Relación entre dimensiones antropométricas de tronco y valores de espirometría / Association between anthropometric dimensions of trunk and spirometry indices

Los objetivos del presente estudio fueron primero evaluar la asociación de dimensiones antropométricas de tórax y tronco con índices espirométricos, segundo, ajustar una ecuación de predicción con dimensiones antropométricas de tronco y tercero, comparar nuestro modelo predictivo con dos ecuaciones diagnósticas. Se evaluaron 59 estudiantes universitarios entre 20 y 40 años, de ambos sexos, sin hábito tabáquico. Las variables consideradas fueron: edad, sexo, peso, estatura, diámetro transverso de tórax, diámetro anteroposterior de tórax, perímetro de tórax, altura de tórax, altura de tronco, flujo espiratorio máximo (FEM), volumen espiratorio forzado en el primer segundo (VEF1) y capacidad vital forzada (CVF). Se utilizó el análisis de regresión múltiple para estimar los valores espirométricos en función de las variables demográficas y antropométricas. La CVF y el VEF1 tienen asociación lineal directa con el diámetro transverso de tórax, altura de tórax, perímetro de tórax y altura de tronco. Se ajustó una ecuación de regresión lineal múltiple que indicó que es posible estimar la CVF y el VEF11 en función de la altura de tronco y el perímetro de tórax para ambos sexos. Estas variables son capaces de explicar el 74 % de los valores de CVF y el 68 % de los valores de VEF1. Al comparar los valores obtenidos por nuestras ecuaciones predictivas con las ecuaciones de referencia nacional observamos que nuestros resultados son más cercanos a los de Quanjer et al. (2012) que a los de Knudson et al. (1983). La altura de tronco y el perímetro de tórax tienen asociación directa con el VEF1 y CVF y son buenos predictores del VEF1 y CVF en estudiantes universitarios. Nuestros valores estimados son más cercanos a las ecuaciones de Quanjer et al. (2012) en comparación a las estimaciones de Knudson (1983).

SUMMARY: The purposes of the present study were first to evaluate the association between anthropometric dimensions of the thorax and trunk with spirometric indices, second, to fit a prediction equation with anthropometric dimensions of the trunk, and third, to compare our predictive model with two diagnostic equations. Fifty-nine university students between 20 and 40 years old, of both sexes and non-smokers were recruited. Variables considered were age, sex, weight, height, chest transverse diameter, chest anteroposterior diameter, chest perimeter, chest height, trunk height, maximum expiratory flow (PEF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Multiple regression analysis was used to estimate spirometric values based on demographic and anthropometric variables. FVC and FEV1 have a direct linear association with chest transverse diameter, chest height, chest circumference, and trunk height. A multiple linear regression equation was fitted, indicating that it is possible to estimate FVC and FEV1 as a function of trunk height and chest girth for both sexes. These variables can explain 74% of the FVC values and 68% of the FEV1 values. Comparing the values obtained by our predictive equations with the national reference equations, we observe that our results are closer to those of Quanjer et al. (2012) than to those of Knudson et al. (1983). Trunk height and chest circumference have a direct association with FEV1 and FVC and are good predictors of FEV1 and FVC in university students. Our estimated values are closer to Quanjer et al. (2012) than Knudson et al. (1983) prediction equations.

Screening Parameters for COPD-OSA Overlap Syndrome in COPD Patients: Indian Perspective

Introduction: As Indian patients have different predisposing morphological characteristics, we undertook this study to evaluate the clinical profile of overlap syndrome and compare them with COPD patients to find out the screening tools for obstructive sleep apnea (OSA) in Indian chronic obstructive pulmonary disease (COPD) patients. Aims and objectives: • To study the clinical profile of patients with overlap syndrome. • To compare them with COPD patients. • To develop screening tools for overlap syndrome in COPD. Materials and methods: A prospective case-control study was carried out in a tertiary care center. Overnight pulse oximetry was carried out for all COPD patients. Those having snoring or saw-tooth pattern on overnight oximetry were subjected to level 1 polysomnography. About 30 patients of overlap syndrome were compared with 65 COPD patients. Results: The mean age in overlap syndrome group (56.9 ± 6.86 years) was significantly lower (p < 0.01). The daytime PaO2 and lowest nocturnal saturation were significantly lower in overlap group. PaCO2 and forced expiratory volume at 1 second (FEV1) were significantly higher. For diagnosing overlap syndrome, the positive and the negative predictive values of snoring were 84.42 and 100%; of body mass index (BMI) ?25 kg/m2 were 86.67 and 98.88%; and of excessive daytime sleepiness were 37.57 and 97.86%, respectively. Conclusion: Absence of snoring and BMI <25 kg/m2 virtually rules out overlap syndrome. The EDS has a high false-positive rate for predicting OSA. Patients having overlap syndrome have poor daytime and nocturnal oxygenation despite good lung functions.

Clinical efficacy of caspofungin combined with voriconazole in the treatment of older adult patients with pulmonary fungal infection / 中国基层医药

Objective:To investigate the clinical efficacy of caspofungin combined with voriconazole in the treatment of older adult patients with pulmonary fungal infection and its effects on pulmonary function and inflammatory factors.Methods:A total of 100 patients with pulmonary fungal infection admitted to Hangzhou Ninth People's Hospital from January 2016 to December 2020 were included in this study. They were randomly assigned to undergo treatment with either voriconazole (control group, n = 50) or caspofungin combined with voriconazole (observation group, n = 50) for 14 consecutive days. Clinical efficacy and changes in pulmonary function and inflammatory factors after treatment relative to before treatment were determined in each group. Results:Total response rate in the observation group was significantly higher than that in the control group [90.00% (45/50) vs. 74.00% (37/50), χ2 = 4.33, P < 0.05). After treatment, forced vital capacity, forced expiratory volume in 1 second, and maximum expiratory flow rate in the observation group were (2.31 ± 0.77) L, (79.30 ± 6.72)%, (86.14 ± 7.27)%, respectively, which were significantly higher than (1.78 ± 0.74) L, (73.22 ± 6.56)%, (78.16 ± 7.09)% in the control group ( t = 3.50, 4.57, 5.55, all P < 0.05). Tumor necrosis factor α, interleukin-6, and procalcitonin levels in the observation group were (8.32 ± 1.41) ng/L, (35.19 ± 3.40) μg/L, (1.94 ± 0.78) ng/L, respectively, which were significantly lower than (10.15 ± 1.58) ng/L, (46.09 ± 3.64) μg/L, (2.43 ± 0.84) ng/L in the control group ( t = 6.11, 15.43, 3.02, all P < 0.05). The incidence of adverse reactions in the observation group was 4.0% (2/50), which was significantly lower than 18.0% (9/50) in the control group ( χ2 = 5.00, P < 0.05). Conclusion:Caspofungin combined with voriconazole for the treatment of pulmonary fungal infection in older adult patients can effectively improve pulmonary function, inhibit the inflammatory response, and have no obvious adverse reactions with accurate clinical efficacy.

An Exploration of Pulmonary Fitness of Construction Workers in Delhi NCR in Light of the Building and Other Construction Workers Act, 1996

Workers in the construction sector are exposed to high concentrations of particulate matter at their workplace. This increases their susceptibility to various respiratory diseases, particularly chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The study reports comparative pulmonary fitness and hematological parameters of the migrant workers in the construction sector versus other sectors in Delhi. Parameters such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), the ratio of FEV1 to FVC, and peak expiratory flow were measured in both groups using a spirometer. We observed significant differences (P < 0.05) in FEV1 and FVC between both groups. The study thus confirms that workers exposed to poor air quality at the construction site are susceptible to respiratory diseases, particularly ARDS. All of this reflects the poor enforcement of the adequate safety measures well enlisted in social legislations such as the Building and Other Construction Workers Act.

Assessment of pulmonary functions FVC, FEV1, and FEV1/FVC ratio among athletes and non-athletes

Background: Pulmonary function will improve by regular and intense physical activity. There will be difference in degree of improvement or increase in pulmonary functions in different types of athletic activities. Recent studies have stated forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC ratio to be higher in athletes than in the normal sedentary control individuals. Few studies have found lower values of dynamic pulmonary function while few other studies have found higher values of dynamic pulmonary function tests. We undertook this study to know the pulmonary function in athletes of Bengaluru and compare it with controls. Aim and Objective: This study aims to record dynamic pulmonary function tests (FVC, FEV1 and FEV1/FVC) using COSMED computerized spirometer in athletes and to compare with non-athletes. Materials and Methods: This is a case朿ontrol study which included 50 non-smoking athletes of 18� years age group from Shree Kanteerava Stadium, Bengaluru, and 50 non-athletes as control group after considering inclusion and exclusion criteria. Subjects were age and gender matched. FVC, FEV1, and FEV1/FVC were recorded using COSMED computerized spirometer. For statistical analysis, independent Student抯 t-test was used. Results: FVC, FEV1, and FEV1/FVC (P < 0.001) were significantly increased in athletes than non-athletes. Conclusion: Regular exercise and athletic training will improve the lung function tests.

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.

Effects of passive smoking on pulmonary functions of individuals in an urban area

Background: Passive smoking is a world health problem and part of the tobacco epidemic which victimizes mostly adolescents. Research articles have addressed the relation between passive smoking and respiratory efficiency in adult population and escalated the hazard of chronic obstructive pulmonary disease and lung cancer among adult passive smokers. The present study was conducted to analyze the effects of exposure to passive smoke on pulmonary functions among nonsmoking individuals. Aim and Objectives: The study was determined to assess the effects of passive smoking on pulmonary functions among individuals in urban region. Materials and Methods: The present study was conducted on smokers, passive smokers, and nonsmokers (control), aged between 17 and 25 years. Ninety healthy individuals were placed in three different groups on the basis of questionnaire (Group A: active smoker, Group B: passive smoker, Group C: control). Study was done with the help of spirometer and pulse oximeter. Results: Forced expiratory flow25–75%, Forced expiratory volume in 1 second/Forced vital capacity % values were significantly reduced in passive smokers as compared to control individuals (P < 0.001, P < 0.05). SpO2 level was decreased in passive smokers and active smokers, but it was not statistically significant. Conclusions: The present study showed a strong association between passive smoking and pulmonary abnormalities in individuals exposed to passive smoke. Health hazards caused by passive smoking should be controlled by creating awareness and regular health check-ups among people.

Liver function tests in patients with chronic obstructive pulmonary disease in a tertiary care hospital

Background: Cases of chronic obstructive pulmonary disease (COPD) increasing day by day. Smoking is the major causative agent for COPD. The present study undertaken to estimate the deterioration of liver functions in COPD patients due to smoking. Aims and Objectives: This study aims to investigate various liver function tests (LFTs) such as total bilirubin, alanine amino transferase/serum glutamic pyruvic transaminase (SGPT), aspartate amino transferase/SGPT, alkaline phosphatase (ALP), serum ammonia, and serum albumin among COPD patients. To correlate LFTs with forced expiratory volume at end of 1 second (FEV1) and FEV1/Forced vital capacity (FVC) ratio. Materials and Methods: In our present study, we selected 86 cases of COPD in the age group of 41–60 years. All subjects were smokers and having FEV1 <80% and FEV1/FVC <70%. A control group consists of 55 healthy individuals. LFTs were studied. FEV1 and FEV1/FVC ratio were correlated with LFTs. Statistical analysis done using SPSS software 20.0 Windows version. Results: Mean level of SGPT among cases was 117 ± 10.23 IU/L against controls who had mean SGPT 11.16 ± 8.32 which was statistically significant (P < 0.05). Likewise, mean level of s. ammonia among cases was 154 ± 10.22 mcg/dl as compare to controls who had mean 24.43 ± 7.97 mcg/dl (P < 0.05). However, no significant difference was found in rest of the LFTs. Furthermore, there was no correlation between altered LFTs and severity of COPD. Conclusion: LFTs are significantly altered in COPD patients due to smoking. Corticosteroids treatment must not be initiated without investigating LFTs among COPD patients.

Compound Xianzhuliye combined with compound ipratropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease / 中国基层医药

Objective:To investigate the clinical effect of compound Xianzhuliye combined with compound ipratropium bromide in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease. Methods:160 patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment in Zhejiang Putuo Hospital from December 2019 to December 2020 were included in this study. They were randomly assigned to receive either routine treatment combined with compound ipratropium bromide (control group, n = 80) or routine treatment, compound ipratropium bromide and compound Xianzhuliye in combination (observation group, n = 80) for 14 successive days. Curative effects, blood gas analysis indexes (arterial partial pressure of oxygen, oxygenation index and arterial partial pressure of carbon dioxide), respiratory mechanics indexes (peak airway pressure, airway resistance and mean airway pressure), changes in lung function [percentage of predicted forced expiratory volume in 1 second forced expiratory volume in one second (FEV 1%), FEV 1/forced vital capacity], inflammatory factors (C-reactive protein, interleukin-6 and procalcitonin) before and after treatment were compared between the control and observation groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [90.00% vs. 76.25%, χ2 = 5.391, P < 0.05]. After treatment, arterial partial pressure of oxygen and oxygenation index in the observation group were (62.17 ± 6.19) mmHg and (258.83 ± 25.45) mmHg, respectively, which were significantly higher than those in the control group [(53.86 ± 5.46) mmHg, (210.93 ± 23.12) mmHg, t = 9.005, 12.460, both P < 0.05]. After treatment, arterial partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(46.89 ± 5.25) mmHg vs. (57.12 ± 4.12) mmHg, t = 13.711, P < 0.05]. After treatment, peak airway pressure in the observation group was significantly higher than that in the control group [(37.87 ± 3.25) cmH 2O vs. (30.82 ± 4.26) cmH 2O, t = 11.768, P < 0.05]. After treatment, airway resistance and mean airway pressure in the observation group were (6.75 ± 1.82) cm H 2O/L/s and (7.34 ± 1.30) cm H 2O, respectively, which were significantly lower than those in the control group [(9.82 ± 2.10) cm H 2O/L/s and (9.12 ± 1.23) cm H 2O, t = 9.881, 8.896, both P < 0.05). After treatment, FEV 1%, FEV 1/ forced vital capacity in the observation group were (67.31 ± 4.56)% and (61.23 ± 3.67)%, respectively, which were significantly higher than those in the control group [(58.98 ± 3.67)%, (52.18 ± 4.68)%, t = 12.729, 13.610, both P < 0.05). After treatment, C-reactive protein, interleukin-6 and procalcitonin in the observation group were (8.86 ± 1.53) mg/L, (65.87 ± 12.90) ng/L and (0.15 ± 0.04) μg/L, respectively, which were significantly lower than those in the control group [(19.90 ± 3.56) mg/L, (109.32 ± 19.76) ng/L and (0.34 ± 0.07) μg/L, t = 25.484, 16.469, 21.079, all P < 0.05). Conclusion:Compound Xianzhuliye combined with compound ipratropium bromide in the treatment of acute exacerbation of chronic obstructive pulmonary disease can acquire good clinical curative effects through improving blood gas analysis indexes, respiratory mechanics indexes and lung function, and reduce inflammatory reactions.

Screening tool for restrictive and obstructive ventilatory abnormalities in a population-based survey

Abstract Background: A 6 s spirometry with an inexpensive pocket spirometer efficiently selects individuals for a diagnostic-quality spirometry for airflow limitation, but could also be useful to identify individuals with a restrictive pattern. Objectives: We evaluated an inexpensive simplified spirometer (chronic obstructive pulmonary disease [COPD]-6) as a screening tool to identify spirometric abnormalities. Methods: A population-based survey in Mexico City, with 742 participants performing pre- and post-BD spirometry and a three-maneuver 6 s spirometry (pre-BD) with a COPD-6. We evaluated forced expiratory volume in 1 s (FEV1), FEV6, and FEV1/FEV6 from the COPD-6, crude and expressed as the percentage of predicted (%P), to discriminate post-bronchodilator airflow obstruction (FEV1/forced vital capacity [FVC] <5th percentile) or restriction (FVC or FEV1 <5th percentile with normal FEV1/FVC) through receiver operating characteristics and their area under the curve (AUC). Results: FEV1%P was the best predictor to identify pre- and post-BD ventilatory abnormalities (best cutoff point 87%P, AUC 92% for restrictive pattern, 89% for obstructive pattern, and 91% for any spirometric abnormality). Deriving to clinical spirometry only those with <87%P (26% of the sample) missed only 12% of spirometric abnormalities most of the latter mild. Conclusions: An FEV1 <87%P from a pre-BD 6 s spirometry correctly identified individuals with spirometric ventilatory defects, either obstructive or restrictive.

Evaluación de la respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos / Evaluation of the acute response to the bronchodilator in overweight and obese asthmatic patients

Introducción: La obesidad está asociada al uso frecuente de medicación de rescate y padecer asma de mayor gravedad. Los obesos asmáticos tienen menor reactividad bronquial, sin embargo, existe información limitada sobre la magnitud de la reversibilidad aguda al broncodilatador (RAB). Objetivo: Evaluar la magnitud de respuesta aguda al broncodilatador en pacientes asmáticos sobrepesos y obesos. Métodos: Se realizó un estudio descriptivo transversal con 49 pacientes asmáticos sobrepesos y obesos atendidos en consulta externa del Hospital Neumológico Benéfico Jurídico (enero 2017˗ enero 2018) y se constató mediante espirometría la respuesta aguda al broncodilatador. Resultados: Predominó la edad (40-59 años), mayor asociación de padecer asma, poca mejoría con la aplicación del broncodilatador. El sexo femenino (20-59 años) presentó mayor número que el masculino y menor reversibilidad al broncodilatador. Los pacientes con antecedentes patológicos familiares de asma o atopia representaron 73,5 por ciento del total. El 76,5 por ciento de los obesos no presentó mejoría con la aplicación del broncodilatador. Predominó la categoría de gravedad persistente moderada. Conclusiones: El sexo femenino tiene más riesgo de padecer asma y no tener mejoría al aplicar el broncodilatador. Los obesos mayores de 40 años tienen mayor riesgo de no presentar reversibilidad aguda al broncodilatador. Los antecedentes patológicos familiares de asma o atopia y personales de otras enfermedades no predisponen a menor reversibilidad aguda al broncodilatador. La gravedad del asma no influye en la reversibilidad aguda al broncodilatador(AU)

Introduction: Obesity is associated with the frequent use of rescue medication and suffering from more severe asthma. Obese asthmatics have less bronchial reactivity, however, there is limited information on the magnitude of acute bronchodilator reversibility. Objective: To assess the magnitude of the acute response to the bronchodilator in overweight and obese asthmatic patients. Methods: A cross-sectional descriptive study was carried out in 49 overweight and obese asthmatic patients seen in the outpatient clinic at Benéfico Jurídico Pneumologic Hospital from January 2017 to January 2018, and the acute response to bronchodilator was verified by spirometry. Results: Age predominated (40-59 years), greater association of suffering from asthma, and little improvement with the use of bronchodilator. The female sex (20-59 years) showed greater number than the male and less reversibility to bronchodilator. Patients with family pathological history of asthma or atopy represented 73.5 percent of the total. 76.5 percent of the obese did not show improvement with the use of bronchodilator. The category of moderate persistent severity predominated. Conclusions: The female sex has greater risk of suffering from asthma and has no improvement when applying bronchodilator. Obese individuals over 40 years of age have higher risk of not having acute reversibility to the bronchodilator. Family pathological history of asthma or atopy and personal history of other diseases do not predispose to less acute reversibility of bronchodilator. The severity of asthma does not influence acute reversibility to bronchodilator(AU)

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.

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.

Importance of spirometry, pulse oximetry and hematocrit in chronic obstructive pulmonary disease

Background: To study the correlation of clinical features, spirometry, pulse oximetry assessment and haematocrit abnormalities in chronic obstructive pulmonary disease and to assess the severity of chronic obstructive pulmonary disease by spirometry.Methods: In the present study total 50 cases were selected on the basis of simple random sampling method from the Department of Pulmonary Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Bommakal, Karimnagar, Telangana, India. During study period from June 2017 to December 2018.Results: About 50 patients of chronic obstructive pulmonary disease were studied. Majority of the patients were in the age group of 50-70 years. COPD was seen predominantly in male patients and majorities were smoker. In the majority of patients, the duration of illness was 6-10 years, cough with expectoration was present in all patients. As the number of cigarettes/day and duration increases the severity of the disease also increases in the studied population. In the study, about 40 % of cases were in stage III disease. Computerised spirometry was found to be most sensitive investigation in diagnosing and assessing the severity of the disease in all these cases. As the severity and duration of the disease increases, they are more prone to develop hypoxia and polycythaemia as a complication. In present study 8 patients had hypoxia, as assessed by pulse oximeter.Conclusions: Computerized spirometry is a very useful investigation in the management of chronic obstructive pulmonary disease. Pulse oximetry is a useful tool in diagnosing periods of oxygen desaturation. Pulse oximetry also useful in monitoring the oxygen therapy during management. Haematocrit analysis is a useful adjunct in assessing the severity of the disease. Polycythaemia, even though uncommon in chronic obstructive pulmonary disease patients is one of the rare but preventable complication with early cessation of smoking and with oxygen therapy.

Clinical outcome of pain management in paravertebral block and continuous intercostal nerve block for post-thoracotomy pain

Introduction: Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the ‘gold standard’ for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management. Aim of the study: To compare paravertebral block and continuous intercostal nerve block after thoracotomy. Materials and methods: Fifty adult patients undergoing elective posterolateral thoracotomy were randomized to receive either a continuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessed for 48 hours. Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals. Results: With respect to the objective visual assessment (vas), both techniques were effective for post-thoracotomy pain. The average vas score at rest was 29±10 mm for paravertebral block and 31.5±11 mm for continuous intercostal nerve block. The average vas score on coughing was 36±14mm for the first one and 4 ±14 mm for the second group. Conclusion: Thoracic epidural analgesia or nerve blocks are so far considered as the best option but one needs to consider personnel and equipment resources available. A combination of local anesthetics along with opioids can be given to reduce the agony of the patient and early discharge from the hospital.

Lung Function of Grain Millers Exposed to Grain Dust and Diesel Exhaust in Two Food Markets in Ibadan Metropolis, Nigeria

BACKGROUND: Despite growing concern over occupational exposure to particulate matter (PM) such as grain dust and diesel exhaust, information about the exposure level and health implications among workers in small-scale milling enterprises in developing countries like Nigeria has not been adequately documented. The purpose of this study was to assess the level of exposure to grain dust and diesel exhaust and effect on lung function among grain millers in food markets in Ibadan metropolis, Nigeria. METHODS: The study adopted descriptive cross-sectional design with a comparative approach. Sixteen grain milling shops each were randomly selected from two major food markets in Ibadan metropolis for indoor PM₁₀ and PM(2.5) monitoring. Seventy-two respondents each were proportionately selected from grain millers and shop owners for forced expiratory volume in one second and peak expiratory flow rate tests. RESULTS: The PM(2.5) concentrations for both market locations ranged between 1,269.3 and 651.7 μg/m³, while PM₁₀ concentrations were between 1,048.2 and 818.1 μg/m³. The recorded concentrations exceeded the World Health Organization guideline limit of 50 μg/m³ and 25 μg/m³ for PM(2.5) and PM₁₀, respectively. As compared with control group (2.1 L), significantly lower forced expiratory volume in one second value (1.61 L) was observed among the exposed group (p < 0.05). Likewise, significantly lower peak expiratory flow rate value (186.7 L/min) was recorded among the exposed group than the control group (269.51 L/min) (p < 0.05). CONCLUSION: Exposure to grain dust and diesel exhaust accentuated respiratory disorders with declines in lung functions amongst grain millers. Improved milling practices and engaging cleaner milling facilities should be adopted to minimize exposure and related hazards.

Efficacy of ambroxol hydrochloride in the treatment of exacerbation of chronic obstructive pulmonary disease / 中国基层医药

Objective To observe the efficacy of ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods From January 2015 to December 2017,84 patients with COPD exacerbation in Zhuji Central Hospital were selected and randomly divided into two groups according to the digital table,with 42 cases in each group.The control group was treated with routine therapy,the observation group was treated with ambroxol hydrochloride on the basis of routine treatment.The course of treatment in both two groups was 14 days.The clinical efficacy,clinical symptom disappearance time,pulmonary function index,inflammation index and adverse reaction were compared between the two groups.Results The total effective rate in the observation group was 95.24％ (40/42),which was higher than that in the control group (78.57％,33/42),and the difference was statistically significant(x2 =5.126,P ＜ 0.05).The disappearance time of cough,wheezing,sputum and dampness in the observation group was (4.01 ± 0.68) d,(3.22 ± 0.60) d,(3.62 ± 1.25) d,(4.16 ± 0.72) d,respectively,which were shorter than those in the control group [(5.32 ± 1.17)d,(4.66 ± 1.12)d,(4.50 ± 1.83)d,(5.10 ± 1.06)d] (t =6.274,7.345,2.573,4.754,all P ＜ 0.05).After treatment,the forced expiratory volume,oxygen partial pressure,carbon dioxide partial pressure,C-reactive protein,neutrophil count and total white blood cell count in the observation group were (0.99 ± 0.32) L,(71.36 ± 7.61) mmHg,(42.28 ± 4.39) mmHg,(8.71 ± 2.46) mg/L,(6.40 ± 3.19) × 109/L,(6.11 ± 3.28) × 109/L,respectively,which in the control group were (0.80 ± 0.20) L,(65.28 ±7.29)mmHg,(48.40 ±6.00)mmHg,(13.60 ±4.50)mg/L,(11.45 ±5.27) × 109/L,(7.81 ±3.82) × 109/L,respectively,and the differences between the two groups were statistically significant (t =3.263,3.739,5.335,6.179,5.313,2.188,all P ＜ 0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion Ambroxol hydrochloride can shorten the time of disappearance of clinical symptoms,improve the clinical efficacy and improve the pulmonary function and inflammation related indicators in the exacerbation period of COPD.

The Relationship between Pulmonary Function and Serum Uric Acid Level in the Korean Population

BACKGROUND: Forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and the ratio of FEV₁ to FVC (FEV₁/FVC) are considered as the major spirometry parameters. Serum uric acid is associated with increased risk of gout and cardiovascular disease. We analyzed the relationship between pulmonary function and serum uric acid level in the Korean men and women.METHODS: This study was based on the data collected during the 2016 Korea National Health and Nutrition Examination Survey (KNHANES VII-1). A total of 3,411 adults were retrieved from KNHANES VII-1. Among 3,411 adults, 1,500 were men and 1,911 were women.RESULTS: In this study, a significant negative correlation was observed between serum uric acid level and pulmonary function values only in females. Also, in the male non-smoker group, pulmonary function values were negatively associated with serum uric acid level (FVC %predicted, β=−0.014; FEV₁ %predicted, β=−0.015).CONCLUSIONS: In this study, hyperuricemia was associated with the low lung function in males and females. In order to obtain an accurate assessment of the association between hyperuricemia and pulmonary function values, further prospective cohort study in the future is necessary.

Estudio comparativo de la estadificación de pacientes con EPOC según GOLD 2007, 2011 y 2019 / Comparative study of the categorization of COPD patients based on GOLD 2007, 2011 and 2019

INTRODUCCIÓN: La Enfermedad Pulmonar Obstructiva Crónica afecta a 260 millones de personas a nivel mundial y representará la tercera causa de muerte para el año 2020. MATERIALES Y MÉTODOS: Se realizó un estudio observacional descriptivo transversal con la finalidad de comparar la estadificación de un grupo de pacientes venezolanos con EPOC según la Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007, 2011 y 2019. RESULTADOS: La muestra estuvo constituida por ochenta y nueve (89) pacientes con una edad promedio de 66,7 ± 0,9 años, siendo el 60,7% de los pacientes del sexo masculino y 82% fumadores. El 14,6% de los pacientes presentaban EPOC leve, 36% EPOC moderado, 41,6% EPOC severo y 7,9% EPOC muy severo. El valor del test Kappa de Cohen entre las escalas mMRC y CAT (COPD Assessment Test) fue de 0,529 (GOLD 2011) y 0,555 (GOLD 2019). CONCLUSIONES: 1) la poca concordancia entre el VEF1, grado de disnea e historial de exacerbaciones impacta la clasificación de la severidad de la EPOC al utilizar GOLD 2011; 2) la concordancia moderada entre las escalas mMRC y CAT sugiere que el tipo de cuestionario utilizado afecta la categorización de la severidad de la enfermedad; 3) los pacientes del grupo B mostraron una importante afectación en el intercambio gaseoso dado por valores más bajos de DLCO y oximetría arterial y 4) una proporción significativa de pacientes fueron clasificados en los grupos de alto riesgo (B y D) en GOLD 2011 y 2019.

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) affects 260 million people worldwide and it is thought to become the third leading cause of mortality by the year 2020. MATERIAL AND METHODS: A transversal descriptive observational study was conducted to compare the categorization of a group of Venezuelan COPD patients according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007, 2011 and 2019. RESULTS: Eighty-nine (89) patients with a mean age of 66.7 ± 0.9 years were included, 60.7% were male and 82% smokers. 14.6% of the patients had mild COPD, 36% moderate COPD, 41.6% severe COPD and 7.9% very severe COPD. Cohen's Kappa coefficient value between mMRC and COPD Assessment test (CAT) was 0,529 (GOLD 2011) and 0,555 (GOLD 2019). CONCLUSIONS: 1) the lack of concordance between FEV1 values, degree of dyspnea and history of exacerbations impacts COPD severity classification when using GOLD 2011; 2) moderate agreement between mMRC and CAT scales suggests that the type of questionnaire used to evaluate perception of dyspnea can affect disease severity categorization; 3) group B patients showed a significant gas exchange impairment due to lower values of DLCO and arterial oxymetry and 4) a significant proportion of patients were categorized in the high-risk groups (B and D) both in GOLD 2011 and 2019. Optimization of the evaluation of COPD severity is important to allow a better standardization of care and pharmacological management of patients with this disease.

Clinical value of low attenuation area ratio and lung volume on CT in evaluating severity of spirometric abnormality / 上海交通大学学报（医学版）

Objective • To explore the clinical value of the ratio of low attenuation areas (LAA%) and lung volume calculated according to chest CT in evaluating the severity of spirometric abnormality. Methods • The patients who underwent chest CT scan and lung function test at the same time from January 2010 to July 2014 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively enrolled. LAA% and lung volume were calculated by Myrian software. The correlation analysis was performed between post-bronchodiation forced expiratory volume in 1 second (FEV1) or its percentage of predicted value (FEV1%pred) and LAA% or lung volume. Multi-variable models for post-bronchodiation FEV1 and FEV1%pred were developed based on LAA%, lung volume, gender, height, and weight. The ROC curves were depicted and the diagnostic values of LAA%, lung volume, and models were compared. The cut points were chosen according to Younden indexes and specificity. Results • A total of 1 150 patients were included in summarization group. LAA% was negatively correlated with post-bronchodiation FEV1 and FEV1%pred. Lung volume was positively correlated with post-bronchodiation FEV1. The regression models of post-bronchodiation FEV1 and FEV1%pred were FEV1=-2.700+0.111×lung volume-0.216×ln (LAA%+0.1)-0.025×age+0.154×gender+0.034×height and FEV1%pred=65.582+4.014×lung volume-7.508×ln (LAA%+0.1)-10.264×gender, respectively. The regression model performed better than LAA% and lung volume in estimating the degree of post-bronchodiation FEV1 decrease. LAA% and the regression model performed better than lung volume in estimating the degree of post-bronchodiation FEV1%pred decrease. The sensitivity was 75.6% and the specificity was 90.6% in estimating post-bronchodiation FEV1%pred1.61% as the criteria. The sensitivity was 58.9% and the specificity was 81.4% in estimating post-bronchodiation FEV1<1 L by using the value of regression model<1.76. Conclusion • The regression models of post-bronchodiation FEV1 and FEV1%pred were obtained based on lung volume and LAA% on chest CT. LAA% and lung volume can roughly estimate the severity of spirometric abnormality.