Improved outcomes in cystic fibrosis using modified Re-Education of Airway Clearance Technique (REACT) programme

Background and objectivesCystic fibrosis (CF) is known to reduce lung function as measured by per cent predicted for the forced expiratory volume in the first second (ppFEV1) over time. Our paediatric CF programme demonstrated significant gaps in benchmarked ppFEV1 predicted compared with the national median. Our objective was to assess whether the implementation of a modified Re-Education of Airway Clearance Techniques (REACT) programme could lead to an improvement in lung function as measured by ppFEV1.MethodsThis 2-year prospective quality improvement study at Lurie Children’s CF Center for children aged >6 years used improvement methodology to implement a modified REACT programme. Outcome measures were assessed for our entire programme via the CF Foundation Patient Registry (CFFPR) and statistical process control. Comparisons were also made before and after REACT for outcome measures.ResultsBy the end of implementation, monthly participation rate achieved 100%. Using CFFPR data and SPC, median ppFEV1 increased by 3.9%, whereas only body mass index (BMI) as a secondary outcome increased. Comparison of pre and post REACT showed improvements in average ppFEV1 (95% vs 96%, p<0.0001), FEF25%−75% (82% vs 83%, p=0.0590), rate of ppFEV1 decline (+2% vs −4%, p=0.0262) and BMI percentile (57% vs 60%, p<0.0001).ConclusionsImplementation of a modified REACT at Lurie Children’s paediatric CF programme led to an increase in ppFEV1, FEF25%−75% and BMI percentile.

Smoking and lung function among adults with newly onset asthma

IntroductionSmoking increases the risk of asthma and reduces lung function among subjects with and without asthma. We assessed the effects of smoking on lung function reflecting both central and small airways among adults with newly onset asthma.MethodsIn a population-based study, 521 (response rate 86%) working-aged adults with clinically defined newly diagnosed asthma answered a questionnaire on personal smoking and other factors potentially influencing lung function, and performed spirometry. We applied multiple linear regression analysis to estimate the relations between smoking and lung function adjusting for confounding.ResultsAmong asthmatics, FEV1 level was reduced significantly, on average 208 mL, related to regular smoking (adjusted effect estimate −0.208, 95% CI −0.355 to −0.061) and 245 mL in relation to former smoking, that is, among those who quit less than a year ago (−0.245, 95% CI −0.485 to −0.004). In contrast, FEV1 was not significantly related to occasional smoking or former smoking among those who quit over a year ago. Forced expiratory flow (FEF) levels (L/s) were also significantly reduced among regular smokers (FEF25–75%: −0.372, 95% CI −0.607 to −0.137; FEF50%: −0.476, 95% CI −0.750 to −0.202). An exposure–response pattern related to both daily smoking rate and lifetime cumulative smoking was seen both among men and women.ConclusionsThis study provides new evidence that among working-aged adults with new asthma, regular smoking and former smoking reduce lung function levels with a dose–response pattern. The lung function parameters applied as outcomes reflect both larger and smaller airways.

Large airway ventilatory functions in female patients of rheumatoid arthritis with methotrexate therapy- is there any change?

Background: Methotrexate (MTX) is widely used in the treatment of Rheumatoid arthritis (RA) as first line disease modifying anti-rheumatoid drug. Low dose MTX may reduce lung function status in RA patients.Objective: To observe the changes in large airway ventilatory variables in RA patients after MTX therapy.Methods: For this prospective observational study, 24 female RA patients of age ranges between 15 to 65 years were selected from the Out-Patient Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University, Dhaka. Age and BMI matched 24 apparently healthy females were also selected Control. To assess the large airway ventilatory function, FVC, FEV1, FEV1/ FVC% and PEFR of all subjects were measured with a portable digital Spirometer, PONY FX (Cosmed, Italy) at Day 0. In addition, all these variables were again measured in the RA patients after 180 days of MTX therapy. For statistical analysis, independent sample t test and paired sample t test were performed.Results: All the study variables (except FEV1/FVC%) were significantly (p<0.001) lower in RA groups at day 0 as well as at day 180, compared to healthy controls. Again all these variables were almost similar in the RA patients at day 180 when compared to those of day 0.Conclusion: Large airway ventilatory function deteriorated in RA patients, which may not be recovered by six months methotraxate therapy.J Bangladesh Soc Physiol. 2018, June; 13(1): 35-40

Respiratory Tract Problems among Wood Furniture Manufacturing Factory Workers in the Northeast of Thailand

Background Wood furniture manufacturing factory workers are at high risk of exposure to wood dust in wood working processes. Wood dust exposure could cause respiratory symptoms, such as reduce lung function, chronic bronchitis, and asthma. The Northeast region of Thailand has many wood furniture manufacturing factories. However, limited studies were carried out to explore the effect of wood dust exposure on workers.Objective This study aimed to assess the respiratory symptoms and determine factors associated with these symptoms among wood furniture manufacturing factory workers.Method This cross-sectional analytical research used a multistage random sampling to select 511 workers from three provinces in the Northeast of Thailand. The data was collected using a structured questionnaire interview. The content validity of questionnaire was tested by 3 experts and had a Cronbach’s alpha coefficient of 0.82. Data were analyzed using descriptive statistics and multiple logistic regressions.Result The result indicated that 29.94% of these workers had respiratory symptoms, including coughing(18.79%), nasal secretion (15.66%), and stuffy nose (15.07%). Factors that were significantly associated with respiratory symptoms (p–value<0.05) were (a) not always wearing mask (adjusted OR=2.26;95% CI=1.37-3.72), (b) low to medium level of knowledge on dust prevention (adjusted OR=1.83;95% CI=1.23- 2.73) and (c) contacted softwood dust (adjusted OR=1.97;95% CI= 1.06-3.64).Conclusion About 30% of wood furniture manufacturing factory workers had respiratory symptoms with related to both personal preventive behaviors and their working environments. Therefore, the raising awareness for using personal protective equipment during work will help them to prevent from various respiratory track problems.

"No Time to Play": Perceptions Toward Physical Activity in Youth With Cystic Fibrosis

Although physical activity may reduce lung function decline in youth with cystic fibrosis (CF), most patients are inactive. Little is known about why youth with CF are inactive or how to facilitate physical activity. This study explored perceptions toward physical activity in 14 youth with CF at a Canadian Hospital. Qualitative interviews were conducted and a grounded theory analysis was undertaken. The participants demonstrated positive or negative perceptions toward physical activity and different experiences—such as parental support and illness narratives—influenced youths’ perceptions. In addition, the participants experienced physical activity within the context of reduced time. Recommendations for developing physical activity interventions, including the particular need to ensure that such interventions are not perceived as wasteful of time, are provided.