways as well as smaller airways are affected on exposure to car AC. So, Exposure to car Air Conditioner leads to risk of developing respiratory dysfunction.

Comparison of efficacy between levosalbutamol and levosalbutamol-ipratropum nebulization in mild to moderate childhood asthma

Background: The objective of the study was to compare the efficacy between levosalbutamol and ipratropium combination over levosalbutamol nebulisation in reversing airflow obstruction and improve oxygenation, evaluated using the pulmonary asthma score, SaO2, and PEFR in mild and moderate asthma.Methods: A prospective, randomized, study was performed in RMMCH pediatric emergency department. Children between 6 and 12 years of age who presented with mild to moderate asthma exacerberations were enrolled in the study. They were randomly allocated into two different groups: one nebulised with levosalbutamol alone and another with addition of ipratropium bromide to levosalbutamol. Baseline Peak expiratory flow rate and Final absolute values or change from baseline 60-120 minutes after the inhalation are measured. Patients were evaluated using the pulmonary score.Results: After treatment there is improvement in the mean pulmonary asthma scores and PEFR percentage in A+B group than A group, but it is not statistically significant (p value >0.05). There is statistically significant improvement in pulmonary asthma score and PEFR in each of the groups after nebulisation and pulmonary asthma score has a sensitivity of 66.7% and 65.6% in diagnosing severity of asthma in relation to PEFR.

Effect Of Different Phases Of Menstrual Cycle On Pulmonary Function Tests In Healthy Young Females

Background: Alteration in the levels of female sex hormones during the menstrual cycle are known to affect the smooth muscles of respiratory tract. Aim and Objective: Main objective of the study is to find out the effects of different phases of menstruation on pulmonary function parameters in different phases of menstrual cycle. Material and Method: In the present cross sectional descriptive study conducted in female nursing students aging 18 to 22 years were considered. . The study was undertaken to assess pulmonary function parameters in different phases of menstrual cycle Results: Longest FVC, FEV1 and PEFR were found to be in secreatory phase in comparison to proliferative and menstrual phase. Shortest FVC, FEV1 and PEFR were found in secretary phase.