The impact of metabolic parameters on the change of pulmonary function in obese patients

BackgroundEthnic differences exist in the function and distribution of adipose tissue, which influences whole body metabolism, including pulmonary function. The object of this study was to examine the relationships between serum metabolic parameters and pulmonary function in a morbidly obese Asia-Pacific population.MethodsOne-hundred thirty-seven morbidly obese Chinese patients, aged≥18 years with a body mass index (BMI)>32 kg/m² who were being evaluated for bariatric surgery between July 2007 and December 2008, were studied. Cross-sectional associations between serum metabolic parameters, including lipids, glucose, insulin, leptin, and adiponectin levels with forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) assessed by spirometry, were analyzed. Multiple regression analyses also were conducted, with age, gender, smoking history, and various anthropometric measurements of obesity as confounders.ResultsSerum adiponectin and HDL cholesterol had a positive correlation with FVC and FEV₁. In addition, insulin resistance, determined by the homeostatic model assessment method (HOMA), was negatively correlated with FVC. In the multiple linear regression analysis, only serum adiponectin was significantly correlated with FVC and FEV₁, independent of obesity level.ConclusionsSerum adiponectin level was positively and independently associated with pulmonary function in morbidly obese Chinese adults.     

Improvement of restrictive and obstructive pulmonary mechanics following laparoscopic bariatric surgery

Background  Morbidly obese patients often have impaired respiratory mechanics leading to restrictive and obstructive lung diseases. Weight loss after bariatric surgery has been shown to improve or resolve many obesity-related comorbidities. However, few studies have examined long-term changes in pulmonary mechanics after bariatric surgery. We hypothesize that pulmonary function improves after surgically induced weight loss. Methods  We examined the pulmonary function of 104 morbidly obese patients who underwent laparoscopic gastric bypass or gastric banding. Pulmonary studies, including forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume at midexpiratory phase (FEV_25–75%) were measured preoperatively and at 3-month intervals. All results are expressed as a percentage of the baseline values. Results  There were 80 females and 24 males with a mean age of 41 years. The mean body mass index was 48 kg/m². The mean percentage of excess body weight loss at 12 months was 54%. At 12 months postoperatively, restrictive pulmonary mechanics significantly improved as demonstrated by an increase in the FEV₁ to 112% of baseline value, increase in the FVC to 109% of baseline value, increase in the PEF to 115% of baseline value, and increase in the FEV_25–75% to 130% of baseline value. Additionally, the percentage of patients with obstructive lung pattern (FEV₁/FVC ratio less than 0.8) decreased from 9.6% preoperatively to 1.9% postoperatively (p = 0.03). Conclusions  Weight loss after laparoscopic gastric bypass significantly improves restrictive and obstructive respiratory mechanics. The improvements were observed as early as 3 months postoperatively. Presented at the Society of American Gastrointestinal Endoscopic Surgeons Annual Scientific Session, Philadelphia, PA, April, 11th 2008.     

Assessment of pulmonary function in patients before and after laparoscopic and open esophagogastric surgery

Background Laparoscopy is a technique used in various surgical procedures. Few studies in the literature compare stress between laparoscopic and open surgery used for esophagogastric surgical procedures. Pulmonary function is known to be significantly affected in open surgeries, increasing postoperative morbidity and mortality. The current study aimed to assess pulmonary function in patients before and after open and laparoscopic esophagogastric surgery.Methods For this study, 75 patients were divided into two groups: 50 patients undergoing laparoscopy and 25 patients undergoing open surgery. The following parameters were determined by spirometry before and after surgery: forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and forced expiratory flow in the midexpiratory phase (FEF_25–75%).Results A decrease in FEV_1, FVC, and FEF_(25–75%) was observed in the two groups on postoperative days 2, 3, and 4, as compared with the preoperative period. Likewise, FEV₁ and FVC showed a significant reduction on postoperative days 2, 3, and 4 in the patients who underwent to open surgery, but only on the day 2 in those who underwent to laparoscopic surgery. A significant decrease in FEF_(25–75%) was observed only on postoperative day 2 in the group that underwent open surgery. Significant differences in FEV₁ between the groups were observed on postoperative days 2, 3, and 4. No significant difference in FVC was noted between the groups, and a difference in FEF_(25–75%) was observed only on postoperative day 4.Conclusions Postoperative pulmonary dysfunction was more important for the patients undergoing open surgery than for those undergoing laparoscopic surgery.     

Lung Ultrasound and Pulmonary Function Test in Cirrhotic Patients

Lung ultrasound (LU) is useful in the diagnosis of pulmonary interstitial-alveolar syndrome (IAS) when B-lines are detected. Its prevalence and effect in lung function is not well studied in cirrhotic patients. The objective of this study was to detect the prevalence of interstitial-alveolar involvement with LU and correlate with pulmonary function test to distinguish the effect of ascites and B-lines in pulmonary function. This was an observational single-center study with 49 patients listed for liver transplantation submitted for LU and pulmonary function tests. Patients were divided into 4 groups: no ascites and no B-lines (n = 19), B-lines only (n = 19), ascites only (n = 6), and ascites and B-lines (n = 5). There was a worse forced vital capacity (FVC) in patients with B-lines only (76.1% ± 9.2; P = .0058) and ascites only (66.8% ± 10.2; P = .0010). 1-second forced expiratory volume (FEV₁) also was lower in patients with B-lines only (78.5% ± 10.3; P = .0001), ascites only (71.3% ± 13.2; P = .0004), and B-lines and ascites (74.2% ± 7.6; P = .0035). Model for End-Stage Liver Disease score was worse in the group with ascites and B-lines (22.4 ± 10.1; P = .0229). B-Lines reduced FVC and FEV₁ in our study and may be an independent factor in worsening pulmonary function in these patients.     

Pulmonary function and health-related quality of life in patients with early onset scoliosis after repeated traditional growing rod procedures

PurposeThe purpose of this study was to investigate pulmonary function and health-related quality of life after traditional growing rod (TGR) procedures.MethodsBetween January 2006 and December 2017, a retrospective observational study of 17 early onset scoliosis (EOS) patients with a mean follow-up of 6.2 years (2.3 to 10.4) was conducted. The forced expiratory volume in one second (FEV₁), expiratory forced vital capacity (FVC) and 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) score before the index surgery and at last follow-up were investigated.ResultsThe mean percentage of predicted FEV₁ improved from 50% (20% to 86%) to 53% (15% to 80%; p = 0.08); and the mean percentage of predicted FVC improved from 51% (24% to 81%) to 55% (25% to 89%; p = 0.06). The mean EOSQ-24 score was 78.2 (58 to 90) preoperatively and 77.2 (55 to 88) at last follow-up, there was no statistical difference (p = 0.70). The subdomain scores of pulmonary function (p < 0.01) and daily living (p < 0.01) significantly improved, whereas the subdomain scores of pain (p < 0.01), emotion (p < 0.01) and satisfaction (p = 0.02) significantly declined at last follow-up.ConclusionThe TGR procedure was associated with stable pulmonary function and decline in EOSQ-24 pain, emotion and satisfaction scores.Level of EvidenceLevel III, retrospective cohort study.     

Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery

Background

Obesity is associated with respiratory symptoms and impaired pulmonary function, which could increase the risk of complications after bariatric surgery. The purpose of this study is to assess the relationship between pulmonary function parameters before, and the risk of complications after, laparoscopic bariatric surgery.

Methods

This prospective study included patients (age 18–60, BMI >35 kg/m²), who were eligible for bariatric surgery. Spirometry was performed in all patients. Complications up to 30 days after bariatric surgery were recorded.

Results

Four hundred eighty-five patients were included (304 laparoscopic sleeve gastrectomy, 181 laparoscopic gastric bypass). There were 53 complications (8 pulmonary, 27 surgical, 14 infectious, 4 other) in 50 patients (10 %). There were 35 re-admissions (7.2 %), and 17 re-laparoscopies (3.5 %). Subjects with and without complications did not differ significantly with respect to demographics, weight, BMI, abdominal circumference or fat percentage. Subjects with complications had a significantly lower mean FEV₁ (mean 86.9 % predicted) and FVC (95.6 % predicted) compared to patients without complications (95.9 % predicted, p?=?0.005, and 100.1 % predicted, p?=?0.045, respectively). After adjustment for age, gender, BMI, and smoking, abnormal spirometry value remained the single predictive covariable of postoperative complications: FEV₁/FVC <70 % adjusted OR 3.1 (95%CI 1.4–6.8, p?=?0.006) and ΔFEV₁ ≥12 % adjusted OR 2.9 (95 %CI 1.3–6.6, p?=?0.010).

Conclusions

The risk of pulmonary complications after laparoscopic bariatric surgery is low. However, subjects with abnormal spirometry test results have a threefold risk of complications after laparoscopic bariatric surgery. Preoperative pulmonary function testing might be useful to predict the risk of complications of laparoscopic bariatric surgery.     

64层螺旋CT低剂量双相扫描测定肺体积评价慢性阻塞性肺疾病患者肺功能

目的探讨64层CT低剂量双相扫描肺体积测量指标评估慢性阻塞性肺疾病(COPD)患者肺功能的价值。方法选择经临床肺功能检查确诊的36例COPD患者(COPD组)及30名健康体检者(正常对照组),采用64层CT行深吸气末、深呼气末全肺低剂量(50mAs)及常规剂量(100mAs)吸气末扫描,得出每次扫描的容积CT剂量指数(CTDIvol)和剂量长度乘积(DLP),并换算出有效剂量(ED)。以配对样本t检验比较两组间不同扫描剂量及不同呼吸状态下的CT-DIvol、DLP、ED;应用Fisher确切概率法比较CT图像质量。按扫描层数将全肺分为上、中、下3个肺区,应用Pulmo软件测量和计算COPD组与正常对照组的各体积指标:深吸气末体积(Vin)、深呼气末体积(Vex)、体积差(Vin-Vex)、体积比(Vex/Vin)、体积变化百分比(Vin-Vex)/Vin×100%。于CT检查前后3天完成PFT检查,对比研究指标为第1秒用力肺活量(FEV1)的实测值与预计值的比值(FEV1%)及FEV1与用力肺活量(FVC)的比值(FEV1/FVC)。结果所有图像均成功用于自动分割技术与数据处理。与正常对照组比较,COPD组除各肺区的Vin及上肺区Vin-Vex外,其余各体积指标差异均有统计学意义(P均<0.05);Vex、Vex/Vin、(Vin-Vex)/Vin×100%均与FEV1%、FEV1/FVC存在相关性(P<0.01)。结论 64层CT低剂量双相扫描肺体积指标可较好评价COPD患者肺功能,临床应用价值较高。     

Cross-sectional associations of pulmonary function with systemic inflammation and oxidative stress in individuals with chronic spinal cord injury

Context/Objective: Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. Our objective was to evaluate the associations between biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and novel makers of global oxidative stress (fluorescent oxidation products (FLOx)) with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI).

Design: Cross-sectional study.

Setting: Veterans Affairs Medical Center.

Participants: One-hundred thirty-seven men with chronic SCI participating in an epidemiologic study.

Methods: Participants provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure, after adjustment for a number of potential confounders.

Outcome Measures: Percent-predicted forced vital capacity in one second (FEV₁), percent-predicted forced vital capacity (FVC), FEV₁/FVC, percent-predicted residual volume (RV), percent-predicted FRC, and percent-predicted total lung capacity (TLC).

Results: After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV₁ and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures.

Conclusion: Increased systemic inflammation was associated with reductions in FEV₁ and FVC independent of a number of covariates. Although the mechanism is uncertain, these results suggest that reductions in pulmonary function in SCI are associated with systemic inflammation.     

Pulmonary function after posterior retroperitoneoscopic surgery

Pulmonary function tests were performed in 12 patients who underwent posterior retroperitoneoscopic surgery, before and on the 3rd and 7th days after operation. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FCV, vital capacity (VC), total lung capacity (TLC), residual volume (RV) and functional residual capacity (FRC) were not significantly different between before and after surgery. It is assumed that posterior retroperitoneoscopic surgery could be performed without impairment of pulmonary function after surgery.     

Short-term effects of respiratory muscle training combined with the abdominal drawing-in maneuver on the decreased pulmonary function of individuals with chronic spinal cord injury: A pilot randomized controlled trial

Objective: To investigate the effects of respiratory muscle training (RMT) combined with the abdominal drawing-in maneuver (ADIM) on the pulmonary function in patients with chronic spinal cord injury (SCI).

Methods: Thirty-seven subjects with SCI (level of injury: C4–T6, time since injury: 4–5 years) were randomly allocated to three groups; the integrated training group (ITG), the RMT group (RMTG), and the control group (CG). The ITG performed RMT using an incentive respiratory spirometer (IRS) and the ADIM using a stabilizer. The RMTG received only RMT using an IRS. Subjects in the CG received alternative and routine physical therapy or usual care. The interventions were conducted over an eight-week period. Pulmonary function was evaluated using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁).

Results: The differences between the pre- and post-test values for FVC (0.47?±?0.05 versus 0.15?±?0.06 versus –0.03?±?0.01) and FEV₁ (0.74?±?0.07 versus 0.27?±?0.17 versus 0.02?±?0.67)were significant among the groups. Post-test, in the ITG, the FVC and FEV₁ values showed significant differences from those in the RMTG and CG (F?=?11.48 and 11.49, P?=?0.002 and 0.001). Furthermore, following the 8­week intervention, the change ratio values of the FVC and FEV₁ of the ITG were increased further by an average of 9.75% and 7.91%, respectively, compared with those of the RMTG.

Conclusion: These findings suggest positive evidence that RMT with additional ADIM training can improve pulmonary function in SCI pulmonary rehabilitation.     

Alterations in Pulmonary Function Following Pneumonectomy for Bronchogenic Carcinoma

Twenty-one patients who underwent pneumonectomy for bronchogenic carcinoma at the Nashville Veterans Administration Hospital from November, 1977, to March, 1980, were evaluated with standard pulmonary function tests preoperatively and postoperatively. Twelve patients had Stage I disease, 4 patients had Stage II, and 5 patients had Stage III disease. The interval between the operative procedure and postoperative testing ranged from 2 to 33 months (mean, 12.4 months).Mean functional loss of pulmonary capacity after pneumonectomy was based on analysis of preoperative and postoperative forced vital capacity (FVC) and initial-second forced expiratory volume (FEV₁) indices. The mean functional loss as expressed by FVC was 41.5% after right pneumonectomy and 34.0% after left pneumonectomy. The mean functional loss as expressed by FEV₁ was 40.2% after right pneumonectomy and 38.3% after left pneumonectomy.The postoperative functional status of each patient was classified according to the New York Heart Association criteria. Nineteen of the 21 patients were in Class I or II preoperatively. Postoperatively, 10 patients were in Class I or II and 11 in Class III or IV. The results indicate that a postoperative FVC less than 2.5 liters and FEV₁ less than 1.5 liters are not compatible with active life.     

Measuring Breathing Pattern in Patients With Chronic Obstructive Pulmonary Disease by Electrical Impedance Tomography

Background and ObjectiveThe measurement of breathing pattern in patients with chronic obstructive pulmonary disease (COPD) by electrical impedance tomography (EIT) requires the use of a mathematical calibration model incorporating not only anthropometric characteristics (previously evaluated in healthy individuals) but probably functional alterations associated with COPD as well. The aim of this study was to analyze the association between EIT measurements and spirometry parameters, static lung volumes, and carbon monoxide diffusing capacity (DLCO) in a group of male patients to develop a calibration equation for converting EIT signals into volume signals.Materials and MethodsWe measured forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FVC, residual volume, total lung capacity, DLCO, carbon monoxide transfer coefficient (KCO) and standard anthropometric parameters in 28 patients with a FEV₁/FVC ratio of <70%. We then compared tidal volume measurements from a previously validated EIT unit and a standard pneumotachometer.ResultsThe mean (SD) lung function results were FVC, 72 (16%); FEV₁, 43% (14%); FEV1/FVC, 42% (9%); residual volume, 161% (44%); total lung capacity, 112% (17%); DLCO, 58% (17%); and KCO, 75% (25%). Mean (SD) tidal volumes measured by the pneumotachometer and the EIT unit were 0.697 (0.181) L and 0.515 (0.223) L, respectively (P<.001). Significant associations were found between EIT measurements and CO transfer parameters. The mathematical model developed to adjust for the differences between the 2 measurements (R²=0.568; P<.001) was compensation factor=1.81 – 0.82 × height (m) – 0.004×KCO (%).ConclusionsThe measurement of breathing pattern by EIT in patients with COPD requires the use of a previously calculated calibration equation that incorporates not only individual anthropometric characteristics but gas exchange parameters as well.     

Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders

Background contextNeuromuscular disorders (NMD) are characterized by loss of lung volume and respiratory muscle weakness, but the effects of scoliosis on lung function are unclear.PurposeTo compare pulmonary function and respiratory muscle strength in patients with NMD with and without scoliosis as well as in healthy controls.Study design/settingProspective comparison of pulmonary function testing and respiratory muscle strength were made at the pediatric pulmonology and cardiopulmonary rehabilitation units of a university hospital.Patient sampleTwenty-two patients with NMD and scoliosis, 17 patients with NMD without scoliosis, and 24 age- and sex-matched healthy controls. Outcome measures were compared in patients with NMD with and without scoliosis and healthy subjects using Student t test, Mann-Whitney U test, chi-square test, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Pearson correlation coefficients, and Spearman rank correlation, as appropriate.Outcome measures1) Pulmonary function: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow rate (PEF), forced expiratory flow between 25% and 75% of FVC (FEF_25–75%), and maximum expiratory flows at 75%, 50%, and 25% of FVC (MEF₇₅, MEF₅₀, and MEF₂₅, respectively); 2) oxygen saturation: pulse oxymeter reading; and 3) respiratory muscle strength: maximal inspiratory mouth pressure (MIP) and maximal expiratory mouth pressure (MEP).MethodsPulmonary function, oxygen saturation, MIP, and MEP were measured and compared in patients with NMD, patients with and without scoliosis, and in healthy subjects.ResultsThe patients with NMD, both with and without scoliosis, had significantly lower PEF, MIP, MEP, % predicted MIP (%MIP), and % predicted MEP (%MEP) than those of healthy subjects (p<.05). The patients with NMD and scoliosis had significantly lower values than those with NMD without scoliosis and controls (p<.05) for FVC, FEV₁, and FEF_25–75%.ConclusionBoth inspiratory and expiratory muscle strength were diminished in patients with NMD compared with healthy controls. Significant differences were also noted in pulmonary function in patients with NMD with or without scoliosis. This suggests that NMD may impact respiratory function independently of the effects of scoliosis. Clinicians treating patients with NMD should be aware of the possibility of compromised respiratory function in these patients to address possible complications.     

Prediction of pulmonary function after lobectomy

Aim-Background

Lung cancer is the most common cause of cancer death in both men and women in our country. It has been estimated that there will be 7,000 lung cancer deaths every year in Greece. However, many patients with bronchogenic carcinoma also have coexistent obstructive lung disease. In these patients, preoperative prediction of functional status after lung resection is mandatory. The aim of our study was to determine the effect of lobectomy on postoperative spirometric lung function.

Methods

Seventy-two patients underwent spirometric pulmonary tests preoperatively, and at three and six months after surgery. The predicted postoperative forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) were calculated using the following formula suggested by Juhl and Frost.

Results

The functional percentage loss at six months for lobectomies was 7.34% for FVC and 7.72% for FEV₁ respectively. The linear regression analysis derived from the correlation between predicted and measured FEV₁ revealed the following equation: FEV ₁ POSTOP = 0.00211+0.896660 X FEV ₁ PREOP.

Conclusions

We conclude that our formula is a reliable method for predicting postoperative respiratory function of the patients with lung cancer.     

Reliability of assessment of nasal flow rate for nostril selection during nasotracheal intubation

Study ObjectiveTo evaluate the reliability of assessments of nasal flow rate for improved nostril selection for nasotracheal intubation.DesignProspective, randomized, double-blinded study.SettingOperating room of a university-affiliated hospital.Patients118 ASA physical status 1 and 2 patients, aged 18-65 years, scheduled for elective maxillofacial and oral surgery requiring nasotracheal intubation.InterventionsPatients were randomized to the left or right nostril groups. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁) through the mouth and each nostril were measured before anesthesia induction.MeasurementsThe relationship between the rate of airflow through the selected nostril and frequency of epistaxis and navigability of the nasotracheal tube were evaluated.Main ResultsThere were no significant differences in the frequency of epistaxis and degree of navigability of the tracheal tube between the left and right nostril groups. In both nostril groups, patients who suffered epistaxis showed significantly less FEV₁ and FEV₁/FVC values than did patients without epistaxis (P < 0.05). In addition, in both groups patients who passed the tube easily showed significantly higher FEV₁ and FEV₁/FVC values than did patients who passed the tube with resistance or failed tube passage (P < 0.05).ConclusionMeasurement of nasal flow rate is a useful clinical method for choosing a nostril for nasotracheal intubation.     

Omalizumab for asthma and allergic bronchopulmonary aspergillosis in adults with cystic fibrosis

BackgroundIn cystic fibrosis (CF), omalizumab has been used for difficult-to-treat asthma and allergic bronchopulmonary aspergillosis (ABPA) but safety and efficacy data are limited for this population.MethodsWe assessed patients receiving omalizumab for asthma or ABPA in the Toronto adult CF center between 2005 and 2017. We evaluated treatment safety and efficacy by analyzing changes in FEV₁% predicted (FEV₁pp) max value, slope and variability captured by the area under the curve (AUC), the cumulative dose of systemic corticosteroids (SCS), use of intravenous (IV) antibiotics and hospitalization days before omalizumab and up to 1 year after treatment initiation. Linear mixed effects model was used for FEV₁pp slope and the trapezoidal rule for FEV₁pp AUC.ResultsTwenty-seven CF patients received omalizumab, 16 (59.3%) for asthma and 11 (40.7%) for ABPA. No significant omalizumab-related adverse effects were observed. In the asthmatic group, the max value of FEV₁pp improved on omalizumab and the cumulative dose of SCS decreased. In the ABPA group, the rate of FEV₁pp decline (slope) and the variability of FEV₁pp (AUC) improved on omalizumab. In ABPA patients, the cumulative SCS dose was not significantly different but 4 (36%) patients decreased their SCS dose by >50% compared to baseline. Days on IV antibiotics and hospital days did not differ significantly before and while on omalizumab therapy.ConclusionsIn adult CF patients with difficult-to-treat asthma or ABPA, omalizumab should be considered. Larger studies are needed to identify patient characteristics that may predict response to omalizumab.     

Pulmonary function after early vs late lobectomy during childhood: a preliminary study

Background

One proposed reason for the early resection of asymptomatic congenital cystic adenomatoid malformations is the theoretical benefit of optimizing compensatory lung growth during infancy and early childhood. Our aim was to determine if early lobectomy is associated with better long-term pulmonary function than lobectomy later in childhood.

Methods

A retrospective chart review of children undergoing pulmonary lobectomy for benign disease from 1990 to 2006 was performed. Those having surgery before and after 2 years of age were compared. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) were used as indicators of pulmonary growth, with FVC less than 80% predicted and FEV₁ less than 80% consistent with impaired pulmonary function.

Results

Of 115 patients identified, 14 had postoperative pulmonary function testing at a mean age of 10 years. Of these, 7 had lobectomy before and 7 had lobectomy after 2 years of age. There was no significant difference between groups in mean FVC (81.5 vs 83.3) or the number of children with FVC less than 80% predicted, nor was there a difference in mean FEV₁ (87.6 vs 82.9) or the number of children with FEV₁ less than 80%.

Conclusions

Age at the time of lobectomy did not influence FVC or FEV₁. These preliminary data suggest that early lobectomy does not confer an advantage to the child with respect to long-term pulmonary function. A prospective study is necessary to confirm or refute these findings in a larger group of children.     

Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division,Australia

Summary

Given limited information available regarding associations between lung function and bone mineral density among healthy subjects, we undertook these analyses in the Hertfordshire Cohort Study. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC were not associated with bone mineral density at any site; associations with bone mineral content were removed by adjustment for body size.

Purpose

There is limited information available regarding the association between lung function and bone mineral density among healthy elderly subjects. We addressed this issue in the Hertfordshire Cohort Study.

Methods

From the above cohort, 985 subjects (496 men and 489 women) aged 60–72 years were recruited. All subjects underwent bone density measurements using dual energy X-ray absorptiometry and lung function tests using standardised spirometry. Chronic obstructive pulmonary disease (COPD) was defined as a FEV₁/FVC ratio Results

Measures of lung function (FEV₁, FVC and FEV₁/FVC) were not associated with bone mineral density at the lumbar spine, femoral neck and total hip in men or women; associations with bone mineral content and bone area were removed by adjustment for body size and lifestyle confounders. In this cohort, there were no associations observed between COPD and any measure of bone mass.

Conclusions

There was no association between lung function and bone mass in this community dwelling cohort after adjustment for body size and other confounders.

     

Six-minute walking and pulmonary function test outcomes during the early period after lung cancer surgery with special reference to patients with chronic obstructive pulmonary disease

Objective: To evaluate physical dysfunction during the early period after lung resection in patients with lung cancer and coexisting chronic obstructive pulmonary disease (COPD), we examined the relationship between the ratio of the forced expiratory volume in 1 second to the forced vital capacity (FEV₁/FVC%) and the results of a 6-minute walk (6MW) test before and after surgery. Methods: Eighty-three patients who underwent lobectomy for lung cancer were classified into three groups according to their preoperative FEV₁/FVC: more than 70% (non-COPD, n=61), 60–69% (mild COPD, n=15), and 40–59% (moderate COPD, n=7). The 6MW and pulmonary function tests were performed before surgery and repeated 1 and 2 weeks after surgery. During the 6MW test, the distance covered during a 6MW test (6MWD) and the decrease in oxygen saturation (SpO₂) were measured. Results: During both the preoperative and postoperative 6MW tests, the decrease in SpO2 correlated significantly with the preoperative FEV₁/FVC% (p<0.001). The percentage decrease in 6MWD at 1 and 2 weeks after surgery correlated significantly with the preoperative FEV₁/FVC% (p<0.001 and p=0.04, respectively), but not with the concomitant percentage reduction in vital capacity (VC). The differences of the decreases in postoperative 6MWD and SpO₂ during the 6MW test were significant between the moderate and mild COPD patients and between the mild COPD and non-COPD patients (p<0.01–0.001). Conclusion: The decreases in 6MWD and SpO₂ after surgery were significantly influenced by the preoperative FEV₁/FVC%, but not by the decrease in VC. COPD patients have a limited capacity for walking during the early period after surgery due to significant oxygen desaturation.     

高海拔地区脊柱侧凸患者心肺功能变化

目的评估高寒缺氧环境对脊柱侧凸患者心肺功能的影响。方法回顾分析2006年1月~2012年12月本院收治的高海拔地区特发性脊柱侧凸患者31例,并选取同时期来自平原地区的其他特征(年龄、性别、侧凸角、后凸角)相似特发性脊柱侧凸患者31例作配对研究。收集并分析62例患者术前站立位全脊柱正侧位X线片、术前肺功能和心脏彩超检查结果。结果高海拔地区脊柱侧凸患者心脏彩超结果中每搏输出量(stroke volume,SV)、射血分数(ejection fraction,EF)、左房内径(left atrial internal diameter,LAID)、左室内径(left ventricular internal diameter,LVID)、右房内径(right atrial internal diameter,RAID)以及肺功能检查中肺活量(vital capacity,VC)、肺总量(total lung capacity,TLC)、用力肺活量(forced vital capacity,FVC)、一秒率(FEV1/FVC%)大小与平原地区脊柱侧凸患者检查结果相比差异无统计学意义(P0.05)。而高海拔地区与平原地区脊柱侧凸患者的右室内径(right ventricular internal diameter,RVID)、第一秒用力呼气容积(forced expiratory volume in one second,FEV1)实测值相比,差异具有统计学意义(P0.05)。结论高海拔地区与平原地区脊柱侧凸患者的心肺功能总体上无明显差异,在进行术前评估、准备和围手术期处理上,高海拔地区脊柱侧凸患者与平原地区脊柱侧凸患者相比并无特殊。