Sex differences in habitual physical activity and lung function decline in children with cystic fibrosis.

OBJECTIVES: To evaluate the feasibility of measuring habitual physical activity (HPA) in children with cystic fibrosis (CF) and to assess the relation between HPA and the rate of decline in FEV1 over a period of 2 years. STUDY DESIGN: At regular clinic visits, 109 patients (7 to 17 years; 56 girls) performed pulmonary function testing and completed the Habitual Activity Estimation Scale (HAES). Patients were divided into quartiles, based on activity levels derived from the HAES. RESULTS: Girls in the two lowest activity quartiles had a more rapid rate of decline FEV1 (-3.40% and -3.05% predicted, respectively) than girls in the two highest activity quartiles (-0.93% and +1.17% predicted, respectively) (P = .02). In boys, the rate of decline of FEV1 was similar in all activity quartiles (-1.95% predicted). Patients reported significantly more activity in summer compared with spring, winter, and fall (P < .0001), and boys reported greater activity than girls (6.5 +/- 2.9 vs 5.4 +/- 2.5 h/d, P < .05). CONCLUSIONS: The annual rate of change of FEV1 was related to activity quartile in girls but not in boys. This research suggests that an inactive lifestyle may partially explain the poorer survival of female patients with CF. The HAES is a feasible tool for routine follow-up of HPA in our CF clinic.

Does carbon dioxide retention during exercise predict a more rapid decline in FEV1 in cystic fibrosis?

BACKGROUND: Carbon dioxide (CO2) retention during exercise is uncommon in mild to moderate lung disease in cystic fibrosis (CF). The ability to deal with increased CO2 is dependent on the degree of airflow limitation and inherent CO2 sensitivity. CO2 retention (CO2R) can be defined as a rise in P(ET)CO2 tension of > or =5 mm Hg with exercise together with a failure to reduce P(ET)CO2 tension after peak work by at least 3 mm Hg by the termination of exercise. AIM: To ascertain if carbon dioxide retention during exercise is associated with more rapid decline in lung function. METHODS: Annual spirometric and exercise data from 58 children aged 11-15 years, with moderate CF lung disease between 1996 and 2002 were analysed. RESULTS: The mean FEV1 at baseline for the two groups was similar; the CO2R group (n = 15) was 62% and the non-CO2 retention group (CO2NR) was 64% (n = 43). The decline in FEV1 after 12 months was -3.2% (SD 1.1) in the CO2R group and -2.3% (SD 0.9) in the CO2NR group. The decline after 24 months was -6.3% (SD 1.3) and -1.8% (SD 1.1) respectively. After 36 months, the decline in FEV1 was -5.3% (SD 1.2) and -2.6% (SD 1.1) respectively. The overall decline in lung function was 14.8% (SD 2.1) in the CO2R group and 6.7% (SD 1.8) in the CO2NR group. Using the primary outcome measure as a decline in FEV(1) of >9%, final multivariate analysis showed that the relative risks for this model were (95% CIs in parentheses): DeltaP(ET)CO2 11.61 (3.41 to 24.12), peak VO2 1.23 (1.10 to 1.43), and initial FEV(1) 1.14 (1.02 to 1.28). CONCLUSION: Results show that the inability to defend carbon dioxide during exercise is associated with a more rapid decline in lung function.

Comparison of calibration methods for respiratory inductive plethysmography in infants.

In infants under the age of 6 mo respiratory inductive plethysmograph (RIP)-calculated tidal volumes (VT) were compared with simultaneously measured volumes using a pneumotachograph (PNT) to 1) assess whether using multiple points (MP) along the inspiratory profile of a breath is superior to using only VT when calculating volume-motion (VM) coefficients, 2) verify the assumption of independent contributions of the abdomen and rib cage to VT, which was accomplished by extending the normal RIP model to include a term representing interaction between these two compartments, and 3) investigate whether VM coefficients are sleep-state dependent. Neither use of multiple points nor inclusion of the interacting term improved the performance of the RIP over that observed using a simple two-compartment model with VT measurements. However, VM coefficients obtained during quiet sleep (QS) were not reliable when used during rapid-eye-movement (REM) sleep, suggesting that coefficients obtained during one sleep state may not be applicable to another state where there is a substantial change in the relative abdominal/rib cage contributions to VT.

Evaluation of respiratory inductive plethysmography in infants weighing less than 1,500 grams.

Calibration of the respiratory inductive plethysmograph (RIP) was performed in premature infants weighing less than 1,500 g. In only 25% of the studies was an acceptable calibration achieved, as assessed by statistical comparison of simultaneously measured pneumotachygraph and RIP tidal volumes. In 6 infants, dead space loading or air injection was performed in an attempt to alter abdominal and rib cage volume contributions and thereby improve the calibration. Neither of these maneuvers resulted in an improvement of the accuracy of the RIP calibration coefficient. We conclude that, when calibrated by the least squares technique, the reliability of inductive plethysmography in measuring tidal volume in small infants is low. This is presumably because they have very small tidal volumes and highly compliant rib cages.

Effect of graded erythrocythemia on cardiovascular and metabolic responses to exercise.

The effects of graded induced erythrocythemia on cardiovascular and metabolic responses to intense treadmill running were studied in four highly trained endurance runners. Three autologous infusions of 1 unit (U) whole blood (450 ml/U) were administered sequentially 2-7 days apart. Maximal O2 consumption (VO2max) increased from 5.04 l/min at control (C) to 5.24 l/min after 2 U (R2) and 5.38 l/min after 3 U (R3). Cardiac output during treadmill running at 91% control VO2max was 28.2 l/min at C, 29.8 l/min at R2, and 33.1 l/min at R3. Corresponding heart rates were unchanged, and stroke volume was increased at R3. Peak lactate concentration was reduced, and arterial acid-base status improved at R2 and R3 after standardized bouts of intense exercise. Arterial blood pressures and electrocardiograms during exercise were not affected by erythrocythemia. We conclude that the reinfusion of up to 3 U of autologous blood into highly trained endurance runners who have normal hematology does not adversely affect their cardiovascular response to maximal exercise. In addition, the increases in VO2max following reinfusion of 2 U, and again after 3 U, suggest that the aerobic power of the working muscles was not surpassed at these levels of erythrocythemia.

Calibration of respiratory induction plethysmography (Respitrace) in infants.

To determine whether the recently increased sensitivity of the variable frequency oscillator and the use of separate rib cage and abdominal transducers made calibration of the Respitrace system easier, we performed 106 different calibration procedures against a pneumotachygraph in 36 normal infants, 41 using 2 separate periods of quiet sleep, 49 using quiet and REM sleep, and 16 using 2 separate periods of REM sleep. When the calibration was done using 2 separate periods of quiet sleep, or using periods of quiet and REM sleep, a change of at least 50% in the amplitudes of both the abdominal and rib cage signals between the 2 sleep periods, gave accurate calibration factors in 92%, compared with only 30% when the amplitude of either signal changed by less than 50%. Calculation of the calibration factors can be done either by the least squares method or by solving simultaneous equations with no significant difference between the results.