scholarly journals Lung function and breathing patterns in hospitalised COVID-19 survivors: a review of post-COVID-19 Clinics

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
James A. Stockley ◽  
Eyas A. Alhuthail ◽  
Andrew M. Coney ◽  
Dhruv Parekh ◽  
Tarekegn Geberhiwot ◽  
...  
Keyword(s):  
Lung Function ◽  
Intensive Therapy ◽  
Respiratory Physiology ◽  
Lung Damage ◽  
P Value ◽  
Gas Transfer ◽  
Breathing Patterns ◽  
Nominal Data ◽  
Respiratory Muscle Fatigue ◽  
Alveolar Volume

Abstract Introduction There is relatively little published on the effects of COVID-19 on respiratory physiology, particularly breathing patterns. We sought to determine if there were lasting detrimental effect following hospital discharge and if these related to the severity of COVID-19. Methods We reviewed lung function and breathing patterns in COVID-19 survivors > 3 months after discharge, comparing patients who had been admitted to the intensive therapy unit (ITU) (n = 47) to those who just received ward treatments (n = 45). Lung function included spirometry and gas transfer and breathing patterns were measured with structured light plethysmography. Continuous data were compared with an independent t-test or Mann Whitney-U test (depending on distribution) and nominal data were compared using a Fisher’s exact test (for 2 categories in 2 groups) or a chi-squared test (for > 2 categories in 2 groups). A p-value of < 0.05 was taken to be statistically significant. Results We found evidence of pulmonary restriction (reduced vital capacity and/or alveolar volume) in 65.4% of all patients. 36.1% of all patients has a reduced transfer factor (TLCO) but the majority of these (78.1%) had a preserved/increased transfer coefficient (KCO), suggesting an extrapulmonary cause. There were no major differences between ITU and ward lung function, although KCO alone was higher in the ITU patients (p = 0.03). This could be explained partly by obesity, respiratory muscle fatigue, localised microvascular changes, or haemosiderosis from lung damage. Abnormal breathing patterns were observed in 18.8% of subjects, although no consistent pattern of breathing pattern abnormalities was evident. Conclusions An “extrapulmonary restrictive” like pattern appears to be a common phenomenon in previously admitted COVID-19 survivors. Whilst the cause of this is not clear, the effects seem to be similar on patients whether or not they received mechanical ventilation or had ward based respiratory support/supplemental oxygen.

scholarly journals Lung Function and Breathing Patterns in Hospitalised COVID-19 Survivors: a Review of Post-COVID-19 Clinics

2021 ◽  
Author(s):  
James Stockley ◽  
Eyas A Alhuthail ◽  
Andrew M Coney ◽  
Dhruv Parekh ◽  
Tarekegn Geberhiwot ◽  
...  
Keyword(s):  
Lung Function ◽  
Intensive Therapy ◽  
Respiratory Physiology ◽  
Lung Damage ◽  
P Value ◽  
Gas Transfer ◽  
Breathing Patterns ◽  
Nominal Data ◽  
Respiratory Muscle Fatigue ◽  
Alveolar Volume

Abstract Introduction: There is relatively little published on the effects of COVID-19 on respiratory physiology, particularly breathing patterns. We sought to determine if there were lasting detrimental effect following hospital discharge and if these related to the severity of COVID-19.Methods: We reviewed lung function and breathing patterns in COVID-19 survivors >3 months after discharge, comparing patients who had been admitted to the intensive therapy unit (ITU) (n=47) to those who just received ward treatments (n=45). Lung function included spirometry and gas transfer and breathing patterns were measured with structured light plethysmography. Continuous data were compared with an independent t-test or Mann Whitney-U test (depending on distribution) and nominal data were compared using a Fisher’s exact test (for 2 categories in 2 groups) or a chi-squared test (for >2 categories in 2 groups). A p-value of < 0.05 was taken to be statistically significant.Results: We found evidence of pulmonary restriction (reduced vital capacity and/or alveolar volume) in 65.4% of all patients. 36.1% of all patients has a reduced transfer factor (TLCO) but the majority of these (78.1%) had a preserved/increased transfer coefficient (KCO), suggesting an extrapulmonary cause. There were no major differences between ITU and ward lung function although KCO alone was higher in the ITU patients (p = 0.03). This could be explained partly by obesity, respiratory muscle fatigue, localised microvascular changes, or haemosiderosis from lung damage. Abnormal breathing patterns were observed in 18.8% of subjects, although no consistent pattern of breathing pattern abnormalities was evident.Conclusions: An “extrapulmonary restrictive” like pattern appears to be a common phenomenon in previously admitted COVID-19 survivors. Whilst the cause of this is not clear, the effects seem to be similar on patients whether or not they received mechanical ventilation or had ward based respiratory support/supplemental oxygen.

scholarly journals A comparative analysis of lung function and spirometry parameters in genotype-controlled natives living at low and high altitude

2021 ◽  
Author(s):  
Esteban Ortiz-Prado ◽  
Sebastián Encalada ◽  
Johanna Mosquera ◽  
Katherine Simbaña-Rivera ◽  
Lenin Gomez-Barreno ◽  
...  
Keyword(s):  
Lung Function ◽  
High Altitude ◽  
Influencing Factor ◽  
Cross Sectional Study ◽  
Respiratory Physiology ◽  
Categorical Variables ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Restrictive Pattern

Abstract BackgroundThe reference values for lung function are associated to anatomical and lung morphology parameters, but anthropometry it is not the only influencing factor: altitude and genetics are two important agents affecting respiratory physiology. Altitude and its influence on respiratory function has been studied independently of genetics, considering early and long-term acclimatization.ObjectiveThe objective of this study is to evaluate lung function through a spirometry study in autochthonous Kichwas permanently living at low and high-altitude.MethodologyA cross-sectional study of spirometry differences between genetically matched lowland Kichwas from Limoncocha (230 m) at Amazonian basin and high-altitude Kichwas from Oyacachi (3,180 m) in Andean highlands. Chi-square method was used to analyze association or independence of categorical variables, while Student’s t test was applied to comparison of means within quantitative variables. ANOVA, or in the case that the variables didn’t meet the criteria of normality, Kruskal Wallis test were used to compare more than two groups.ResultsPeople from Oyacachi (high altitude) showed a higher predicted values than those from Limonocha (low altitude). The FVC and the FEV1 were significantly greater among highlanders than lowlanders (p value < 0.001). The FEV1/FVC was significantly higher among lowlanders than highlanders for men and women. A restrictive pattern was found in 12.9% of the participants.ConclusionResidents of Oyacachi had greater lung capacity than their peers from Limoncocha, a finding physiologically plausible according to published literature. When analyzing the spirometric patterns obtained in these populations, it was evident that no person had an obstructive pattern, while on the other hand, the restrictive pattern appeared in Limoncocha and Oyacachi populations in 12.9% although it is clear that there is a predominance of this in the individuals belonging to Limoncocha.

scholarly journals Examining the possible causal relationship between lung function, COPD and Alzheimer’s disease: a Mendelian randomisation study

2021 ◽  
Vol 8 (1) ◽  
pp. e000759
Author(s):  
Daniel Higbee ◽  
Raquel Granell ◽  
Esther Walton ◽  
Roxanna Korologou-Linden ◽  
George Davey Smith ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Lung Function ◽  
Causal Relationship ◽  
Mendelian Randomisation ◽  
P Value ◽  
Unmeasured Confounding ◽  
Increased Risk ◽  
Shared Risk

RationaleLarge retrospective case-control studies have reported an association between chronic obstructive pulmonary disease (COPD), reduced lung function and an increased risk of Alzheimer’s disease. However, it remains unclear if these diseases are causally linked, or due to shared risk factors. Conventional observational epidemiology suffers from unmeasured confounding and reverse causation. Additional analyses addressing causality are required.ObjectivesTo examine a causal relationship between COPD, lung function and Alzheimer’s disease.MethodsUsing two-sample Mendelian randomisation, we used single nucleotide polymorphisms (SNPs) identified in a genome wide association study (GWAS) for lung function as instrumental variables (exposure). Additionally, we used SNPs discovered in a GWAS for COPD in those with moderate to very severe obstruction. The effect of these SNPs on Alzheimer’s disease (outcome) was taken from a GWAS based on a sample of 24 807 patients and 55 058 controls.ResultsWe found minimal evidence for an effect of either lung function (OR: 1.02 per SD; 95% CI 0.91 to 1.13; p value 0.68) or liability for COPD on Alzheimer’s disease (OR: 0.97 per SD; 95% CI 0.92 to 1.03; p value 0.40).ConclusionNeither reduced lung function nor liability COPD are likely to be causally associated with an increased risk of Alzheimer’s, any observed association is likely due to unmeasured confounding. Scientific attention and health prevention policy may be better focused on overlapping risk factors, rather than attempts to reduce risk of Alzheimer’s disease by targeting impaired lung function or COPD directly.

Reduction in TLco and survival in a clinical population

2021 ◽  
pp. 2002046
Author(s):  
Martin Raymond Miller ◽  
Brendan G. Cooper
Keyword(s):  
Lung Function ◽  
Cox Regression ◽  
Clinical Population ◽  
European Ancestry ◽  
Grading System ◽  
Gas Transfer ◽  
Ethnic Bias ◽  
All Cause Mortality ◽  
Z Scores ◽  
Survival Risk

How best to express the level of lung gas transfer (TLco) function has not been properly explored. We used the most recent clinical data from 13 829 patients (54% male, 10% non-European ancestry), median age 60.5 years (range 20–97), median survival 3.5 years (range 0–20) to determine how best to express TLco function in terms of its relation to survival. The proportion of subjects of non-European ancestry with Global Lung Function Initiative (GLI) TLco z-scores above predicted was reduced but was significantly increased between −1.5 to −3.5 suggesting the need for ethnicity appropriate equations. Applying GLI FVC ethnicity methodology to GLI TLco z-scores removed this ethnic bias and was used for all subsequent analysis. TLco z-scores using the GLI equations were compared with Miller's US equations with median TLco z-scores being -1.43 and -1.50 for GLI and Miller equations respectively (interquartile range −2.8 to −0.3 and −2.4 to −0.7, respectively). GLI TLco z-scores gave the best Cox regression model for predicting survival. A previously proposed six-tier grading system for level of lung function did not show much separation in survival risk in the less severe grades. A new four-tier grading based on z-scores of −1.645, −3 and −5 showed better separation of risk with hazard ratio for all-cause mortality of 2.0, 3.4 and 6.6 with increasing severity. Using GLI FVC ethnicity methodology to GLI TLco predictions removed ethnic bias and may be the best approach until relevant datasets are available.

scholarly journals In Silico Ventilation Within the Dose-Volume is Predictive of Lung Function Post-radiation Therapy in Patients with Lung Cancer

2020 ◽  
Author(s):  
Yu Dong ◽  
H. Kumar ◽  
M. Tawhai ◽  
C. Veiga ◽  
A. Szmul ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Radiation Therapy ◽  
Lung Function ◽  
Significant Negative Correlation ◽  
Forced Expiratory Volume ◽  
Lung Damage ◽  
Common Side Effect ◽  
Individual Response ◽  
Large Variability ◽  
Dose Volume

AbstractLung cancer is a leading cause of death worldwide. Radiation therapy (RT) is one method to treat this disease. A common side effect of RT for lung cancer is radiation-induced lung damage (RILD) which leads to loss of lung function. RILD often compounds pre-existing smoking-related regional lung function impairment. It is difficult to predict patient outcomes due to large variability in individual response to RT. In this study, the capability of image-based modelling of regional ventilation in lung cancer patients to predict lung function post-RT was investigated. Twenty-five patient-based models were created using CT images to define the airway geometry, size and location of tumour, and distribution of emphysema. Simulated ventilation within the 20 Gy isodose volume showed a statistically significant negative correlation with the change in forced expiratory volume in 1 s 12-months post-RT (p = 0.001, R = − 0.61). Patients with higher simulated ventilation within the 20 Gy isodose volume had a greater loss in lung function post-RT and vice versa. This relationship was only evident with the combined impact of tumour and emphysema, with the location of the emphysema relative to the dose-volume being important. Our results suggest that model-based ventilation measures can be used in the prediction of patient lung function post-RT.

scholarly journals Feather duvet lung

2019 ◽  
Vol 12 (11) ◽  
pp. e231237 ◽  
Author(s):  
Patrick Liu-Shiu-Cheong ◽  
Chris RuiWen Kuo ◽  
Struan WA Wilkie ◽  
Owen Dempsey
Keyword(s):  
Lung Function ◽  
Hypersensitivity Pneumonitis ◽  
Oral Corticosteroid ◽  
Gas Transfer ◽  
Mosaic Pattern ◽  
Pet Birds ◽  
History Of ◽  
Function Testing ◽  
Oral Corticosteroid Therapy ◽  
Restrictive Pattern

A 43-year-old non-smoker was referred with a 3-month history of malaise, fatigue and breathlessness. Blood avian precipitins were strongly positive. Lung function testing confirmed a restrictive pattern with impaired gas transfer. A ‘ground glass’ mosaic pattern was seen on CT imaging, suggestive of hypersensitivity pneumonitis. Although he had no pet birds, on closer questioning he had recently acquired a duvet and pillows containing feathers. His symptoms, chest radiograph and lung function tests improved after removal of all feather bedding, and he was also started on oral corticosteroid therapy. Our case reinforces the importance of taking a meticulous exposure history and asking about domestic bedding in patients with unexplained breathlessness. Prompt recognition and cessation of antigen exposure may prevent the development of irreversible lung fibrosis.

scholarly journals Volatile organic compound breath signatures of children with cystic fibrosis by real-time SESI-HRMS

2020 ◽  
Vol 6 (1) ◽  
pp. 00171-2019 ◽  
Author(s):  
Ronja Weber ◽  
Naemi Haas ◽  
Astghik Baghdasaryan ◽  
Tobias Bruderer ◽  
Demet Inci ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
High Resolution ◽  
Organic Compound ◽  
Real Time ◽  
Volatile Organic Compound ◽  
Lung Damage ◽  
Support Vector ◽  
P Value ◽  
Large Set ◽  
Volatile Organic

Early pulmonary infection and inflammation result in irreversible lung damage and are major contributors to cystic fibrosis (CF)-related morbidity. An easy to apply and noninvasive assessment for the timely detection of disease-associated complications would be of high value. We aimed to detect volatile organic compound (VOC) breath signatures of children with CF by real-time secondary electrospray ionisation high-resolution mass spectrometry (SESI-HRMS).A total of 101 children, aged 4–18 years (CF=52; healthy controls=49) and comparable for sex, body mass index and lung function were included in this prospective cross-sectional study. Exhaled air was analysed by a SESI-source linked to a high-resolution time-of-flight mass spectrometer. Mass spectra ranging from m/z 50 to 500 were recorded.Out of 3468 m/z features, 171 were significantly different in children with CF (false discovery rate adjusted p-value of 0.05). The predictive ability (CF versus healthy) was assessed by using a support-vector machine classifier and showed an average accuracy (repeated cross-validation) of 72.1% (sensitivity of 77.2% and specificity of 67.7%).This is the first study to assess entire breath profiles of children with SESI-HRMS and to extract sets of VOCs that are associated with CF. We have detected a large set of exhaled molecules that are potentially related to CF, indicating that the molecular breath of children with CF is diverse and informative.

Evaluation of estimates of alveolar gas exchange by using a tidally ventilated nonhomogenous lung model

1997 ◽  
Vol 82 (6) ◽  
pp. 1963-1971 ◽  
Author(s):  
Thierry Busso ◽  
Peter A. Robbins
Keyword(s):  
Gas Exchange ◽  
Lung Model ◽  
Gas Composition ◽  
Breathing Patterns ◽  
Alveolar Volume ◽  
Gas Concentration ◽  
Pulmonary Capillaries ◽  
Partial Pressures ◽  
End Tidal ◽  
Alveolar Gas Exchange

Busso, Thierry, and Peter A. Robbins. Evaluation of estimates of alveolar gas exchange by using a tidally ventilated nonhomogenous lung model. J. Appl. Physiol. 82(6): 1963–1971, 1997.—The purpose of this study was to evaluate algorithms for estimating O2 and CO2 transfer at the pulmonary capillaries by use of a nine-compartment tidally ventilated lung model that incorporated inhomogeneities in ventilation-to-volume and ventilation-to-perfusion ratios. Breath-to-breath O2 and CO2 exchange at the capillary level and at the mouth were simulated by using realistic cyclical breathing patterns to drive the model, derived from 40-min recordings in six resting subjects. The SD of the breath-by-breath gas exchange at the mouth around the value at the pulmonary capillaries was 59.7 ± 25.5% for O2 and 22.3 ± 10.4% for CO2. Algorithms including corrections for changes in alveolar volume and for changes in alveolar gas composition improved the estimates of pulmonary exchange, reducing the SD to 20.8 ± 10.4% for O2 and 15.2 ± 5.8% for CO2. The remaining imprecision of the estimates arose almost entirely from using end-tidal measurements to estimate the breath-to-breath changes in end-expiratory alveolar gas concentration. The results led us to suggest an alternative method that does not use changes in end-tidal partial pressures as explicit estimates of the changes in alveolar gas concentration. The proposed method yielded significant improvements in estimation for the model data of this study.

scholarly journals Comparison of Bronchodilator Effect of Salbutamol Delivered via MDI and DPI in COPD Patients

1970 ◽  
Vol 6 (2) ◽  
pp. 22-30 ◽  
Author(s):  
R Shrestha ◽  
R Shakya
Keyword(s):  
Lung Function ◽  
Smoking Habit ◽  
Dry Powder Inhaler ◽  
Smoking History ◽  
Dose Inhaler ◽  
Chronic Obstructive ◽  
P Value ◽  
Total N ◽  
Copd Patients ◽  
Significant Difference

Introduction : Chronic Obstructive Pulmonary Disease (COPD) is one of the leading problems affecting majority of population all over the world which diminishes the quality of life of the individual and create extra burden to the society as well as country. Inhaled bronchodilator therapy is the mainstay of treatment in the management of COPD. Various inhaled [e.g. metered dose inhaler (MDI) /dry powder inhaler (DPI)] formulations are available and are widely used among the COPD patients in Nepal. Methodology : This is cross sectional prospective study, designed to compare the bronchodilating effect produced when salbutamol is delivered via two devices: MDI (Asthalin® from Cipla) and DPI (Asthalin® rotacap delivered via Rotahaler® from Cipla), in patients with stable COPD. It is proven by previous studies that intervention is necessary to improve the compliance of the patients; all subjects (total n=60; 30 in each group) are counseled and trained to follow correct inhaling technique through particular device. Then their improvements in lung function were measured with reference to the pulmonary function test based on spirometry. Results : Patients enrolled in each group were not statistically different regarding to age (P=0.318), weight (P=0.324) & BMI (P=0.836). Among the total subjects 87% had smoking history and 2% were still smoking and there was no signifi cant difference in smoking habit between the two groups (p-value 0.544 > 0.05). Similarly 91.6 % of the total had exposure to indoor air pollution which had been the major risk factor for COPD. Most of the patients were on stage II COPD (62%). Salbutamol was found to have no effect on vital statistics of patients. Study showed there was no significant difference in the improvement of forced expiratory volume in one second (FEV1) (p=0.802), FVC (p= 0.693), FEV1 % (p=1) and PEF (p=0.448) between MDI and Rotahaler groups. Major side effect associated with the MDI users is headache (79%) while those among Rotahaler users were muscle cramps (79%). Even though intervention improved the inhaler using technique among the patients in both the groups, it was found even after counseling, DPI seemed to be better understood by the patients in comparison to MDI (p=0.003 & 0.00). In addition DPI was preferred by most of the patients who were familiar with both delivery systems. It was also found to be cheaper than the MDI. Conclusion : Overall evidence suggests that although both MDI & DPI improve the lung function of COPD patients to similar extent, DPI is cheaper and more preferred and can be easily handled by the patients which can result in reduction of non-compliance. Keyword : COPD; Salbutamol; DPI; MDI; Spirometry DOI: 10.3126/saarctb.v6i2.3054 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (2) 22-30

scholarly journals The Global Lung Function Initiative (GLI) Network: bringing the world’s respiratory reference values together

Breathe ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. e56-e64 ◽  
Author(s):  
Brendan G. Cooper ◽  
Janet Stocks ◽  
Graham L. Hall ◽  
Bruce Culver ◽  
Irene Steenbruggen ◽  
...  
Keyword(s):  
Lung Function ◽  
Reference Values ◽  
Age Groups ◽  
Data Repository ◽  
Gas Transfer ◽  
List Type ◽  
Lung Function Testing ◽  
Recent Developments ◽  
Reference Equations ◽  
Function Testing

The Global Lung Function Initiative (GLI) Network has become the largest resource for reference values for routine lung function testing ever assembled. This article addresses how the GLI Network came about, why it is important, and its current challenges and future directions. It is an extension of an article published inBreathein 2013 [1], and summarises recent developments and the future of the GLI Network.Key pointsThe Global Lung Function Initiative (GLI) Network was established as a result of international collaboration, and altruism between researchers, clinicians and industry partners. The ongoing success of the GLI relies on network members continuing to work together to further improve how lung function is reported and interpreted across all age groups around the world.The GLI Network has produced standardised lung function reference values for spirometry and gas transfer tests.GLI reference equations should be adopted immediately for spirometry and gas transfer by clinicians and physiologists worldwide.The recently established GLI data repository will allow ongoing development and evaluation of reference values, and will offer opportunities for novel research.Educational aimsTo highlight the advances made by the GLI Network during the past 5 years.To highlight the importance of using GLI reference values for routine lung function testing (e.g. spirometry and gas transfer tests).To discuss the challenges that remain for developing and improving reference values for lung function tests.

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