Spirometric lung age for predicting the risk of pulmonary complications after thoracic surgeries

Annotation. Surgical interventions for diseases of the thoracic cavity are one of the most invasive surgical procedures, which are often accompanied by postoperative complications, which increase mortality, prolong hospital stays, require additional costs and correlate with poor long-term survival. However, respiratory complications remain the most common of non-surgical complications and their frequency varies from 13 to 38%. So far, several studies have shown that respiratory dysfunction is an independent risk factor for postoperative pneumonia. The aim – investigate whether it is possible to use spirometric lung age to predict the occurrence of postoperative pneumonia after thoracic surgeries. The study was performed on 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), underwent surgery in the thoracoabdominal department of the Shalimov’s National Institute of Surgery and Transplantation. Statistical software EZR v.1.54 was used for statistical calculations (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). We found a very strong association between the risk of developing pulmonary complications and the age of the lungs, AUC=0.97 (95% confidence interval from 0.94 to 0.99). When choosing the optimal point for predicting the risk of pulmonary complications obtained: Lung age critical = 99.6 years. Thus, at Lung age >99.6 years, the development of postoperative pulmonary complications is predicted. At Lung age <99.6 years, the absence of postoperative pulmonary complications is predicted. When choosing this decision point, the sensitivity is 93.5% (82.1-98.6%), specificity – 95.9% (91.3-98.5%). Therefore, spirometric age of the lungs was associated with the incidence of postoperative pulmonary complications in patients undergoing surgery for thoracic disease. This parameter deserves attention as a predictor of the probability of developing postoperative pneumonia after thoracic surgeries and can help in assessing the state of respiratory function of patients.

Difference Between ‘Lung Age’ and Real Age as a Novel Predictor of Postoperative Complications, Long-term Survival for Patients With Esophagus Cancer After Minimally Invasive Esophagectomy

Background This study aimed to investigate whether difference between ‘lung age’ and real age (L-R) could be useful for the prediction of postoperative complications and long-term survival in patients with esophageal cancer followed by minimally invasive esophagectomy (MIE).Methods This retrospective cohort study included 625 consecutive patients who had undergone MIE. ‘Lung age’ was determined by the calculation method proposed by Japanese Respiratory Society. According to L-R, patients were classified into three groups: group A: L-R≦ 0 (n =104), group B:15>L-R>0 (n =199), group C:L-R≥15 (n = 322). Clinicopathological factors, postoperative complications evaluated by comprehensive complications index (CCI) and overall survival were compared between the groups. A CCI value >30 indicated a severe postoperative complication.Results Male, smoking status, smoking index, chronic obstructive pulmonary disease, American Society of Anesthesiologists status, lung age, and forced expiratory volume in 1 s were associated with group classification. CCI values, postoperative hospital stays, and hospital cost were significantly different among groups. Multivariate analysis indicated that L-R, coronary heart disease, 3-field lymphadnectomy were significant factors for prediction of CCI value>30. Regarding overall survival, there was a significant difference between group A and group B+C (log rank test: P= 0.03). Conclusions Esophageal cancer patients with impaired pulmonary function had a higher risk of severe postoperative complications and poorer prognosis than those with normal pulmonary function. Difference between ‘lung age’ and ‘real age’ is a novel predictor of severe postoperative complications and long-term survival and has extensive clinical value.

Survey on the Awareness of Nontuberculous Mycobacterial Pulmonary Disease in the Japanese General Public

Background: In Japan, people are typically aware of tuberculosis (TB) as a respiratory infection, but awareness of nontuberculous mycobacteriosis is lacking. In 2014, the estimated incidence of nontuberculous mycobacterial pulmonary disease (NTM-PD) in Japan exceeded that of TB. Furthermore, the risk of infection is increasing because of the lack of public awareness regarding the high incidence of NTM-PD. The purpose of this study was to determine and raise the public awareness of NTM-PD, chronic obstructive pulmonary disease (COPD), and pulmonary rehabilitation (PR) in Japan. Methods: A questionnaire survey was administered to 845 subjects who participated in and consented to a pulmonary age measurement event in Tokyo, Japan. The questions included items related to age, sex, smoking history, previous lung age measurement experience, and assessment of awareness of respiratory diseases such as NTM-PD and COPD, and PR awareness. Results: Awareness of NTM-PD was significantly lower (5.9%) than that of other diseases and independently of age. Of the subjects questioned, 10.3% had experienced PR and 18.6% were aware about PR. Those individuals who were aware of lung age measurement, PR, and other respiratory diseases were more likely to be aware of NTM-PD than those who were unaware. Conclusions: The general public is largely unaware of NTM-PD, regardless of age. In the future, more proactive educational activities targeting a wide range of age groups through different events such as lung age measurement are needed.

Impact of Exposure to Biomass Fuel on Pulmonary Function and Lung Age in Rural Women

BACKGROUND Around half a million of people still rely on biomass fuels for cooking, which is a major source of household air pollution, associated with increased morbidity and mortality. Biomass smoke exposure is associated with airway obstruction and decreased ventilatory function. Though various studies are available in relation to biomass exposure and pulmonary function, literature is limited on lung age. Hence, the current study was undertaken to evaluate the effect of biomass fuel on pulmonary function and lung age in rural women and correlate biomass exposure index with the spirometry parameters and lung age. METHODS A cross sectional study was conducted in rural areas of Tamilnadu. Around 350 women were screened and 100 women aged > 18 years with biomass exposure for at least five years and able to perform spirometry were selected for inclusion in the study. After obtaining consent, the subjects were evaluated further with detailed history and spirometry to record the lung function parameters and lung age. Biomass exposure index was calculated from hours spent in cooking per day multiplied with the years of cooking. RESULTS Mean age of the participants was 49.88 ± 10.76 years. 68 % had indoor kitchen with inadequate ventilation in 57 % of households. Majority of the women were housewives and belonged to the middle- and low-income groups. Around 19 % were symptomatic with cough and expectoration being predominant symptoms. Spirometry was abnormal in 83 % of the women and showed obstruction in majority. Mean forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), forced expiratory flow 25 - 75 % (FEF) and peak expiratory flow (PEF) were reduced in the study population. A significant negative correlation was observed between the biomass exposure index (BEI) hour-years and FEV 1 and FEF 25 % - 75 %. A significant positive correlation was observed between BEI hours-year and lung age. CONCLUSIONS Majority of the women exposed to biomass fuel smoke, though asymptomatic, had abnormal lung function with increased lung age. Intensity of exposure as measured by biomass exposure index correlated significantly with FEV1, FEF 25 - 75 % and lung age. Hence, regular surveillance of the women using biomass fuel for cooking should be done for early identification of respiratory impairment. KEY WORDS Biomass Exposure, Biomass Fuel, Pulmonary Function, Lung Age, Biomass Exposure Index

Effectiveness of Combining Feedback about Lung Age or Exhaled Carbon Monoxide Levels with Very Brief Advice (VBA) and Support for Smoking Cessation in Primary Care Compared to Giving VBA and Support Alone – Protocol for a Randomized Controlled Trial withi

INTRODUCTION: In 2015, smoking prevalence in Republic of Macedonia was 36% in men and 21% in women We aim to assess the effectiveness and cost-effectiveness of two methods of motivating smokers to quit smoking compared with very brief advice (VBA) alone. Тo date, there are no studies investigating smoking cessation treatment in Republic of Macedonia. METHODS/DESIGN: RCT with process evaluation and cost-effectiveness analysis within 31 general practices in Republic of Macedonia recruiting smokers currently smoking >10 cigarettes per day, aged >35 years, attending primary care practices for any reason, regardless of motivation to quit smoking. Respondents will be randomized into one of three groups: (1) VBA and assessment and communication of lung age; (2) VBA and additional assessment and communication of exhaled carbon monoxide (CO) levels; or (3) control group – VBA. All participants who attempt to quit smoking will be offered behavioral support based on the UK standard program for smoking cessation. Primary outcome: Proportion of smokers who are quit at 4 weeks (7-day point prevalence, confirmed by salivary cotinine level). Secondary outcomes: Proportion who have attempted to quit smoking or have quit smoking, a proportion that has reduced the number of cigarettes and motivation to quit smoking; cost-effectiveness analysis calculating cost per quality-adjusted life year. We will evaluate the fidelity to the intervention and will explore patients’ and GPs’ experience and the acceptability of the study intervention by interview. DISCUSSION: The study will evaluate the effectiveness of combining feedback about lung age or exhaled CO levels with VBA and support for smoking cessation in primary care compared to giving VBA and support alone. It will explore how willing primary care physicians are to perform such interventions and the acceptability and effectiveness of such interventions to patients in Republic of Macedonia. TRIAL REGISTRATION: The study is registered on the ISRCTN registry (ISRCTN54228638).