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1.
Non-fasting bioelectrical impedance analysis in cystic fibrosis: Implications for clinical practice and research.
Hollander-Kraaijeveld, FM, Lindeman, Y, de Roos, NM, Burghard, M, van de Graaf, EA, Heijerman, HGM
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2020;(1):153-158
Abstract
BACKGROUND Nutritional status affects pulmonary function in cystic fibrosis (CF) patients and can be monitored by using bioelectrical impedance analysis (BIA). BIA measurements are commonly performed in the fasting state, which is burdensome for patients. We investigated whether fasting is necessary for clinical practice and research. METHODS Fat free mass (FFM) and fat mass (FM) were determined in adult CF patients (n = 84) by whole body single frequency BIA (Bodystat 500) in a fasting and non-fasting state. Fasting and non-fasting BIA outcomes were compared with Bland-Altman plots. Pulmonary function was expressed as Forced Expiratory Volume at 1 s percentage predicted (FEV1%pred). Comparability of the associations between fasting and non-fasting body composition measurements with FEV1%pred was assessed by multiple linear regression. RESULTS Fasting FFM, its index (FFMI), and phase angle were significantly lower than non-fasting estimates (-0.23 kg, p = 0.006, -0.07 kg/m2, p = 0.002, -0.10°, p = 0.000, respectively). Fasting FM and its index (FMI) were significantly higher than non-fasting estimates (0.22 kg, p = 0.008) 0.32%, p = 0.005, and 0.07 kg/m2, (p = 0.005). Differences between fasting and non-fasting FFM and FM were <1 kg in 86% of the patients. FFMI percentile estimates remained similar in 83% of the patients when measured after nutritional intake. Fasting and non-fasting FFMI showed similar associations with FEV1%pred (β: 4.3%, 95% CL: 0.98, 7.70 and β: 4.6%, 95% CI: 1.22, 8.00, respectively). CONCLUSION Differences between fasting and non-fasting FFM and FM were not clinically relevant, and associations with pulmonary function remained similar. Therefore, BIA measurements can be performed in a non-fasting state.
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2.
Infant lung function tests as endpoints in the ISIS multicenter clinical trial in cystic fibrosis.
Davis, SD, Ratjen, F, Brumback, LC, Johnson, RC, Filbrun, AG, Kerby, GS, Panitch, HB, Donaldson, SH, Rosenfeld, M, ,
Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society. 2016;(3):386-91
Abstract
BACKGROUND The Infant Study of Inhaled Saline (ISIS) in CF was the first multicenter clinical trial to utilize infant pulmonary function tests (iPFTs) as an endpoint. METHODS Secondary analysis of ISIS data was conducted in order to assess feasibility of iPFT measures and their associations with respiratory symptoms. Standard deviations were calculated to aid in power calculations for future clinical trials. RESULTS Seventy-three participants enrolled, 70 returned for the final visit; 62 (89%) and 45 (64%) had acceptable paired functional residual capacity (FRC) and raised volume measurements, respectively. Mean baseline FEV0.5, FEF75 and FRC z-scores were 0.3 (SD: 1.2), -0.2 (SD: 2.0), and 1.8 (SD: 2.0). CONCLUSIONS iPFTs are not appropriate primary endpoints for multicenter clinical trials due to challenges of obtaining acceptable data and near-normal average raised volume measurements. Raised volume measures have potential to serve as secondary endpoints in future clinical CF trials.
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3.
Lung clearance of 99mTc-DTPA in ankylosing spondylitis.
Cabuk, M, Ozdolap, S, Altin, R, Kart, L, Peksoy, I, Sarikaya, S, Aksoy, NB, Besir, HF, Mahmutyazicioglu, K
Hellenic journal of nuclear medicine. 2009;(1):17-21
Abstract
The association of ankylosing spondylitis (AS) and lung parenchyma abnormalities has been shown in previous studies by radiological and pulmonary function tests. Technetium-99m diethylene triamine pentaacetic acid ((99m)Tc-DTPA) dynamic lung scanning is an easy, noninvasive method to assess alveolar-capillary barrier permeability. We aimed to study the abnormalities in pulmonary clearance of (99m)Tc-DTPA in patients with AS, and the presence of any correlation between this clearance and the radiological and pulmonary function tests. We studied twenty-one nonsmoker patients with AS who were compared to 21 age and sex matched healthy volunteers. All subjects underwent pulmonary function tests and pulmonary scintigraphy with (99m)Tc-DTPA to evaluate pulmonary clearance. Clearance half time (T(1/2)) of (99m)Tc-DTPA through the lungs was calculated by placing a monoexponential fit on the 30 min activity curves. High resolution CT and pulmonary function tests were performed for each patient. Our results showed the following: Spirometric parameters of forced vital capecity (FVC) and theratio of forced expiratory value in 1sec/FVC (FEV1%) scores were worse in patients compared to the control group (P<0.005 and P<0.05, respectively). Clearance half time was longer in AS group than in the control group (58.45+/-7.59 and 51.62+/-4.79 min, respectively; P<0.05). There was a negative correlation between T(1/2) value and FEV1% (r=-0.876, P< 0.01), of AS patients and the control group. Additionally, there were moderate positive correlation between T(1/2) and FVC (r=0.705, P<0.001), weak positive correlation between T(1/2) and FEF2575 (r=0.493, P<0.05), and T(1/2) and DLCO (r=0.444, P<0.05). A positive correlation was found between the duration of the disease and T(1/2) (r=0.44, P<0.05). In conclusion, longer T(1/2) values and lower FVC values in nonsmoker AS patients may suggest not only the pulmonary involvement in AS but also the duration of the disease.
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4.
Dietary intake, lung function and airway inflammation in Mexico City school children exposed to air pollutants.
Romieu, I, Barraza-Villarreal, A, Escamilla-Núñez, C, Texcalac-Sangrador, JL, Hernandez-Cadena, L, Díaz-Sánchez, D, De Batlle, J, Del Rio-Navarro, BE
Respiratory research. 2009;(1):122
Abstract
INTRODUCTION Air pollutant exposure has been associated with an increase in inflammatory markers and a decline in lung function in asthmatic children. Several studies suggest that dietary intake of fruits and vegetables might modify the adverse effect of air pollutants. METHODS A total of 158 asthmatic children recruited at the Children's Hospital of Mexico and 50 non-asthmatic children were followed for 22 weeks. Pulmonary function was measured and nasal lavage collected and analyzed every 2 weeks. Dietary intake was evaluated using a 108-item food frequency questionnaire and a fruit and vegetable index (FVI) and a Mediterranean diet index (MDI) were constructed. The impact of these indices on lung function and interleukin-8 (IL-8) and their interaction with air pollutants were determined using mixed regression models with random intercept and random slope. RESULTS FVI was inversely related to IL-8 levels in nasal lavage (p < 0.02) with a significant inverse trend (test for trend p < 0.001), MDI was positively related to lung function (p < 0.05), and children in the highest category of MDI had a higher FEV1 (test for trend p < 0.12) and FVC (test for trend p < 0.06) than children in the lowest category. A significant interaction was observed between FVI and ozone for FEV1 and FVC as was with MDI and ozone for FVC. No effect of diet was observed among healthy children. CONCLUSION Our results suggest that fruit and vegetable intake and close adherence to the Mediterranean diet have a beneficial effect on inflammatory response and lung function in asthmatic children living in Mexico City.
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5.
The usefulness of inspiratory flow rate during inhalation corticosteroid therapy in asthma.
Banno, M, Ibata, H, Niimi, T, Sato, S, Matsushita, R
Respiration; international review of thoracic diseases. 2009;(4):387-92
Abstract
BACKGROUND The recently released handheld In-Check device can be used to measure the peak inspiratory flow rate (PIF) of patients and is reportedly useful in determining whether the PIF is sufficient for using inhaler devices. In this study, we evaluated the effects of instructions for the use of the device and of the device type based on measurements of the PIF in asthma. OBJECTIVES One hundred and thirty-five asthmatic patients who used a fluticasone propionate Diskus (FP-DK) or a budesonide Turbuhaler (BUD-TH) were studied. METHODS The PIF was measured by the In-Check device. For patients without a sufficient PIF of 50 l/min, instructions for the use of the device were given, and the device was changed to hydrofluoroalkan-beclomethasone dipropionate (HFA-BDP). RESULTS A significant correlation between the PIF and peak expiratory flow rate (p < 0.0001) was found. In 10 patients in whom the PIF did not increase to >50 l/min after instructions, the device was changed to HFA-BDP, which resulted in significant improvements in lung function in terms of the forced expiratory volume in 1 s (p = 0.018), peak expiratory flow (p = 0.038) and the maximum expiratory flow rates at 50% (p = 0.018) and 25% (p = 0.011). CONCLUSIONS Measurement of the PIF by the In-Check device is useful in the clinical management of asthma, to provide an appropriate device so as to improve lung function.
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6.
[Evaluation of pulmonary function in the elderly. Intergroupe Pneumo Gériatrie SPLF-SFGG].
Boita, F, Couderc, LJ, Crestani, B, de Wazieres, B, Devillier, P, Ferron, C, Franco, A, Guenard, H, Hayot, M, Housset, B, et al
Revue des maladies respiratoires. 2006;(6):619-28
Abstract
Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.
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7.
Mucociliary and long-term particle clearance in airways of patients with immotile cilia.
Möller, W, Häussinger, K, Ziegler-Heitbrock, L, Heyder, J
Respiratory research. 2006;(1):10
Abstract
Spherical monodisperse ferromagnetic iron oxide particles of 1.9 microm geometric and 4.2 microm aerodynamic diameter were inhaled by seven patients with primary ciliary dyskinesia (PCD) using the shallow bolus technique, and compared to 13 healthy non-smokers (NS) from a previous study. The bolus penetration front depth was limiting to the phase1 dead space volume. In PCD patients deposition was 58+/-8 % after 8 s breath holding time. Particle retention was measured by the magnetopneumographic method over a period of nine months. Particle clearance from the airways showed a fast and a slow phase. In PCD patients airway clearance was retarded and prolonged, 42+/-12 % followed the fast phase with a mean half time of 16.8+/-8.6 hours. The remaining fraction was cleared slowly with a half time of 121+/-25 days. In healthy NS 49+/-9 % of particles were cleared in the fast phase with a mean half time of 3.0+/-1.6 hours, characteristic of an intact mucociliary clearance. There was no difference in the slow clearance phase between PCD patients and healthy NS. Despite non-functioning cilia the effectiveness of airway clearance in PCD patients is comparable to healthy NS, with a prolonged kinetics of one week, which may primarily reflect the effectiveness of cough clearance. This prolonged airway clearance allows longer residence times of bacteria and viruses in the airways and may be one reason for increased frequency of infections in PCD patients.
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8.
Correlation of pulmonary 99mTc-DTPA ventilation and 99mTc-MAA perfusion scans with pulmonary function tests in asymptomatic asthmatic children.
Dai, ZK, Chen, YW, Hsu, JH, Huang, MS, Chou, SH, Wu, JR
Nuclear medicine communications. 2003;(7):819-24
Abstract
Our objective was to examine and correlate 99mTc-diethylenetriaminopentaacetic acid (99mTc-DTPA) ventilation and 99mTc-macroaggregated albumin (99mTc-MAA) perfusion (V/Q) lung scans with spirometry in asymptomatic asthmatic children. We evaluated 89 subjects (age range, 6-15 years; mean age, 9.4 years), all with at least 70% predicted forced expiratory volume in 1 s (FEV(1)). There were four V/Q scan patterns: normal in 38 (42.7%), inhomogeneous ventilation in 11 (12.4%), matched defects in 25 (28.3%) and mismatched perfusion defects in 13 (14.6%). The maximal mid-expiratory flow rate (MMEF) of the normal scan group was significantly different from that in the other groups. The MMEF of the inhomogeneous group was significantly different from that in the matched defect group and the mismatched perfusion defect group. No other significant differences in spirometric indices were found. In two children with perfusion defects, pulmonary arteriograms demonstrated no obstructive lesions. In conclusion, lung scans provide diagnostic information in asymptomatic asthmatic children, even when they are uncooperative. Abnormal scans are common in these children and are significantly correlated with reduced MMEF (% predicted), reflecting small airway flow obstruction. The pathophysiology of V/Q defects in asymptomatic asthmatic children warrants further investigation.
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9.
Human skeletal muscle energy metabolism: when a physiological model promotes the search for new technologies.
Binzoni, T
European journal of applied physiology. 2003;(3-4):260-9
Abstract
The idea that muscle function and, in fact, the function of all living tissues may be described by physical laws appeared in the second half of the 19th century. During this period, Helmoltz (Uber die Erhaltung der Kraft, 1847) showed that the principle of energy conservation may be applied to living systems. In the field of exercise physiology, this idea has been subsequently developed by Rodolfo Margaria's (1901-1983) School and the mathematical formalization of the theory has succeeded in the bioenergetic model. During the last 20 years methodical and critical study of the bioenergetic model has been carried out by Paolo Cerretelli, one of the most important heirs of Rodolfo Margaria's School. Original results and technological developments have been generated by his activity and many young scientists have been educated in this approach. The present paper wants to present the modern history of the bioenergetic model and is dedicated to Paolo Cerretelli on the occasion of his seventieth birthday.
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10.
Use of electrical impedance tomography (EIT) for the assessment of unilateral pulmonary function.
Serrano, RE, de, LB, Casas, O, Feixas, T, Calaf, N, Camacho, V, Carrió, I, Casan, P, Sanchis, J, Riu, PJ
Physiological measurement. 2002;(1):211-20
Abstract
We describe a fully automatable quantification process for the assessment of unilateral pulmonary function (UPF) by means of EIT and propose a measurement protocol for its clinical implementation. Measurements were performed at the fourth and sixth intercostal levels on a first group of ten healthy subjects (5M, 5F, ages 26-48 years) to define the proper protocol by evaluating the most common postures and ventilation modes. Several off-line processing tools were also evaluated, including the use of digital filters to extract the respiratory components from EIT time series. Comparative measures were then carried out on a second group consisting of five preoperatory patients with lung cancer (4M, IF, ages 25-77 years) scheduled for radionuclide scanning. Results show that measurements were best performed with the subject sitting down, holding his arms up and breathing spontaneously. As regards data processing, it is best to extract Fourier respiratory components. The mean of the healthy subject group leads to a left-right division of lung ventilation consistent with literature values (47% left lung, 53% right lung). The comparative study indicates a good correlation (r = 0.96) between the two techniques, with a mean difference of (-0.4+/-5.4)%, suggesting that the elimination of cardiac components from the thoracic transimpedance signal leads to a better estimation of UPF.