Diagnostic value of fractional exhaled nitric oxide combined with small airway function test for chronic cough / 中国基层医药

Objective:To investigate the value of fractional exhaled nitric oxide (FeNO) combined with small airway function test to replace bronchial provocation test and induced sputum test in differentiating cough variant asthma (CVA) from eosinophilic bronchitis (EB).Methods:The clinical data of 105 patients with chronic cough admitted to The Third People's Hospital of Hubei, Jianghan University from January 2018 to December 2021 were retrospectively analyzed. These patients consisted of 40 patients with CVA (CVA group), 25 patients with EB (EB group), and 40 patients with other chronic coughs (other chronic cough group). FeNO and lung function were compared between groups. The value of FeNO, small airway function, and their combination in differentiating CVA from EB were analyzed using the receiver operating characteristic curves.Results:FeNO level was the highest in the CVA group [33.0 (30.0, 37.8) ppb], followed by the EB group [28.0 (25.5, 32.0) ppb], and the lowest in other chronic cough group [13.0 (11.0, 15.0) ppb]. There was significant difference in FeNO level between groups ( H value = 79.00, P < 0.05). There were no significant differences in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), FEV 1/FVC, peak expiratory flow (PEF) between groups (all P > 0.05). Maximal mid-expiratory flow (MMEF) [74 (66.0, 77.4) in the CVA group, 80 (79.0, 83.3) in the EB group, 88.0 (86.4, 90.0) in other chronic coughs group], FEF25 (%) [70.0 (60.3, 75.1) in the CVA group, 78.0 (74.1, 85.0) in the EB group, 81.7 (78.9, 86.3) in other chronic coughs group], FEF50 (%) [75.2 (67.1, 80.8) in the CVA group, 80.6 (75.7, 85.9) in the EB group, 89.4 (87.0, 90.5) in other chronic coughs group], FEF75 (%) [76.4 (68.7, 85.8) in the CVA group, 80.9 (77.4, 89.7) in the EB group, 90.8 (87.2, 94.2) in other chronic coughs group] were significantly lower in the CVA group than those in other chronic coughs group. With the exception of FEF25 (%), MMEF (%), FEF50 (%), and FEF75 (%) were significantly lower in the EB group compared with other chronic coughs group. MMEF (%) and FEF25 (%) in the CVA group were significantly lower compared with the EB group. There were significant differences in MMEF (%), FEF50 (%), and FEF75 (%) between groups ( H = 62.82, 47.04, 47.41, 49.11, all P < 0.01). There were significant differences in FEF50 (%) and FEF75 (%) between CVA and EB groups (both P > 0.05). In binary logistic regression equation, FeNO and MMEF (%) were important indexes to distinguish CVA from EB ( P < 0.05). Bronchial provocation test and induced sputum test were used as the gold standard to distinguish CVA from EB. When FeNO and MMEF (%) were used separately to distinguish CVA from EB, the optimal threshold value was 30.0 ppb and 77.7 respectively, the area under the receiver operating characteristic curve was 0.77 and 0.82 respectively, the diagnostic sensitivity was 70% and 77.5% respectively, and the diagnostic specificity was 72% and 88% respectively. When FeNO and MMEF (%) were used in combination to distinguish CVA from EB, the area under the receiver operating characteristic curve was 0.89, and the diagnostic sensitivity and specificity was 75% and 96% respectively. Conclusion:FeNO and MMEF (%) can be used to distinguish CVA from EB. FeNO combined with MMEF (%) has a higher value in distinguishing CVA from EB than FeNO and MMEF alone.

Assessment of pulmonary functions among the elderly in Hangzhou City / 预防医学

Objective@#To investigate the pulmonary functions among the elderly in Hangzhou City, so as to provide insights into the management of respiratory diseases among the elderly. @* Methods@#Permanent residents at ages of 60 to 75 years were sampled from Hangzhou City from November to December 2020. The pulmonary function was tested using a portable pulmonary function monitor, including large airway function parameters [forced expiratory volume (FVC), forced expiratory volume in a second (FEV1) and FEV1/FVC], and small airway function parameters [maximum expiratory flow rate at 75% vital capacity (MEF75%), the maximum expiratory flow rate at 25% of vital capacity (MEF25%) and the forced expiratory flow rate (FEF25%-75%) at 25% to 75% of vital capacity]. The pulmonary functions were compared among the elderly with different genders, ages and body mass index (BMI).@*Results @#Totally 314 participants were recruited, including 126 men (40.13%), with a mean age of (68.49±4.47) years and mean BMI of (23.51±2.79) kg/m2. The mean FEV1, FVC, FEV1/FVC, MEF25%, MEF75% and FEF25%-75% were (1.97±0.53) L, (2.51±0.72) L, (79.79±11.47)%, (0.98±0.53) L/s, (3.84±1.65) L/s and (1.99±0.91) L/s among the participants, respectively. Higher FEV1 [(2.22±0.55) vs. (1.79±0.43) L, P<0.05], FVC [(2.92±0.75) vs. (2.24±0.55) L, P<0.05], MEF75% [(4.19±1.82) vs. (3.59±1.49) L/s, P<0.05] and FEF25%-75% [(2.14±1.07) vs. (1.90±0.77) L/s, P<0.05] were tested among men than among women, and lower FEV1 [(1.75±0.46) L], FVC [(2.27±0.64) L], MEF25% [(0.88±0.57) L/s], MEF75% [(3.39±1.45) L/s] and FEF25%-75% [(1.79±0.96) L/s] were tested among the elderly at ages of 70 to 74 years. The proportion of large and small airway dysfunctions was 40.45% among the participants. @* Conclusions@# The proportion of large and small airway dysfunctions was 40.45% among the elderly in Hangzhou City, and poor pulmonary functions were tested among the women and the advanced elderly.

Prevalence of abnormal lung function and risk factors of small airway dysfunction in asymptomatic healthy subjects receiving physical examination / 中华健康管理学杂志

Objective:To investigate the prevalence of abnormal lung ventilation function in asymptomatic subjects receiving healthy examination and the risk factors of small airway dysfunction (SAD).Methods:From August 2016 to October 2017, the pulmonary function test results of 610 healthy subjects who met the standards of this study in Fuxing Hospital affiliated to Capital Medical University were analyzed. The detection rate of abnormal lung function was described; the difference of lung function was compared between smokers and non-smokers, among groups with different smoking age, between individuals with normal body mass index and obese individuals; the risk factors of SAD was investigated; and the characteristics of abnormal lung function in asymptomatic subjects receiving physical examinations were summarized.Results:Among the 610 subjects, the overall prevalence of abnormal pulmonary function was 42.6%, and the rate of obstructive, restrictive, mixed and pure SAD were 16.7% and 5.9%, 2.5% and 17.5% respectively. The prevalence of the ratio of forced expiratory volume in 1 second (FEV 1) to forced vital capacity (FVC) (FEV 1/FVC) less than 70% was 4.6%; small airway function indicators of maximal mid expiratory flow (MMEF), forced expiratory flow at 50% and 75% of forced vital capacity (FEF 50% and FEF 75%) for smokers were significantly lower than that of non-smokers, and decreased progressively with smoking age. Smoking was an independent risk factor for SAD. Compared with non-smokers, smokers had a 65-fold increase in the risk of SAD. Obesity was not associated with SAD. Conclusions:The prevalence of abnormal lung function is high in asymptomatic subjects receiving healthy examination. The main abnormalities are obstructive ventilation dysfunction and SAD. Cigarette smoking is the major risk factor for SAD.

Quantitative study on the degree of small airway disease and emphysema injury in pulmonary lobes of patients with smoking combined with chronic obstructive pulmonary disease based on biphasic CT / 中华放射学杂志

Objective:To explore the value of biphasic quantitative CT on small airway disease and emphysema injury in patients with smoking combined with chronic obstructive pulmonary disease (COPD).Methods:A total of 186 male physical examination subjects who underwent biphasic CT and pulmonary function (PFT) examinations in the Affiliated Hospital of Yan′an University from July 2018 to September 2020 were enrolled in this retrospective study. These subjects were divided into 121 smokers with COPD (COPD group), aged 34 to 84 (64±8) years old and 65 smokers without COPD (non-COPD group) aged 34 to 72 (61±5) years old. According to the guidelines of the COPD global initiative, patients in COPD group were divided into Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) Ⅰ-Ⅳ grades. The original DICOM data of CT were imported into the "Digital Lung" test and analysis platform. Quantitative parameters of functional small airway disease percentage (fSAD%) and emphysema area percentage (Emph%) of each lobe were calculated. The differences of CT quantitative parameters among non-COPD group and each grade in COPD group were analyzed by One-Way ANOVA or Kruskal-Wallis H test. The correlation between the smoking index and CT quantitative parameters was analyzed by Spearman correlation analysis. Results:There were significant differences in fSAD% and Emph% of each lobe among non-COPD group and COPD group GOLD Ⅰ-Ⅳ ( P<0.001). Except that the Emph% in right middle lobe of GOLD grade Ⅰ was higher than that of GOLD grade Ⅱ in COPD group, the fSAD% and Emph% in other lobes increased gradually with the increase of GOLD grade in COPD group. The fSAD% and Emph% were larger in the right middle lobe and both upper lobes of COPD group GOLD Ⅰ-Ⅳ. The comparison among each lobe showed that the differences were statistically significant ( P<0.01), except for the fSAD% and Emph% of GOLD Ⅳ ( P=0.395, 0.840). The smoking index was positively correlated with fSAD% and Emph% in each lung lobe. Among them, smoking index was highly correlated with fSAD% in the lower right lobe and Emph% in the lower left lobe ( r=0.474, 0.619, P<0.001). Conclusion:The biphasic quantitative CT can early and sensitively reflect the degree of small airway disease and emphysema injury in smoking combined with COPD, which is of great significance for the early diagnosis and evolution of COPD.

Analysis of inflammatory characteristics and changes of small airway function in patients with eosinophil and neutrophil asthma / 中国综合临床

Obsjective To analyze the inflammation characteristics and changes of small airway function in patients with eosinophil and neutrophil asthma, and provide evidence for individualized treatment of asthma. Methods:Using a cross-sectional study, 46 patients with eosinophilic asthma and 42 patients with neutrophilic asthma confirmed by cytology of induced sputum were recruited from July 1, 2017 to June 30, 2019 at the respiratory Department of Respiratory Medicine,Jinshan Branch of the Sixth People's Hospital of Shanghai. Patients were divided by asthma category into eosinophilic asthma group and neutrophilic asthma group.The severity of acute attack, the score of asthma control test (ACT) and the concentration of serum C-reactive protein (CRP) were compared between the two groups The fraction of exhaled nitric oxide (FeNO), related cytokines(interleukin-4(IL-4), interleukin-5(IL-5), interleukin-13(IL-13), interleukin-17(IL-17) and interferon γ(IFN-γ)) in peripheral blood and induced sputum supernatant and lung function indicators (forced exhalation volume in one second (FEV1)% percent predicted (%pred), maximal mid-expiratory flow (MMEF)% pred, forced expiratory flow (FEF) 75% pred, forced expiratory flow at 50% of FVC exhaled (FEF50%) pred were detected. Independent sample t-test was used for the comparison between measurement data groups comforming to normal distritution, rank sum test was used for the comparison between measurement data groups not conforming to normal distribution, and χ 2 test was used for the comparison of counting data. Results:There were no significant differences in the general data and ACT scores between the two groups (all P>0.05). The ratio of severe and critical degree (52.38%(22/42)), uncontrolled and partially controlled patients (59.52%(25/42)), CRP level (24.6(7.1, 35.0) mg/L) in neutrophil asthma group were higher than those in eosinophilic asthma group(30.43% (14/46), 36.96% (17/46), and 8.5 (2.0, 12.0) mg/L, respectively) (χ 2=4.37, χ 2=4.48, Z=4.76; P=0.036, P=0.034, P<0.001). The concentration of FeNO was higher in eosinophilic asthma group (76(54,93) ppb) than that in neutrophil asthma group(27(15,41) ppb),and the differences was statistically significant ( Z=6.52, P<0.001). The values of FEV1% pred ((56.13±21.51)%), MMEF% pred ((62.03±23.97)%), FEF75% pred ((54.42±20.49)%), FEF50% pred ((66.89±26.47)%) in neutrophil asthma group were lower than those in eosinophilic asthma group ((68.53±29.81)%, (72.16±23.05)%, (65.38±25.46)% and (79.86±27.61)%), and the difference between the two groups was statistically significant( t values were 2.25, 2.02, 2.21, 2.24; P values were 0.027, 0.046, 0.030, 0.027). The concentrations of serum IL-4((49.42±24.46) ng/L), IL-5((104.89±43.91) ng/L) and IL-4((44.49±19.12) ng/L), IL-5((95.45±28.58) ng/L) in induced sputum supernatant were higher than neutrophilic asthma group((32.29±14.19), (50.35±22.30), (33.33±15.08), (55.61±26.41) ng/L). The difference between the two groups was statistically significant ( t values were 4.06, 7.44, 3.02, 6.77, P values were <0.001, <0.001, 0.003, <0.001). In eosinophilic asthma group, the concentrations of serum IL-13 ((76.18±20.62) ng/L), IL-17 ((31.32±9.32) ng/L), IFN-γ ((18.27±5.56) ng/L) and IL-13((71.08±20.08) ng/L), IL-17((26.29±6.70) ng/L), and IFN-γ((17.61±5.94) ng/L) in induced sputum supernatant were lower than those in neutrophilic asthma group((153.83±44.53 ) ng/L, (55.27±18.89) ng/L, (26.46±10.08) ng/L, (120.32±28.41) ng/L, (44.99±12.66) ng/L, (23.91±7.66) ng/L). The difference between the two groups was statistically significant ( t values were 10.33, 7.43, 4.66,9.31,8.54,4.33, respectively; all P<0.001). Conclusion:Eosinophilic asthma and neutrophil asthma have different inflammation, small airway function characteristics and different response to treatment. The small airway function changes in early stage of neutrophil asthma are more obvious.

Application progress of small airway function assessed by lung function testing in children with asthma / 国际儿科学杂志

Bronchial asthma is the most common chronic airway disease in childhood characterized by chronic airway inflammation and airway hyperresponsiveness.The assessment of small airway function plays an important role in the diagnosis and management of asthma.This article will describe the definition of small airways, pulmonary function testing and their application in the clinical diagnosis and management of asthma.

The pulmonary function after pneumonia in children over 3 years old / 中华实用儿科临床杂志

Objective:To analyze the pulmonary function after pneumonia in children over 3 years old.Methods:This was an observational study recruiting children discharged from Beijing Children′s Hospital, Capital Medical University between January 1, 2016 and December 31, 2017 with the first diagnosis of pneumonia who were re-examined for pulmonary function within 0.5 to 2.0 years follow-up at outpatient department.Medical records during hospitalization, clinical information, pulmonary function and/or chest imaging examination were collected for analyzing lung function and relevant risk factors.Results:A total of 159 eligible patients who were followed up at the outpatient department were recruited, involving 100 patients receiving the lung function examination, and among them, 46 had abnormal lung function.There was no significant correlation between the gender and the pulmonary function after pneumonia ( χ2= 0.975, P=0.323). No correlation was found between the pulmonary function and pneumonia pathogens ( χ2=0.549, P=0.908). Children with severe pneumonia ( χ2=5.154, P=0.023) and abnormal chest imaging after pneumonia ( χ2=4.464, P=0.035) were more likely to have lung dysfunction.Among 74 children over 6 years old, there were 45 cases(60.81%) had pulmonary dysfunction after pneumonia, manifesting as the reduced forced expiration volume in one second (FEV 1), forced vital capacity (FVC), forced expiratory flow at 50% vital capacity, forced expiratory flow at 75% vital capacity, maximum mid-expiratory flow and FEV 1/FVC%. Conclusions:Lung dysfunction may occur after pneumonia, manifesting as small airway dysfunction, obstructive ventilation dysfunction and mixed ventilation dysfunction.The gender and etiology of pneumonia are not correlated with lung dysfunction after pneumonia.Children with severe pneumonia and continuous imaging abnormalities are more likely to have lung dysfunction.

Effect of electroacupuncture on small airway function in patients with stable chronic obstructive pulmonary disease / 中国针灸

OBJECTIVE@#To observe the regulatory effect of electroacupuncture (EA) on small airway function and exercise tolerance in patients with stable chronic obstructive pulmonary disease (COPD).@*METHODS@#A total of 62 patients with stable COPD were randomized into an observation group (31 cases, 1 case dropped off) and a control group (31 cases, 5 cases dropped off). On the base of routine medication and aerobic exercise, the patients of the two groups all received EA at Danzhong (CV 17), Rugen (ST 18), Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25) and Yingchuang (ST 16). In the observation group, filiform needles were used and inserted perpendicularly, 3 mm in depth. In the control group, the placebo needling method was performed, in which the needle was not inserted through skin at each point. In both groups, electric stimulation with low-frequency electronic pulse instrument was exerted, with continuous wave, 2 Hz in frequency, lasting 30 min each time in the two groups. The treatment was given once every other day, 3 times a week, for 14 treatments totally. Before and after treatment, the following indexes were compared in patients between the two groups, i.e. the lung function indexes (forced expiratory volume in first second [FEV1], forced vital capacity [FVC], the ratio of FEV1 to FVC [FEV1/FVC], maximal voluntary ventilation [MVV], the percentage of maximal expiratory flow [MEF] at 25% of FVC exhaled [MEF25], MEF50 and MEF75 in predicted value), cardiopulmonary exercise test indexs (metabolic equivalent [METS], oxygen uptake per kg body weight [VO@*RESULTS@#After treatment, FVC%, MVV%, MEF75%, MEF50%, VO@*CONCLUSION@#Electroacupuncture can improve the respiratory function and exercise tolerance in COPD patients through removing small airway obstruction and increasing ventilation.

Influencing factors of pulmonary small airway dysfunction in some occupational populations in Guangzhou City / 中国职业医学

OBJECTIVE: To explore the detection of small airway dysfunction in occupational populations and its influencing factors. METHODS: A convenient sampling method was adopted, and 15 490 occupational health workers who were tested for pulmonary ventilation function in 2018 were selected as study subjects. The results of pulmonary ventilation function examination and chest direct digital radiography(DR) were collected and analyzed. RESULTS: Among the study subjects, 2 083 were detected to have abnormal pulmonary ventilation function, the abnormal detection rate was 13.4%; 3 089 subjects were detected to have small airway dysfunction, and the abnormal detection rate was 19.9%. The two-class logistic regression analysis results suggested that female, exposure to organic dusts during work, exposure to asthmogenic during work, chest DR abnormalities and abnormal pulmonary ventilation function were risk factors for abnormal small airway function(P<0.05). CONCLUSION: The abnormal small airway function in occupational populations is related to various factors such as gender and occupational exposure to allergens. The screening of small airway function in this group may help advance the prevention and treatment of respiratory diseases.

Small airway disease in COPD associated to biomass exposure

Abstract Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous entity that may result from different causative agents and risk factors and may follow diverse clinical courses, including COPD secondary to biomass smoke exposure. At present, this phenotype is becoming more important for two reasons: first, because at least almost half of the world’s population is exposed to biomass smoke, and second, because the possibility of it being diagnosed is increasing. Biomass smoke exposure COPD affects primarily women and is related with insults to the airways occurred during early life. Although constituents of biomass smoke and tobacco smoke are similar, the physiopathological changes they induce differ depending not only on the chemical composition (related with the type of fuel used) but also on the particle size and the inhalation pattern. Evidence has shown that biomass smoke exposure affects the airway, predominantly the small airways causing anthracofibrosis and peribronchiolar fibrosis changes that will clinically translate into chronic bronchitis symptoms, with a high impact on the quality of life. In this review, we focus especially on the main epidemiological and clinical differences between COPD secondary to biomass exposure and COPD caused by tobacco exposure.

Structural and Functional Features on Quantitative Chest Computed Tomography in the Korean Asian versus the White American Healthy Non-Smokers

OBJECTIVE: Considering the different prevalence rates of diseases such as asthma and chronic obstructive pulmonary disease in Asians relative to other races, Koreans may have unique airway structure and lung function. This study aimed to investigate unique features of airway structure and lung function based on quantitative computed tomography (QCT)-imaging metrics in the Korean Asian population (Koreans) as compared with the White American population (Whites). MATERIALS AND METHODS: QCT data of healthy non-smokers (223 Koreans vs. 70 Whites) were collected, including QCT structural variables of wall thickness (WT) and hydraulic diameter (Dh) and functional variables of air volume, total air volume change in the lung (ΔVair), percent emphysema-like lung (Emph%), and percent functional small airway disease-like lung (fSAD%). Mann-Whitney U tests were performed to compare the two groups. RESULTS: As compared with Whites, Koreans had smaller volume at inspiration, ΔVair between inspiration and expiration (p < 0.001), and Emph% at inspiration (p < 0.001). Especially, Korean females had a decrease of ΔVair in the lower lobes (p < 0.001), associated with fSAD% at the lower lobes (p < 0.05). In addition, Koreans had smaller Dh and WT of the trachea (both, p < 0.05), correlated with the forced expiratory volume in 1 second (R = 0.49, 0.39; all p < 0.001) and forced vital capacity (R = 0.55, 0.45; all p < 0.001). CONCLUSION: Koreans had unique features of airway structure and lung function as compared with Whites, and the difference was clearer in female individuals. Discriminating structural and functional features between Koreans and Whites enables exploration of inter-racial differences of pulmonary disease in terms of severity, distribution, and phenotype.

Early diagnosis of COPD and quantitative evaluation of lung function by CT using a voxel-based morphometry / 西安交通大学学报(医学版)

Objective: To improve the time window of early diagnosis of chronic obstructive pulmonary disease (COPD) and make quantitative evaluation of lung function using the voxel-based quantitative CT. Methods: Early COPD and COPD patients who had received inspiratory and expiratory CT scanning were consecutively recruited from the multi-center study named Digital Lung. Quantitative parameters of functional small-airway disease (fSAD) and emphysema (Emph) were measured. For the all COPD patients, Pearson correlation analysis or Spearman rank correlation analysis was used to test the correlation between the quantitative measurements of CT and pulmonary function. Results: Finally, 37 patients with early COPD and 50 patients with COPD were included. The mean value of Emph in early COPD was (3.50±3.36)% and the average value of fSAD was (18.12±12.73)%. Meanwhile, the mean value of Emph in COPD patients was (13.46±9.03)% and the mean value of fSAD was (36.57±9.88)%. Emph was negatively correlated with FEV1% and FEV1/FVC (r=-0.470, P=0.001; r=-0.334, P=0.018), respectively. fSAD was negatively correlated with FEV1% and FEV1/FVC (r=-0.453, P=0.001; r=-0.320, P=0.001). Conclusion: The voxel-based quantitative CT is helpful in early detection of small airway injury in early COPD with respiratory symptoms but no pulmonary function can be achieved.

Application value of simple exercise provocation test combined with small airway function test in early diagnosis of cough variant asthma / 中国综合临床

Objective To explore the value of simple exercise provocation test ( 6?minute running test) combined with small airway function test in early diagnosis of cough variant asthma ( CVA ) in children.Methods Ninety?four children with chronic cough from September 2017 to September 2018 in the pediatric clinic of the Affiliated Hospital of Xuzhou Medical University were selected for routine pulmonary ventilation function examination,simple exercise stimulation test and questionnaire survey.The differences of pulmonary function,clinical manifestations and allergens between positive and negative children with simple exercise stimulation test were compared and analyzed.Results The forced expiratory volume in one second (FEV1) of 94 children with chronic cough were all more than 70% by routine pulmonary function test,and the exercise provocation test was successfully completed.Among them,32 (34.04%) were positive in simple exercise provocation test.Among the positive patients,30 cases ( 93.75%) were diagnosed as CVA after further examination,clinical treatment and follow?up.In CVA group, FEV1 ( 81.52 ± 14.22)%,forced vital capacity (FVC) (89.00 ± 14.31)%, peak expiratory flow ( PEF) ( 65.05 ± 15.10)%, one?second rate (FEV1／FVC) (92.18±13.59)%,and instantaneous flow at 50% forced expiratory flow were observed after exercise.The vital capacity ( FEF50 ) ( 57.57 ± 22.49 )%, forced expiratory flow at 75% vital capacity (FEF75) (41.15±18.28)%,maximum expiratory flow ( MMEF75／25) (53.14±22.53)% were significantly lower than those before exercise ((94.07±9.69)%,( 92.30± 13.60)%,(80.73± 17.85)%,(101.07± 13.79)%,(66.71±19.29)%,(51.32±18.38)%,(63.75±19.43)%),(t values were 8.592 ,2.617 , 10.246 ,5.428,3.590 ,3.646 ,3.687 ,respectively,all P＜0.05)) In routine examination of pulmonary ventilation function,FEF50 (66.71 ± 19.29)% and FEF75 ( 51.32 ± 18.38)% in the positive group were significantly lower than those in the negative group (( 79.75 ± 21.94)%、( 69.08 ± 29.28)%),( t values were －2.841,－3.123,all P＜0.01).The proportion of night cough,morning cough and severe dry cough in positive group was significantly higher than that in negative group,while the proportion of day cough and wet cough was significantly lower than that in negative group ( P＜0.01).The proportion of eczema history in positive group was significantly higher than that in negative group ( P＜0.01).Conclusion Patients with CVA have high airway responsiveness and small airway dysfunction.Combination of simple motor stimulation test and small airway function test has important clinical value in the early diagnosis of CVA.

Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

PURPOSE: Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). METHODS: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. RESULTS: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. CONCLUSIONS: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.

Evaluation of air trapping in lung using biphasic quantitative CT in young asymptomatic females / 实用放射学杂志

Objective To evaluate the extent and anatomic distribution of air trapping in lung in young asymptomatic female subjects to achieve early diagnosis of small airway diseases.Methods Fifty young females with normal pulmonary function were included retrospectively in this study.All subjects underwent both inspiratory and expiratory CT scans,the percentage of the area of air trapping(AT)and the percentage of the area of emphysema(Emph)were quantitatively analyzed.Comparison between bilateral lungs was analyzed using independent-samples t test;Comparisons among lobes were done using one-way ANOVA or Kruskal-Wallis rank sum test;Pairwise comparisons between lobes were conducted using LSD test or paired comparison;The effects of each lobe on AT were analyzed using Spearman's rank correlation coefficient,simple linear regression and multiple stepwise regression.Results There was a certain degree of air trapping in lung and a small amount of emphysema in young asymptomatic females.Air trapping was mainly located in the right middle lobe (RML)and bilateral upper lobes.The ratio of air trapping to volume was the highest in RML and the change of air trapping in the bilateral upper lobes had the greatest influence on the air trapping degree of the whole lung.Conclusion There is a certain degree of air trapping in lung in young asymptomatic females.The occurrence and development of air trapping in RML may be a sensitive biomarker for the early detection of pathophysiological changes in small airway diseases using imaging procedures.

The condition of small airway function and its related influence factors in controlled bronchial asthmatic children / 中华实用儿科临床杂志

Objective To investigate the condition and the related influence factors of small airway function in controlled bronchial asthmatic children.Methods Children diagnosed with bronchial asthma controlled,aged 5-14 years old without gender limitation were consecutively enrolled.Survey questionnaire including asthma symptoms in the past one month and medication usage were conducted.Physical condition and lung function were examined.Results A total of 255 patients were included in this study,and 224 patients had normal small airway function in which the level of forced expiratory flow at 50％ of forced vital capacity(FVC) exhaled (FEF50),forced expiratory flow at 75％ of FVC exhaled(FEF75),maximal mid-expiratory flow(MMEF) was 87.9％ (77.0％,97.2％),73.8％ (65.6％,93.5％),and 84.9％ (76.4％,97.5％) of the predicted value,respectively.Thirty-one patients had small airway dysfunction,accounting for 12.2％ (31/255 cases),and the level of FEF50,FEF75,MMEF were 62.8％ (59.9％,65.5％),51.9％ (46.6％,55.5％),and 62.7％ (57.2％,64.4％) of the predicted value,in which FEF75 had shown more decrease than others.In small airway dysfunction group,10 patients had conducted bronchodilation testing,and improvement rate of FEF50,FEF75 and MMEF were 41.1％,47.5％ and 41.3％,and all 10 cases (100.0％) returned to normal level.No significant difference was found in gender,body mass index,atopy,disease duration,drug usage between 2 groups (all P ＞ 0.05).Conclusion In 5-14 controlled asthmatic children,12.2％ have small airway dysfunction with a certain degree of reversibility.Gender,body mass index,atopy,disease duration,drug usage are not influencing factors.

Reference Equations for Impulse Oscillometric and Respiratory System Model Parameters in Anglo and Hispanic Children / Ecuaciones de referencia para parámetros de oscilometría de impulsos y de modelo del sistema respiratorio en niños anglos e hispanos

Abstract The Impulse Oscillometry System (IOS) has been recognized as a useful diagnostic tool. Previous research by our group has shown that R5 (Resistance at 5 Hz), R5-R20 (frequency dependence of resistance), AX (the "Goldman Triangle") and the extended Resistor-Inductor-Capacitor (eRIC) model-derived parameter Cp (peripheral Compliance) are reliable measures that track respiratory system function. Here we determined the predictive equations from 112 asthmatic and non-asthmatic Anglo and Hispanic children data, that were previously classified into four groups: Normal, PSAI (Probable Small Airway Impairment), SAI (Small Airway Impairment), and Asthma by using regression analysis of IOS and eRIC model parameters as dependent variables regressed against age, height, and weight. Height showed the greatest correlation with IOS and eRIC model parameters and provided the most significant reference values for these measures in Anglo and Hispanic children. These values could serve as a useful framework for diagnosis, early interventions, and treatment of respiratory diseases in this population.

Resumen El Sistema de Oscilometría Impulsos (por sus siglas en Inglés: IOS) ha sido reconocido como una herramienta de diagnóstico útil. Investigaciones previas realizadas por nuestro grupo han demostrado que R5 (Resistencia a 5 Hz), R5-R20 (dependencia a la frecuencia de la resistencia), AX (el "Triángulo de Goldman") y el párametro Cp (Capacitancia periférica) derivado del modelo extendido Resistencia-inductor-condensador (eRIC) son medidas fiables que monitorean la función del sistema respiratorio. El presente estudio determina las ecuaciones de predicción de 112 niños Anglo e Hispanos asmáticos y no asmáticos, que previamente clasificados en cuatro grupos: Normal, PSAI (por su nombre en inglés: Probable daño en las vías aéreas menores), SAI (por su nombre en inglés: Daño en las vías aéreas menores), y Asma. Las ecuaciones de predicción se determinaron mediante análisis de regresión de parámetros del IOS y del modelo eRIC (variables dependientes) contra edad, estatura y peso. La estatura mostró la mejor correlación con los parámetros del IOS y del modelo eRIC, proporcionando los valores de referencia más significativos para estas medidas en niños Anglos e Hispanos. Estos valores podrían servir como un marco de referencia útil para el diagnóstico, intervenciones tempranas, y tratamiento de las enfermedades respiratorias en esta población.

Effect of treating allergic rhinitis with intranasal corticosteroids on small airway function / 中国耳鼻咽喉头颈外科

OBJECTIVE To observe the effect of administration intranasal corticosteroids on small airway disfunction for allergic rhinitis (AR) patients. METHODS AR patients with small airway disfunction were administrated intranasal corticosteroids for twelve weeks. Before treatment, nasal VAS, RQLQ were recorded, pulmonary function test were given. After therapy, VAS, RQLQ were obtained again at the 4th, 8th and 12th week. Pulmonary function test were performed at the 4th and 12th week. RESULTS VAS, RQLQ were all improved after therapy (P <0.01). The indices of FEV1/FVC%, MMEF pred%, MEF75pred%, MEF50pred%, MEF25pred%were also improved significantly (P<0.05), especially for MMEFpred%, MEF75pred%, MEF50pred% (P<0.01). CONCLUSION Small airway lesions can be obviously improved by the intranasal corticosteroids applied for AR. It has positive significance for preventing AR from developing into asthma.

Effect of salmeterol/fluticasone propionate combined with lip shrinkage respiration on the treatment of pneumoconiosis complicated COPD / 中国职业医学

OBJECTIVE: To observe the effects of combined treatment using salmeterol / fluticasone propionate and lip shrinkage respiration on the treatment of patients with pneumoconiosis complicated with chronic obstructive pulmonary disease( COPD). METHODS: By random number table method,98 patients with stable pneumoconiosis complicated with COPD were divided into 3 groups: drug treatment group( 33 cases) was treated only with inhalation of salmeterol /fluticasone propionate( 50 μg /500 μg),twice a day; lip shrinkage respiration group( 34 cases) was treated with abdominal breathing and lip shrinkage respiration training,three times daily for 15 min per session; combined treatment group( 31 cases) was treated with both the above treatments. Before and after 6 months of treatment,the lung function,the 6-minute walk distance and the oxygen saturation( Sa O2) were detected. The modified Medical Research Council( m MRC) Respiratory Questionnaire was used to evaluate the degree of dyspnea. RESULTS: After 6 months of treatment,the forced vital capacity percentage( FVC%),percentage of forced expiratory volume in one second( FEV1%),maximum ventilatory volume( MVV),6-minute walking distance,m MRC degree and the Sa O2 improved in the patients of these 3groups compared with those before treatment( P < 0. 05). Compared with the drug treatment group or lip shrinkage respiration group after treatment,the FVC%,FEV1%,MVV,6-minute walking distance and the Sa O2 in the combined treatment group were higher( P < 0. 05),and the m MRC degree was lower( P < 0. 05). CONCLUSION: Salmeterol /fluticasone propionate combined with lip shrinkage respiration treatment had better therapeutic effect than single treatment in treating patients with pneumoconiosis combined with COPD.

Clinical features of chronic cough with airway hyper-responsiveness in children / 中华实用儿科临床杂志

Objective To study the clinical features and spirometry of children with chronic cough and positive findings by bronchial provocation test.Methods Four hundred and fifty children with chronic cough from 3 hospitals of Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong Medical University School of Medicine,Gong Li Hospital of Pudong New Area,Pudong Hospital,were enrolled in this study from December 2012 to December 2014,and among them,373 cases completed the questionnaires,spirometry and bronchial provocation test.The differences in clinical features and spirometry between the bronchial provocation test positive group and negative group were compared.And the further evaluation of their clinical value was performed.Results Two hundred and thirty-six cases of children with bronchial provocation tests positive showed much higher rate of dry [72.03％ (170/236 cases)] and night cough[58.90％ (139/236 cases)] than those in the negative group[27.00％ (37/137 cases),22.63％ (31/137cases)],and the differences were significant (x2 =71.154,45.973,all P ＜0.01).Children in positive group also had higher morbidity of eczema[52.12％ (123/236 cases)],allergic conjunctivitis [24.15％ (57/236 cases)] and inhaled allergy history[40.25％ (95/236 cases)] than those in negative group[32.85％ (45/137 cases),10.95％ (15/137cases),18.98％ (26/137 cases)],and there existed significant differences (x2 =13.006,9.701,17.904,all P ＜0.01).And they also had higher asthma heredity [18.22％ (43/236 cases)] than that in negative group [9.49％(13/137 cases)],and the difference was significant (x2 =5.179,P =0.023);with worse small airway function [50.85％ (120/137 cases) vs 36.50％ (50/137 cases)] (x2 =7.197,P =0.007).For further study,the sensitivity and specificity for dry cough were both high(72.03％ and 72.99％).For specificity,family history was the most highest one (90.51％),and night cough and allergic conjunctivitis were also high.Conclusions Pulmonary function tests to reflect small airway function abnormalities,combined with a family history of asthma and chronic cough in children related to eczema,allergic conjunctivitis,and inhalation allergy history clinical features,can better predict airway hyperresponsiveness.