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.

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.

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.

Prediction of Treatment Response in Patients with Chronic Obstructive Pulmonary Disease by Determination of Airway Dimensions with Baseline Computed Tomography

OBJECTIVE: To determine the predictive factors for treatment responsiveness in patients with chronic obstructive pulmonary disease (COPD) at 1-year follow-up by performing quantitative analyses of baseline CT scans. MATERIALS AND METHODS: COPD patients (n = 226; 212 men, 14 women) were recruited from the Korean Obstructive Lung Disease cohort. Patients received a combination of inhaled long-acting beta-agonists and corticosteroids twice daily for 3 months and subsequently received medications according to the practicing clinician's decision. The emphysema index, air-trapping indices, and airway parameter (Pi10), calculated using both full-width-half-maximum and integral-based half-band (IBHB) methods, were obtained with baseline CT scans. Clinically meaningful treatment response was defined as an absolute increase of ≥ 0.225 L in the forced expiratory volume in 1 second (FEV1) at the one-year follow-up. Multivariate logistic regression analysis was performed to investigate the predictors of an increase in FEV1, and receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the suggested models. RESULTS: Treatment response was noted in 47 patients (20.8%). The mean FEV1 increase in responders was 0.36 ± 0.10 L. On univariate analysis, the air-trapping index (ATI) obtained by the subtraction method, ATI of the emphysematous area, and IBHB-measured Pi10 parameter differed significantly between treatment responders and non-responders (p = 0.048, 0.042, and 0.002, respectively). Multivariate analysis revealed that the IBHB-measured Pi10 was the only independent variable predictive of an FEV1 increase (p = 0.003). The adjusted odds ratio was 1.787 (95% confidence interval: 1.220–2.619). The area under the ROC curve was 0.641. CONCLUSION: Measurement of standardized airway dimensions on baseline CT by using a recently validated quantification method can predict treatment responsiveness in COPD patients.