The use of pulmonary function testing and questionnaires as epidemiologic tools in the study of occupational lung disease

Abstract Introduction Head drop is an unusual clinical manifestation of myositis or neuromuscular weakness, and typically requires extensive investigation to identify the underlying pathology. Case report data are limited on this topic. Case description A 72-year-old man with a background of extractable nuclear antigen (ENA) negative mixed connective tissue disease, trigeminal neuralgia, interstitial nephritis and ischaemic heart disease presented with an isolated head drop. On further prompting, he confirmed mild shortness of breath on exertion. He had sclerodactyly but no features of mechanic’s hands. Serum creatinine kinase was 1398 IU/L. Electromyography was myelopathic. Muscle biopsy taken from the neck was inconclusive. He had a strongly positive anti-nuclear antibody (ANA) test, and borderline myositis ENA panel result with borderline positive anti-EJ antibody. The myositis panel result prompted further investigation for underlying interstitial lung disease. Pulmonary function testing revealed a restrictive picture, with KCO of 82%. High resolution computed tomography showed areas of fine interstitial fibrotic change in all lobes. He was treated with a reducing course of oral prednisolone and 15mg weekly oral methotrexate with an excellent clinical response, with resolution of the head drop and normalisation of serum CK value. Repeat pulmonary function testing remains stable after 5 months. Discussion This is an unusual presentation of presumed anti-synthetase syndrome. As methotrexate had already been prescribed before the underlying lung pathology was identified with resulting excellent clinical response and stable respiratory symptoms, a multi-disciplinary decision was made to continue with this choice of disease modifying agent. The decision to use methotrexate in the presence of interstitial fibrosis is always difficult, and requires close liaison between rheumatology and respiratory colleagues. Key learning points Positive anti-synthetase antibodies should prompt further investigation for underlying interstitial lung disease. Head drop can be a first symptom of autoimmune myositis and warrants further investigation. Conflicts of interest The authors have declared no conflicts of interest.

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122. Higher Mortality in RA-Associated Interstitial Lung Disease is Associated with Lack of Pulmonary Function Testing

Rheumatology ◽

10.1093/rheumatology/keu103.006 ◽

2014 ◽

Vol 53 (suppl_1) ◽

pp. i104-i104

Author(s):

Riwa Meshaka ◽

Emma Helm ◽

Alec Price-Forbes ◽

Shirish Dubey ◽

Felix Woodhead

Keyword(s):

Interstitial Lung Disease ◽

Pulmonary Function ◽

Lung Disease ◽

Pulmonary Function Testing ◽

Function Testing

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The clinical physics and physiology of chronic lung disease, inhalation therapy and pulmonary function testing

Journal of Chronic Diseases ◽

10.1016/0021-9681(74)90022-8 ◽

1974 ◽

Vol 27 (7-8) ◽

pp. 428-429

Author(s):

Barry A. Shapiro

Keyword(s):

Pulmonary Function ◽

Lung Disease ◽

Chronic Lung Disease ◽

Pulmonary Function Testing ◽

Inhalation Therapy ◽

Function Testing

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Quantification of heterogeneity in lung disease with image-based pulmonary function testing

Scientific Reports ◽

10.1038/srep29438 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 22

Author(s):

Charlene S. Stahr ◽

Chaminda R. Samarage ◽

Martin Donnelley ◽

Nigel Farrow ◽

Kaye S. Morgan ◽

...

Keyword(s):

Pulmonary Function ◽

Lung Disease ◽

Pulmonary Function Testing ◽

Function Testing

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Improved Lung Function after Sinus Surgery in Cystic Fibrosis Patients with Moderate Obstruction

Otolaryngology ◽

10.1177/0194599817739284 ◽

2017 ◽

Vol 158 (2) ◽

pp. 381-385 ◽

Cited By ~ 14

Author(s):

Sabrina Khalfoun ◽

Dmitry Tumin ◽

Maroun Ghossein ◽

Meredith Lind ◽

Don Hayes ◽

...

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Pulmonary Function ◽

Lung Disease ◽

Pulmonary Function Testing ◽

Sinus Surgery ◽

Before And After ◽

Function Testing ◽

Severe Lung Disease ◽

Severe Lung

Objectives Cystic fibrosis (CF) is characterized by infection and inflammation of the sinorespiratory tract. Functional endoscopic sinus surgery (FESS) is an option for patients with severe sinusitis. We sought to evaluate pulmonary function testing after FESS in pediatric and adult patients with CF. Study Design Retrospective chart review using data from all patients with CF who underwent FESS from January 2009 to July 2014. Setting Patients were from a single institution. Subjects and Methods Data were extracted for 181 patients and 320 surgeries. Lung function data, including the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC, were retrieved within 1 year before and after surgery. Mixed-effects regression was used to compare FEV1 trajectories before and after surgery. The effect of surgery was stratified by presurgery FEV1 to compare patients with mild/no lung disease (FEV1 >80%) and moderate/severe lung disease (FEV1 <80%). Results Of the 181 patients reviewed, 131 with primary FESS had FEV1 data. Presurgery average age was 16 years (95% confidence interval [CI], 14.27-17.73), and FEV1 mean was 85% (95% CI, 81.02-88.98). There were 88 patients with FEV1 >80% and 43 patients with FEV1 <80%. For the entire cohort, lung function did not change related to FESS. Among patients with FEV1 <80%, FEV1 declined presurgery by 3.5% per year (95% CI, −6.1% to −0.8%; P = .010), which halted after surgery with these patients, then showing no subsequent change in FEV1 (95% CI, 0.9%-3.7%; P = .240). No benefit was identified for patients with FEV1 >80%. Conclusion Pulmonary function testing improved in patients with moderate/severe lung disease 1 year following FESS. This suggests FESS may benefit pulmonary outcomes.

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