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This study compared the effects of varying aerobic training programs on pulmonary diffusing capacity (TLCO), pulmonary diffusing capacity for nitric oxide (TLNO), lung capillary blood volume (Vc) and alveolar–capillary membrane diffusing capacity (DM) of gases at rest and just after maximal exercise in young athletes. Sixteen healthy young runners (16–18 years) were randomly assigned to an intense endurance training program (IET, n = 8) or to a moderate endurance training program (MET, n = 8). The training volume was similar in IET and MET but with different work intensities, and each lasted for 8 weeks. Participants performed a maximal graded cycle bicycle ergometer test to measure maximal oxygen consumption (VO2max) and maximal aerobic power (MAP) before and after the training programs. Moreover, TLCO, TLNO and Vc were measured during a single breath maneuver. After eight weeks of training, all pulmonary parameters with the exception of alveolar volume (VA) and inspiratory volume (VI) (0.104 < p < 0889; 0.001 < ES < 0.091), measured at rest and at the end of maximal exercise, showed significant group × time interactions (p < 0.05, 0.2 < ES < 4.0). Post hoc analyses revealed significant pre-to-post decreases for maximal heart rates (p < 0.0001, ES = 3.1) and improvements for VO2max (p = 0.006, ES = 2.22) in the IET group. Moreover, post hoc analyses revealed significant pre-to-post improvements in the IET for DM, TLNO, TLCO and Vc (0.001 < p < 0.0022; 2.68 < ES < 6.45). In addition, there were increases in Vc at rest, VO2max, TLNO and DM in the IET but not in the MET participants after eight weeks of training with varying exercise intensities. Our findings suggest that the intensity of training may represent the most important factor in increasing pulmonary vascular function in young athletes.

Background: In North-African adults, location-specific reference values for membrane diffusion capacity (D m ) and pulmonary capillary blood volume (V c ) were needed. Objectives: To verify the applicability of previously published reference equations for D m and V c in North-African healthy adults (age >18 years) and to determine specific reference equations for North Africa. Methods: The study was designed as a prospective cross-sectional study. Anthropometric data (age, height, weight and body mass index) and D m and V c were assessed in 85 healthy Tunisian adults. Univariate and multiple linear regression analyses were used to determine reference equations and to calculate the lower limit of the normal range (LLN). Results: The mean ages ± SD (minimum – maximum) for male and female adults were 53 ± 21 (21–85) and 42 ± 16 (18–72) years, respectively. Previously published reference equations did not reliably predict measured D m and V c . The reference equation (r 2 = 47%) for D m was –36.16 + 45.37 × height – 0.34 × age + 0.39 × weight + 7.41 × gender (0 = female and 1 = male). To calculate the D m LLN subtract 24.36 from the reference value. The reference equation (r 2 = 30%) for female V c was 94.70 – 0.57 × age, and the reference equation (r 2 = 52%) for male V c was 0.82 – 0.48 × age + 52.47 × height + 0.16 × weight. To calculate the V c LLN subtract 28.52 and 26.54 from these reference values for females and males, respectively. Conclusion: These V c and D m reference equations supplement the international World Bank of reference equations.

Background The patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard. Methods In 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models. Results In PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23–365.04; p  < 0.001) and 186.79 (95% CI: 100.48–379.93; p  < 0.001), respectively. Conclusion CSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.

We assessed the relationships between changes in lung compliance, lung volumes and dynamic hyperinflation in patients with emphysema who underwent bronchoscopic treatment with nitinol coils (coil treatment) (n=11) or received usual care (UC) (n=11). Compared with UC, coil treatment resulted in decreased dynamic lung compliance (CLdyn) (p=0.03) and increased endurance time (p=0.010). The change in CLdyn was associated with significant improvement in FEV1 and FVC, with reduction in residual volume and intrinsic positive end-expiratory pressure, and with increased inspiratory capacity at rest/and at exercise. The increase in end-expiratory lung volume (EELV) during exercise (EELVdyn-ch=EELVisotime EELVrest) demonstrated significant attenuation after coil treatment (p=0.02).

The aims of this prospective study were (1) to select, after weaning and extubation, chronic obstructive pulmonary disease (COPD) patients with expiratory flow limitation (EFL) measured by the negative expiratory pressure method and (2) to assess, in these patients, the short-term (30 minutes) physiologic effect of a session of intrapulmonary percussive ventilation (IPV). All COPD patients who were intubated and needed weaning from mechanical ventilation were screened after extubation. The patients were placed in half-sitting position and breathed spontaneously. The EFL and the airway occlusion pressure after 0.1 second (P0.1) were measured at the first hour after extubation. In COPD patients with EFL, an IPV session of 30 minutes was promptly performed by a physiotherapist accustomed to the technique. Expiratory flow limitation, gas exchange, and P0.1 were recorded at the end of the IPV session. Among 35 patients studied after extubation, 25 patients presented an EFL and were included in the study. Intrapulmonary percussive ventilation led to a significant improvement in EFL, respectively, before and 30 minutes after IPV (65.4 ± 18.2 vs 35.6 ± 22.8; P < .05). Three patients were not expiratory flow limited after IPV. Intrapulmonary percussive ventilation led to a significant decrease in P0.1 (3.9 ± 1.6 vs 2.8 ± 1.1; P < .05). Thirty minutes of IPV led to a significant increase in Pao2 and pH and a decrease in Paco2 and respiratory rate (P < .05). In COPD patients, a session of IPV allowed a significant reduction of EFL and of P01 and a significant improvement of gas exchange.

The objective of this study was to assess whether parameters of the negative expiratory pressure (NEP) technique are able to detect obstructive sleep apnea syndrome (OSAS) in snoring patients. A cross-sectional study included 42 OSAS patients diagnosed by polysomnography (PSG), 34 simple snorers, and 32 healthy subjects. Lung function was measured by using a plethysmograph and the NEP technique was performed with the patient in the seated and supine positions in a random order. The depression was fixed to 5 cmH₂O. All patients had normal forced expiratory flow/volume loops. Apneic patients had lower Dflow in both positions with a number of oscillations on the expiratory curve obtained with NEP and an expiratory flow limitation (EFL) in the supine position higher than that of other groups (p < 0.05). Changing from the sitting to the supine position raised the EFL of the three groups, with a significant decrease in Dflow and an increase in the number of oscillations in snoring and OSAS patients (p < 0.05). The analysis of variance showed that only the number of oscillations was significantly different between apneic and snoring patients. NEP constitutes a simple and useful tool for the screening OSAS by EFL, especially the number of oscillations obtained with NEP.

The aim of this study was to confirm the ability of the airway occlusion pressure after 0.1 second (P0.1) recorded after extubation to define chronic obstructive pulmonary disease (COPD) patients with a high risk of postextubation respiratory failure and to evaluate the role of the expiratory flow limitation (EFL) in these patients. Thirty 5 COPD patients who had been weaned from mechanical ventilation and extubated were included in the study. Expiratory flow limitation by the negative expiratory pressure method and P0.1 were recorded at the first hour of postextubation. We determined whether those patients who developed postextubation respiratory failure (failed extubation group) differed from those who did not (successful extubation group). Fourteen patients presented a postextubation respiratory failure. Expiratory flow limitation and P0.1 values in the failed extubation group, respectively (61.6% ± 34.0%; 4.3 ± 1.7 cm H 20) were significantly different ( P < .05) from those observed in the successful extubation group, respectively (20.3% ± 24.6%; 1.8 ± 0.8 cm H 20). P0.1 and EFL would seem to be of use in predicting extubation outcome, respectively (OR 3.66, 95% confidence interval 1.68-7.94; OR 1.04, 95% confidence interval 1.01-1.07). The area under the receiver operating characteristic curve for diagnosing postextubation respiratory failure was 0.84 for EFL and 0.87 for P0.1. Bedside evaluation of EFL and P0.1 helps to define COPD patients at high risk for postextubation respiratory failure. Extubation failure in COPD was associated with higher EFL.

In both children and adults, acute exercise increases lung capillary blood volume (Vc) and membrane factor (DmCO). We sought to determine whether basketball training affected this adaptation to exercise in children. The purpose of this study was to determine the effects of two years sport activity on the components of pulmonary gas transfer in children. Over a 2-yr period, we retested 60 nine year old boys who were initially separated in two groups: 30 basketball players (P) (9.0 ± 1.0 yrs; 35.0 ± 5.2 kg; 1.43 ± 0.05 m), and matched non players controls (C) (8.9 ± 1.0 yrs; 35.0 ± 6.0 kg; 1.44 ± 0.06 m) who did not perform any extracurricular activity, Vc and DmCO were measured by the NO/CO transfer method at rest and during sub-maximal exercise. Maximal aerobic power and peak power output was 12% higher in the trained group compared to matched controls (p < 0.05). Nitric oxide lung transfer (TLNO) per unit lung volume and thus, DmCO per unit of lung volume (VA) were higher at rest and during exercise in the group which had undergone regular basketball activity compared to matched controls (p < 0.05). Neither lung capillary blood volume nor total lung transfer for carbon monoxide (TLCO) were significantly different between groups. These results suggest that active sport can alter the properties of the lung alveolo-capillary membrane by improving alveolar membrane conductance in children. Key PointsTrained children had greater DmCO/VA and DmCO/Vc ratios compared with control children during exercise.The mechanisms by which basketball playing children were thought to improve lung diffusion are speculative.Further work will be required to determine the kinetics of the alteration in Dm when children switch from non players to players status or vice-versa.

To assess the effects of emphysema onthe apex-to-base gradient of lung density (D) and lung mass (M)and to explore the relationship between M and lung function. CT scans of whole lungs were performed in 12healthy subjects and 29 patients who were breathing at functionalresidual capacity, after which lung function tests were performed. Whole D and M and regional D (RLD) and M (RLM) were calculated. The degree of emphysema was scored. The RLM for each height did not differ significantly between patientswith disease and healthy subjects, while RLD was significantly lower inthe patients with disease. A less marked nonlinear, increasing, craniocaudal gradient of D was observed in the group with disease, suggesting that the distension increases progressively from the apex tothe base. RLD and RLM in the 40 to 90% lung height differedsignificantly among patients in the emphysema group with normal, high, and low M compared to the healthy subjects. M did not differsignificantly between patients with centrilobular and panlobularemphysema, which was thought to stem from the marked variations in theresults. Vital capacity was lower in the patients with low M. The lower RLD in the group with low M was dueto both lung overinflation and to tissue loss, while in the groups withhigh or normal M, it was due only to lungoverinflation.