How and to What Extent Immunological Responses to SARS-CoV-2 Shape Pulmonary Function in COVID-19 Patients.

COVID-19 is a disease caused by a new coronavirus SARS-CoV-2, primarily impacting the respiratory system. COVID-19 can result in mild illness or serious disease leading to critical illness and requires admission to ICU due to respiratory failure. There is intense discussion around potential factors predisposing to and protecting from COVID-19. The immune response and the abnormal respiratory function with a focus on respiratory function testing in COVID-19 patients will be at the center of this Perspective article of the Frontiers in Physiology Series on "The Tribute of Physiology for the Understanding of COVID-19 Disease." We will discuss current advances and provide future directions and present also our perspective in this field.

Slow Vital Capacity: Differences Between the Expiratory Vital Capacity and the Inspiratory Vital Capacity

ABSTRACT Introduction: The vital capacity (VC) can be determined by means of the expiratory vital capacity (EVC) or the inspiratory vital capacity (IVC). Obtaining the highest VC volume is essential for the correct interpretation of lung function tests. Objectives: To determine the differences between the EVC and the IVC (EVC-IVC) according to the ventilatory pattern; to characterize the FEV1/EVC and FEV1/IVC ratios when an obstruction of the airways is detected; to study the effects of the EVC or IVC on the detec tion of air trapping or lung hyperinflation. Materials and Methods: Cross-sectional study. The sample included 388 individuals divided in 3 groups: healthy, airway obstruc tion, and restrictive lung disease. In order to detect the airway obstruction, we studied the FEV1/EVC and FEV1/IVC ratios. The presence of air trapping or lung hyperinflation was determined by means of a lung volume test. The differences between the EVC and the IVC (EVC-IVC) according to the ventilatory pattern were grouped into classes. Results: In the normal group, there was an EVC-IVC difference of ≥ 200 ml in 34.8% of the individuals; in the airway obstruction group, 28.4%, and in the restrictive lung disease group, 22.4%. The FEV1/EVC ratio detected airway obstruction in 44.8% of the individuals, and the FEV1/IVC ratio in 39.4%. In patients with airway obstruction, the EVC maneuver determined the presence of air trapping in 21.6% of subjects and lung hyperinflation in 9.5%. The IVC maneuver showed 18.2% and 10.8%, respectively. Conclusions: The EVC and IVC should not be used as interchangeable maneuvers, considering the volume differences obtained with each one of them. Their results influenced the interpretation of lung function.

Impact of a Pharmacist-driven Spirometry Clinic Service within a Community Family Health Center: A 5-year Retrospective Review.

OBJECTIVE: This study was designed to describe the impact of a trained pharmacist in performing quality spirometry testing within a community family health center. METHODS: This was a retrospective, cohort study of 150 physician-referred patients who attended their scheduled spirometry office appointment between November 2008 and December 2013. Information obtained included type of the disease (patients with obstructive or restrictive pulmonary disease), calculated lung age decline due to smoking history, quality of spirometry testing, and percentage of patients requiring pulmonary drug regimen alterations due to spirometry results. Pearson correlation and descriptive statistics were used to address study objectives. FINDINGS: Spirometry testing performed by a pharmacist resulted in 87% of tests meeting guidelines for quality. Testing identified patients with reversible airway disease (39%), chronic obstructive pulmonary disease (21%), restrictive (11%), and mixed obstructive/restrictive (11%) lung defect. Patients with abnormal spirometry demonstrated a greater smoking pack-year history and calculated lung age than patients with normal spirometry (29.1 pack-years vs. 17 pack-years; P = 0.024 and 76.3 years vs. 54.6 years; P < 0.001, respectively). A weak correlation was found between a 29.1 smoking pack-year history and forced vital capacity (r = -0.3593, P = 0.018). The pharmacist assisted in modifying pulmonary drug regimens in 69% of patients based on evidence-based guidelines. CONCLUSION: A pharmacist-driven spirometry service was associated with quality testing results, identified respiratory disease abnormalities, and helped modifications of pulmonary drug regimens based on evidence-based guidelines. Future direction of this service may include collaborative practice agreements with physicians to expand services of pharmacists to include spirometry testing.

The Impact of Using Non-Birth Sex on the Interpretation of Spirometry Data in Subjects With Air-Flow Obstruction.

BACKGROUND: Sex is an important determinant of lung capacity and function. This study examined the impact of using non-birth sex on the interpretation of spirometry data in transgender subjects with air-flow obstruction. METHODS: This study was a retrospective analysis of anonymous spirometry data. Eighty adult male and 80 adult female subjects were chosen from the database via random sampling. FVC, FEV1, and FEV1/FVC were collected and analyzed. Differences in percent of predicted, Z scores, classification of disease severity, and the incidence of a value migrating above or below the lower limit of normal between sex assignments were examined. RESULTS: For born male subjects, percent of predicted for FVC and FEV1 were significantly higher when the female sex was used: 100.5% versus 118.5% and 78% versus 91.5%, respectively (P < .001). FEV1/FVC Z score was -2.53 for male sex and -2.65 for female sex (P = .004). The presence of obstruction was not affected by sex assignment. Use of non-birth sex moved some FVC and FEV1 data above the lower limit of normal and improved severity classification in others. For born female subjects, percent of predicted for FVC and FEV1 were significantly lower when the male sex was used: 102% versus 87.5% and 81.5% versus 70.5%, respectively (P < .001). FEV1/FVC Z score was -2.17 for female sex and -2.12 for male sex (P < .001). Six born female subjects had their FEV1/FVC normalized when male sex was used. Use of non-birth sex moved some FVC and FEV1 data below the lower limit of normal and worsened severity classification in others. In total, using the non-birth sex affected spirometry interpretation in 45% of born male subjects and 70% of born female subjects. CONCLUSIONS: In transgender subjects with air-flow obstruction, using non-birth sex to calculate predicted spirometry values may have a significant impact on test interpretation and place these patients at risk for misdiagnosis and inappropriate treatment.

Repercussão da displasia broncopulmonar na função pulmonar durante infância: revisão sistemática / Impact of bronchopulmonary dysplasia on pulmonary function during childhood: a systematic review

INTRODUCTION: Bronchopulmonary dysplasia (BPD) is a multifactorial chronic lung disease that contributes to disruption of pulmonary development. It may impair pulmonary function in early childhood and persist throughout school-age, adolescence, and into adulthood. OBJECTIVE: To analyze, through a systematic review, the impact of BPD on pulmonary function in early childhood. : Systematic searches were performed in three electronic databases (Medline, SciELO and PEDro). Two independent examiners analyzed the titles, abstracts and full texts, considering the following study inclusion criteria: studies of pulmonary function in up to 5-year-old children diagnosed with BPD in the neonatal period. RESULTS: Initially, 1789 articles were identified, and the final sample included 22 articles. It could be observed that children diagnosed with BPD in early childhood showed expiratory flow limitation and reduced functional residual capacity. However, pulmonary function in children with a history of BPD remains reduced when compared with healthy full-term children. Moreover, there are no positive responses in pulmonary function values with the use of bronchodilators. CONCLUSION: Children with BPD show changes in pulmonary function, which may improve with growth, and most of them do not respond positively to bronchodilators.

INTRODUÇÃO: A displasia broncopulmonar (DBP) é uma doença pulmonar crônica multifatorial que interrompe o desenvolvimento pulmonar, podendo repercutir em comprometimento da função pulmonar na primeira infância, que pode perdurar durante a idade escolar, adolescência, até a idade adulta. OBJETIVO: Analisar, através de uma revisão sistemática, as repercussões da DBP na função pulmonar de crianças na primeira infância. MÉTODO: Foram realizadas buscas sistematizadas em três bases de dados eletrônicas (Medline, SciELO e PEDro). Dois examinadores independentes analisaram sistematicamente os títulos, resumos e textos na íntegra, considerando os seguintes critérios de inclusão: estudos que avaliaram a função pulmonar de crianças com até 5 anos de idade que apresentaram diagnóstico de DBP no período neonatal RESULTADOS: Inicialmente foram identificados 1789 artigos, sendo que a amostra final foi composta de 22 artigos. Evidenciou-se que crianças com DBP apresentam na primeira infância limitação dos fluxos expiratórios e redução da capacidade residual funcional. Estas alterações podem ser normalizadas ou minimizadas com o crescimento e adequação de peso, porém, a função pulmonar das crianças com história de DBP continua reduzida em comparação a crianças hígidas nascidas a termo. Ainda, a maioria delas não apresenta respostas positivas nos valores de função pulmonar com o uso de broncodilatadores. CONCLUSÃO: Crianças com DBP apresentam alterações na função pulmonar, podendo melhorar com o crescimento, sendo que a maioria não responde positivamente ao broncodilatador.