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Z scores and percent predicted values of spirometry parameters are widely used for the evaluation of pulmonary function and detection of respiratory diseases. Decreased pulmonary function should correlate with reduction of muscle strength although it is unclear whether z scores of respiratory parameters are associated with muscle strength. In a cohort of 398 adults, pulmonary function assessment and muscle strength measurement by handgrip strength and physical activity level were evaluated. Probable sarcopenia was defined by muscle strength reduction. Univariate and multivariate regression analysis and ROC curve were applied. The AUC for FEV1 and FVC were significantly greater than the z FEV1 and z FVC ( p  = 0.0004 and p  = 0.0008) respectively. Multivariate regression analysis adjusted for confounders also reported a significant and independent relationship between z FEV1; z FVC and HGS measurements. FEV 1 and FVC in absolute values have an important role in the detection of sarcopenia status. Predicted values and z scores also show a significant association suggesting the pathophysiological connection between lung function and muscle strength.

BackgroundRecent studies have suggested that a restrictive pattern assessed with a single spirometric test is associated with increased morbidity and mortality. This study was undertaken to determine demographic, clinical and mortality profiles of subjects with either a recurrent or an inconsistent restrictive spirometric pattern assessed prospectively.MethodsData from 2048 adult participants in the population-based TESAOD study were analysed. Normal (forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio ≥70% and FVC ≥80% predicted), restrictive (FEV1/FVC ≥70% and FVC <80% predicted) and obstructive (FEV1/FVC <70%) patterns were assessed at the enrolment survey in 1972 and in 11 subsequent follow-up surveys up to 1996. Demographic and clinical characteristics were measured at enrolment and vital status and cause of death were assessed at January 2005.ResultsOverall, 12% of participants had a restrictive spirometric pattern at enrolment. They were less likely to be male, to smoke and to have asthma, and had lower IgE levels than subjects in the obstructive group. Among subjects with a restrictive pattern at enrolment, 38% developed an obstructive pattern during follow-up. The remaining 62% had either a recurrent (restrictive pattern ≥50% of follow-up surveys) or inconsistent (restrictive pattern <50% of follow-up surveys) longitudinal restrictive pattern. The recurrent and inconsistent restrictive groups had increased mortality risk for all-cause (adjusted HR 1.7 (95% CI 1.3 to 2.3) and 1.9 (95% CI 1.4 to 2.6), respectively), heart disease (2.0 (95% CI 1.3 to 3.1) and 2.7 (95% CI 1.7 to 4.3)), stroke (2.4 (95% CI 0.9 to 6.3) and 3.5 (95% CI 1.2 to 9.8)) and diabetes (8.0 (95% CI 2.9 to 21.8) and 6.0 (95% CI 1.9 to 19.2)).ConclusionsThe restrictive spirometric pattern identifies a pulmonary condition that is distinguishable from obstructive lung disease and is associated with an increased risk of life-threatening comorbidities.

The effect of acute and long-term exposures to outdoor particulate air pollution on lung function in healthy adults is not well established. The objective of this study was to conduct a systematic literature review and meta-analysis of studies that assessed the relationship of outdoor particulate air pollution and lung function in healthy adults. Studies that contained data on outdoor air particulate matter levels (PM 10 or PM 2.5 ) and forced expiratory volume in 1 s (FEV 1 ) in healthy adults were eligible for inclusion. Effect estimates, in relation to long-term and acute exposures, were quantified separately using random effects models. A total of 27 effect estimates from 23 studies were included in this review. Acute exposures were typically assessed with PM 2.5 , while long-term exposures were predominantly represented by PM 10 . A 10 µg/m3 increase in short-term PM 2.5 exposure (days) was associated with a −7.02 mL (95% CI −11.75 to –2.29) change in FEV 1 . A 10 µg/m 3 difference in long-term PM 10 exposure was associated with a −8.72 mL (95% CI −15.39 to –2.07) annual change in FEV 1 and an absolute difference in FEV 1 of −71.36 mL (95% CI −134.47 to –8.24). This study provides evidence that acute and long-term exposure to outdoor particulate air pollution are associated with decreased FEV 1 in healthy adults. Residual confounding from other risk factors, such as smoking, may explain some of the effect for long-term exposures. More studies are required to determine the relationship of long-term exposure to PM 2.5 and short-term exposure to PM 10 , which may have different biologic mechanisms.

BACKGROUND: Specific characteristics of particulate matter (PM) responsible for associations with respiratory health observed in epidemiological studies are not well established. High correlations among, and differential measurement errors of, individual components contribute to this uncertainty. OBJECTIVES: We investigated which characteristics of PM have the most consistent associations with acute changes in respiratory function in healthy volunteers. METHODS: We used a semiexperimental design to accurately assess exposure. We increased exposure contrast and reduced correlations among PM characteristics by exposing volunteers at five different locations: an underground train station, two traffic sites, a farm, and an urban background site. Each of the 31 participants was exposed for 5 hr while exercising intermittendy, three to seven times at different locations during March— October 2009. We measured PM₁₀ , PM₂.₅, particle number concentrations (PNC), absorbance, elemental/organic carbon, trace metals, secondary inorganic components, endotoxin content, gaseous pollutants, and PM oxidative potential. Lung function [FEV₁ (forced expiratory volume in 1 sec), FVC (forced vital capacity), FEF₂₅_₇₅ (forced expiratory flow at 25-75% of vital capacity), and PEF (peak expiratory flow)] and fractional exhaled nitric oxide (FENQ) were measured before and at three time points after exposure. Data were analyzed with mixed linear regression. RESULTS: An interquartile increase in PNC (33,000 particles/cm³) was associated with an 11% [95% confidence interval (CI): 5, 17%] and 12% (95% CI: 6, 17%) FENO increase over baseline immediately and at 2 hr postexposure, respectively. A 7% (95% CI: 0.5, 14%) increase persisted until the following morning. These associations were robust and insensitive to adjustment for other pollutants. Similarly consistent associations were seen between FVC and FEV₁ with PNC, NO₂ (nitrogen dioxide), and NOX (nitrogen oxides). CONCLUSIONS: Changes in PNC, NO₂, and NOX were associated with evidence of acute airway inflammation (i. e., FENO) and impaired lung function. PM mass concentration and PM₁₀ oxidative potential were not predictive of the observed acute responses.

Extracorporeal photopheresis (ECP) is used by few lung transplant centers to treat chronic lung allograft dysfunction (CLAD). Although reported results suggest a beneficial effect on CLAD progression, evidence is limited to single center experiences. The aim of this study is to analyze outcomes of ECP in a large multicenter European cohort. The primary endpoint was patient survival after initiation of ECP. This study included 631 patients, 87% suffered from bronchiolitis obliterans syndrome (BOS), and 13% had restrictive allograft syndrome (RAS). Long-term stabilization was achieved in 42%, improvement in 9%, and no response in 26%. Within the first 12 months of therapy, 23% of patients died. Patients’ survival after initiation of ECP at 5 years was 56% in stable, 70% in responders, and 35% in non-responders ( p = 0.001). In multivariable Cox regression, both stabilization (HR: 0.48, CI: 0.27–0.86, p = 0.013) and response (HR: 0.11, CI: 0.04–0.35, p < 0.001) to ECP were associated with survival. Absolute FEV1 at baseline was also protective (HR: 0.09, CI: 0.01–0.94, p = 0.046). RAS phenotype was the only risk factor for mortality (HR: 2.11, 1.16–3.83, p = 0.006). This study provides long-term outcomes of ECP use in CLAD patients in the largest published cohort to date. Two-thirds of the cohort had a sustained response to ECP with excellent long-term results.

ABSTRACT Asthma is a chronic respiratory disease that poses significant individual, social, financial and healthcare burdens. Physicians and researchers have recommended 25-hydroxy vitamin D supplementation, in combination with prescribed medication, as a potential means of reducing asthma severity. This systematic review focuses on the association between 25-hydroxy vitamin D levels and lung function in both children and adults with asthma. We identified published work by searching MEDLINE via PubMed, using regular search terms related to 25-hydroxy vitamin D and asthma. Fourteen studies were screened out of 643 eligible citations from MEDLINE research that involved 65 children and 951 adults. A strong positive association was observed in four studies, whereas five showed a moderate association, and two had no correlation. The majority of studies found a negative correlation between 25-hydroxy vitamin D deficiency and mild, uncontrolled and partly controlled asthma. 25-hydroxy vitamin D 25 OH values were below 20 ng/ml in the majority of studies, and those with uncontrolled severe asthma showed the lowest values.

The rate of decline of lung function is greater than age-related change in a substantial proportion of patients with chronic obstructive pulmonary disease, even after smoking cessation. Regions of the lung adjacent to emphysematous areas are subject to abnormal stretch during respiration, and this biomechanical stress likely influences emphysema initiation and progression. To assess whether quantifying this penumbra of lung at risk would predict FEV decline. We analyzed paired inspiratory-expiratory computed tomography images at baseline of 680 subjects participating in a large multicenter study (COPDGene) over approximately 5 years. By matching inspiratory and expiratory images voxel by voxel using image registration, we calculated the Jacobian determinant, a measure of local lung expansion and contraction with respiration. We measured the distance between each normal voxel to the nearest emphysematous voxel, and quantified the percentage of normal voxels within each millimeter distance from emphysematous voxels as mechanically affected lung (MAL). Multivariable regression analyses were performed to assess the relationship between the Jacobian determinant, MAL, and FEV decline. The mean (SD) rate of decline in FEV was 39.0 (58.6) ml/yr. There was a progressive decrease in the mean Jacobian determinant of both emphysematous and normal voxels with increasing disease stage (P < 0.001). On multivariable analyses, the mean Jacobian determinant of normal voxels within 2 mm of emphysematous voxels (MAL ) was significantly associated with FEV decline. In mild-moderate disease, for participants at or above the median MAL (threshold, 36.9%), the mean decline in FEV was 56.4 (68.0) ml/yr versus 43.2 (59.9) ml/yr for those below the median (P = 0.044). Areas of normal-appearing lung are mechanically influenced by emphysematous areas and this lung at risk is associated with lung function decline. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

The effect of acute and long-term exposures to outdoor particulate air pollution on lung function in healthy adults is not well established. The objective of this study was to conduct a systematic literature review and meta-analysis of studies that assessed the relationship of outdoor particulate air pollution and lung function in healthy adults. Studies that contained data on outdoor air particulate matter levels (PM10 or PM2.5) and forced expiratory volume in 1 s (FEV1) in healthy adults were eligible for inclusion. Effect estimates, in relation to long-term and acute exposures, were quantified separately using random effects models. A total of 27 effect estimates from 23 studies were included in this review. Acute exposures were typically assessed with PM2.5, while long-term exposures were predominantly represented by PM10. A 10 µg/m3 increase in short-term PM2.5 exposure (days) was associated with a −7.02 mL (95% CI −11.75 to –2.29) change in FEV1. A 10 µg/m3 difference in long-term PM10 exposure was associated with a −8.72 mL (95% CI −15.39 to –2.07) annual change in FEV1 and an absolute difference in FEV1 of −71.36 mL (95% CI −134.47 to –8.24). This study provides evidence that acute and long-term exposure to outdoor particulate air pollution are associated with decreased FEV1 in healthy adults. Residual confounding from other risk factors, such as smoking, may explain some of the effect for long-term exposures. More studies are required to determine the relationship of long-term exposure to PM2.5 and short-term exposure to PM10, which may have different biologic mechanisms.

China has established a goal of reducing adult smoking prevalence from 27.7% to 20% by 2030. Understanding the possible ongoing impairment in lung function in smokers, is critically important to encourage the populations to change their smoking behavior. A total of 14,273 males joined the health examination at Huadong Sanatorium from Jan 2012 to Dec 2019 were included. In cross-sectional analysis, we used multiple linear regression to evaluate the association between baseline lung function and smoking status. Then, 3,558 males who received ≥2 spirometry exams were analyzed in longitudinal study. Annual lung function decline was compared using mixed linear models adjusted for confounders. In cross-sectional analysis, compared with never-smokers, decreases of -133.56 mL (95% CI: -167.27, -99.85) and -51.44 mL (-69.62, -33.26) in FEV , -1.48% (-1.94, -1.02) and -1.29% (-1.53, -1.04) in FEV /FVC were observed in former and current smokers. In longitudinal analysis, significant declines were observed in FEV [5.04 (2.30, 7.78) mL] and FEV /FVC [0.09 (0.05, 0.13) %] in current smokers but not observed in former smokers after adjustment. Participants with long duration of smoking cessation had decelerate lung function than short duration. The annual decline rate of current smokers with high smoking intensity (≥30 cigarettes per day) was 13.80 and 14.17 times greater than that of never-smokers in FEV and FVC. Thus, early smoking cessation can slow down lung function decline trend for current smokers. The harms of current smoking on lung function emphasize the necessity of smoking cessation, especially for those with comorbidities.