Regional Lung Function in Patients with Obstructive Lung Diseases

Regional lung function was measured, using radioactive xenon-133, in a group of normal subjects and in three carefully defined groups of patients with obstructive lung disease. When compared with the normal subjects, patients in the emphysematous group showed a relative reduction of ventilation and perfusion to the upper zones, while patients having chronic bronchitis without cardiac or respiratory failure showed a predominantly lower zone defect. In the group of patients with chronic bronchitis with cardiac and respiratory failure no consistent pattern was found.     

Lung Function in Patients Receiving Busulphan

An attempt was made to achieve earlier detection of busulphan lung (fibrosing alveolitis) and to determine its incidence by means of serial studies during life, including measurement of the gas transfer factor. Twenty-three patients were investigated over an average period of nearly two years of busulphan treatment. One case of busulphan lung was detected and subsequently confirmed at necropsy, but in the remainder there was no clinical, radiological, or physiological evidence of fibrosing alveolitis. It is concluded that the development of fibrosing alveolitis may be related to individual genetic or immunological factors rather than to busulphan dosage.     

Effects of Irradiation on Lung Function

With refinements in radiotherapeutic techniques in recent years, the incidence of pulmonary damage attributable to irradiation has decreased. A significant number of patients, however, still show radiographic evidence of irradiation pneumonitis, with or without associated symptoms. Although these appearances are usually transitory, in some patients they may persist and be associated with varying degrees of pulmonary insufficiency.This report presents an evaluation of the radiographic changes, symptoms, and pulmonary function following irradiation of the chest wall (as for cancer of the breast) in one group of patients, and following deep irradiation of the chest (as for cancer of the lung) in a second group. Forty patients were studied, of whom 32 are available for assessment (20 with carcinoma of the breast and 12 with bronchogenic carcinoma). These patients were studied preoperatively, and from three to 15 months following irradiation. The findings with respect to radiographic appearance, pulmonary function, and symptoms of these patients are presented.     

Relationship between Lung Function and Metabolic Syndrome

Although the link between impaired lung function and cardiovascular events and type 2 diabetes mellitus has been recognized, the association between impaired lung function and metabolic syndrome has not been comprehensively assessed in the United States (U.S.) population. The aim of our study was to explore the association between impaired lung function and metabolic syndrome in a nationally representative sample of men and women. This cross-sectional population-based study included 8602 participants aged 20–65 years in the Third National Health and Nutrition Examination Survey (NHANES III). We examined the relationship between the different features of metabolic syndrome and lung function, including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). After adjusting for potential confounders such as age, body mass index, inflammatory factors, medical condition, and smoking status, participants with more components of metabolic syndrome had lower predicted values of FVC and FEV1 (p for trend <0.001 for both). Impaired pulmonary function was also associated with individual components of metabolic syndrome, such as abdominal obesity, high blood pressure, high triglycerides, and low high density lipoprotein (HDL) cholesterol (p<0.05 for all parameters). These results from a nationally representative sample of US adults suggest that a greater number of features of metabolic syndrome is strongly associated with poorer FVC and FEV1. In clinical practice, more comprehensive management strategies to address subjects with metabolic syndrome and impaired lung function need to be developed and investigated.     

Chorioamnionitis and Subsequent Lung Function in Preterm Infants

Objective

To explore the relationship between prematurity, gender and chorioamnionitis as determinants of early life lung function in premature infants.

Methods

Placenta and membranes were collected from preterm deliveries (<37 weeks gestational age) and evaluated for histological chorioamnionitis (HCA). Patients were followed and lung function was performed in the first year of life by Raised Volume-Rapid Thoracic Compression Technique.

Results

Ninety-five infants (43 males) born prematurely (median gestational age 34.2 weeks) were recruited. HCA was detected in 66 (69%) of the placentas, and of these 55(58%) were scored HCA Grade 1, and 11(12%) HCA Grade 2. Infants exposed to HCA Grade 1 and Grade 2, when compared to those not exposed, presented significantly lower gestational ages, higher prevalence of RDS, clinical early-onset sepsis, and the use of supplemental oxygen more than 28 days. Infants exposed to HCA also had significantly lower maximal flows. There was a significant negative trend for z-scores of lung function in relation to levels of HCA; infants had lower maximal expiratory flows with increasing level of HCA. (p = 0.012 for FEF₅₀, p = 0.014 for FEF_25–75 and p = 0.32 for FEV_0.5). Two-way ANOVA adjusted for length and gestational age indicated a significant interaction between sex and HCA in determining expiratory flows (p<0.01 for FEF₅₀, FEF_25–75 and p<0.05 for FEV_0.5). Post-hoc comparisons revealed that female preterm infants exposed to HCA Grade 1 and Grade 2 had significant lower lung function than those not exposed, and this effect was not observed among males.

Conclusions

Our findings show a sex-specific negative effect of prenatal inflammation on lung function of female preterm infants. This study confirms and expands knowledge upon the known association between chorioamnionitis and early life chronic lung disease.     

无症状吸烟者的肺功能改变情况分析

目的:探讨烟龄≥15年,日吸烟量≥15支的无症状男性吸烟者的肺功能改变情况。方法:选择男性无症状吸烟者190人及非吸烟者180人,进行肺功能测定,并比较两组人群的肺功能改变情况。结果:吸烟组与非吸烟组比较,肺活量(VC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、Tiffeneau 1秒率(FEV1/VC)结果改变不明显,而Gaensler 1秒率(FEV1/FVC)、最大分钟通气量(MVV)、用力呼气50%肺活量的呼气流量(FEF50%)、用力呼气75%肺活量的呼气流量(FEF75%)、呼出25%～75%肺活量时的平均流量(FEF25%～75%)、肺一氧化碳弥散量(DLCO)结果均有显著降低,有统计学意义。结论:通过对无症状吸烟人群肺功能测定结果进行分析。发现有些吸烟者虽无临床症状,但已经出现了小气道及肺弥散功能的损伤,提醒吸烟者应早期戒烟,关爱自身健康,净化生存环境,提高生活质量。     

无症状吸烟者的肺功能改变情况分析

目的：探讨烟龄215年,日吸烟量≥15支的无症状男性吸烟者的肺功能改变情况。方法：选择男性无症状吸烟者190人及非吸烟者180人,进行肺功能测定,并比较两组人群的肺功能改变情况。结果：吸烟组与非吸烟组比较,肺活量（VC）、用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、Tiffeneau1秒率（FEV1／VC）结果改变不明显,而Gaensler1秒率（FEV1/FVC）、最大分钟通气量（MVV）、用力呼气50％肺活量的呼气流量（FEF50％）、用力呼气75％肺活量的呼气流量（FEF75％）、呼出25％-75％肺活量时的平均流量（FEF25％～75％）、肺一氧化碳弥散量（DLCO）结果均有显著降低,有统计学意义。结论：通过对无症状吸烟人群肺功能测定结果进行分析。发现有些吸烟者虽无临床症状,但已经出现了小气道及肺弥散功能的损伤,提醒吸烟者应早期戒烟,关爱自身健康,净化生存环境,提高生活质量。     

慢性阻塞性肺病大鼠模型的肺功能及肺组织病理学变化评估

目的:探讨被动吸烟的时间长短与慢性阻塞性肺病(COPD)大鼠模型的肺功能及肺组织病理学的变化之间的关系.方法:采用被动吸烟法建立COPD大鼠模型,随机分为被动吸烟4周组、6周组、8周组和对照组,分别测定和评估不同时间段的各组大鼠模型的肺功能和气道肺组织的病理变化.结果:6周组及8周组大鼠模型的呼气峰流速(PEF)显著降低、气道内压上升坡度(IP-slope)显著增高,与对照组比较P＜0.01.以PEF值小于对照组的大鼠80%PEF值为存在气流受限的界线,则4周组、6周组、8周组出现气流受限的鼠分别为0只(0)、6只(75%)及8只(100%),6周组及8周组的大鼠气流受限发生率显著高于4周组(P＜0.01).8周组大鼠出现明显气道壁增厚、气道狭窄及显著肺气肿改变,其气道壁炎细胞浸润、杯状细胞化生、气道壁坏死糜烂、纤维结缔组织及平滑肌增生等评分均显著高于对照组(P＜0.01),气道坏死糜烂、小气道阻塞发生率及气道平滑肌增生等指标显著高于6周组(P＜0.01).6周组中有6只大鼠出现气道狭窄及肺气肿改变,气道壁炎细胞浸润、杯状细胞化生、气道壁坏死糜烂、纤维结缔组织及平滑肌增生等评分均显著高于对照组(P＜0.01).6周组及8周组大鼠PEF值与气道壁纤维组织和平滑肌增生呈显著负相关(P＜0.05);而4周组大鼠未出现典型肺气肿及气道狭窄.结论:COPD的形成与吸烟时间有关,在吸烟量相同条件下,吸烟时间越长,气道和肺组织病变越重,气流受限的发生率越高.     

Pyrosequencing Unveils Cystic Fibrosis Lung Microbiome Differences Associated with a Severe Lung Function Decline

Chronic airway infection is a hallmark feature of cystic fibrosis (CF) disease. In the present study, sputum samples from CF patients were collected and characterized by 16S rRNA gene-targeted approach, to assess how lung microbiota composition changes following a severe decline in lung function. In particular, we compared the airway microbiota of two groups of patients with CF, i.e. patients with a substantial decline in their lung function (SD) and patients with a stable lung function (S). The two groups showed a different bacterial composition, with SD patients reporting a more heterogeneous community than the S ones. Pseudomonas was the dominant genus in both S and SD patients followed by Staphylococcus and Prevotella. Other than the classical CF pathogens and the most commonly identified non-classical genera in CF, we found the presence of the unusual anaerobic genus Sneathia. Moreover, the oligotyping analysis revealed the presence of other minor genera described in CF, highlighting the polymicrobial nature of CF infection. Finally, the analysis of correlation and anti-correlation networks showed the presence of antagonism and ecological independence between members of Pseudomonas genus and the rest of CF airways microbiota, with S patients showing a more interconnected community in S patients than in SD ones. This population structure suggests a higher resilience of S microbiota with respect to SD, which in turn may hinder the potential adverse impact of aggressive pathogens (e.g. Pseudomonas). In conclusion, our findings shed a new light on CF airway microbiota ecology, improving current knowledge about its composition and polymicrobial interactions in patients with CF.     

Long-chain Acylcarnitines Reduce Lung Function by Inhibiting Pulmonary Surfactant

The role of mitochondrial energy metabolism in maintaining lung function is not understood. We previously observed reduced lung function in mice lacking the fatty acid oxidation enzyme long-chain acyl-CoA dehydrogenase (LCAD). Here, we demonstrate that long-chain acylcarnitines, a class of lipids secreted by mitochondria when metabolism is inhibited, accumulate at the air-fluid interface in LCAD^−/− lungs. Acylcarnitine accumulation is exacerbated by stress such as influenza infection or by dietary supplementation with l-carnitine. Long-chain acylcarnitines co-localize with pulmonary surfactant, a unique film of phospholipids and proteins that reduces surface tension and prevents alveolar collapse during breathing. In vitro, the long-chain species palmitoylcarnitine directly inhibits the surface adsorption of pulmonary surfactant as well as its ability to reduce surface tension. Treatment of LCAD^−/− mice with mildronate, a drug that inhibits carnitine synthesis, eliminates acylcarnitines and improves lung function. Finally, acylcarnitines are detectable in normal human lavage fluid. Thus, long-chain acylcarnitines may represent a risk factor for lung injury in humans with dysfunctional fatty acid oxidation.     

类风湿性关节炎伴间质性肺病中肿瘤标志物对肺功能的影响分析

目的：探究类风湿性关节炎伴间质性肺病中肿瘤标志物对肺功能的影响。方法：选取2011年3月至2013年3月我院收治的类风湿性关节炎患者88例,根据其是否伴有ILD,分为RA组53例和RA-ILD组35例。检测两组肺功能指标用力肺活量（FVC）、1s用力呼气容积（FEV1）、最大通气量百分比（MVV）、一氧化碳弥散量（DLCO）,肿瘤标志物癌胚抗原CEA、癌抗原125（CA125）、癌抗原199（CA199）及抗环胍氨酸肽抗体（抗CCP抗体）的值,并利用统计学方法分析肿瘤标记物与肺功能指标、抗CCP抗体的相关性。结果：RA．ILD组FVC、FEV1、MVV、DLCO均比RA组低,CEA、CA125、CA199均比RA组高,结果比较差异显著具有统计学意义（P〈0．05）。但两组抗CCP抗体含量相比却无明显差异,不具有统计学意义（P〉0．05）。相关性分析显示,CEA与FVC、FEV1、MVV、DLCO呈负相关（P〈0．05）,而CA125、CA199却与肺功能指标无相关性,CEA、CA125、CA199与抗CCP抗体均无相关性（P〉0．05）。结论：RA-ILD的肺功能指标均有明显下降,而肿瘤标志物表达水平却明显增高,CEA对肺功能损害影响较大,却与关节损害的关系不大,这为临床对类风湿性关节炎伴间质性肺病早诊断、早治疗提供了依据。     

Characterization of Lung Function Impairment in Adults with Bronchiectasis

Background

Characteristics of lung function impairment in bronchiectasis is not fully understood.

Objectives

To determine the factors associated with lung function impairment and to compare changes in spirometry during bronchiectasis exacerbation and convalescence (1 week following 14-day antibiotic therapy).

Methods

We recruited 142 patients with steady-state bronchiectasis, of whom 44 with acute exacerbations in the follow-up were included in subgroup analyses. Baseline measurements consisted of chest high-resolution computed tomography (HRCT), sputum volume, purulence and bacteriology, spirometry and diffusing capacity. Spirometry, but not diffusing capacity, was examined during acute exacerbations and convalescence.

Results

In the final multivariate models, having bronchiectasis symptoms for 10 years or greater (OR = 4.75, 95%CI: 1.46–15.43, P = 0.01), sputum culture positive for Pseudomonas aeruginosa (OR = 4.93, 95%CI: 1.52–15.94, P<0.01) and HRCT total score being 12 or greater (OR = 7.77, 95%CI: 3.21–18.79, P<0.01) were the major variables associated with FEV₁ being 50%pred or less; and the only variable associated with reduced D_LCO was 4 or more bronchiectatic lobes (OR = 5.91, 95%CI: 2.20–17.23, P<0.01). Overall differences in FVC and FEV₁ during exacerbations and convalescence were significant (P<0.05), whereas changes in other spirometric parameters were less notable. This applied even when stratified by the magnitude of FEV₁ and D_LCO reduction at baseline.

Conclusion

Significant lung function impairment should raise alert of chest HRCT abnormality and sputum culture positive for Pseudomonas aeruginosa, in patients with predominantly mild to moderate steady-state bronchiectasis. Acute exacerbations elicited reductions in FVC and FEV₁. Changes of other spirometric parameters were less significant during exacerbations.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01761214","term_id":"NCT01761214"}}NCT01761214     

The Association of Systemic Microvascular Changes with Lung Function and Lung Density: A Cross-Sectional Study

Smoking causes endothelial dysfunction and systemic microvascular disease with resultant end-organ damage in the kidneys, eyes and heart. Little is known about microvascular changes in smoking-related lung disease. We tested if microvascular changes in the retina, kidneys and heart were associated with obstructive spirometry and low lung density on computed tomography. The Multi-Ethnic Study of Atherosclerosis recruited participants age 45–84 years without clinical cardiovascular disease. Measures of microvascular function included retinal arteriolar and venular caliber, urine albumin-to-creatinine ratio and, in a subset, myocardial blood flow on magnetic resonance imaging. Spirometry was measured following ATS/ERS guidelines. Low attenuation areas (LAA) were measured on lung fields of cardiac computed tomograms. Regression models adjusted for pulmonary and cardiac risk factors, medications and body size. Among 3,397 participants, retinal venular caliber was inversely associated with forced expiratory volume in one second (FEV₁) (P<0.001) and FEV₁/forced vital capacity (FVC) ratio (P = 0.04). Albumin-to-creatinine ratio was inversely associated with FEV₁ (P = 0.002) but not FEV₁/FVC. Myocardial blood flow (n = 126) was associated with lower FEV₁ (P = 0.02), lower FEV₁/FVC (P = 0.001) and greater percentage LAA (P = 0.04). Associations were of greater magnitude among smokers. Low lung function was associated with microvascular changes in the retina, kidneys and heart, and low lung density was associated with impaired myocardial microvascular perfusion. These cross-sectional results suggest that microvascular damage with end-organ dysfunction in all circulations may pertain to the lung, that lung dysfunction may contribute to systemic microvascular disease, or that there may be a shared predisposition.