Blood neutrophil-to-lymphocyte ratio (NLR) is higher in stable COPD than healthy controls and further increased in COPD exacerbations, and has been suggested as a predictor of exacerbations. Our aim was to study if NLR can predict future COPD exacerbations. In the Tools for Identifying Exacerbations (TIE) study, participants with physician-diagnosed and spirometry-verified COPD attended three yearly visits. Blood cell counts, spirometry and questionnaire-assessed exacerbation history (worsening of COPD leading to an unscheduled visit and/or use of antibiotics and/or use of oral corticosteroids) were collected at each visit. Subjects with available data on NLR and exacerbations at least at one follow-up visit were included (N=478, 42% males). At baseline, mean±SD FEV1 was 57±17% predicted, and median NLR 2.2, interquartile range (IQR) 1.7-3.1. Subjects with ≥1 exacerbation the preceding year (38%) had higher baseline NLR (median 2.5, IQR 1.8-3.5) than those with no exacerbation the preceding year (2.2, IQR 1.6-2.8, Mann-Whitney p<0.001). Subjects with ≥1 exacerbation the first year following baseline (32%) had higher baseline NLR (median 2.4, IQR 1.8-3.4) than those with no exacerbation the first year (2.2, IQR 1.6-2.9, Mann-Whitney p<0.001). In a three-level (longitudinal observations in subjects nested within study sites) mixed effects logistic regression model, NLR was associated with future exacerbations (OR 1.21, 95% CI 1.05-1.38) after adjustment for exacerbations the preceding year, blood eosinophils, COPD assessment test (CAT) score, BMI, smoking, use of inhaled corticosteroids, lung function, gender and age. In conclusion, NLR appears to have an independent prognostic value for future COPD exacerbations.
Hedenström H, Wegener T, Boman G, Wåhlander L, Melander B. Effect of inhaled formoterol versus terbutaline on respiratory function in moderate bronchial asthma. In a double‐blind cross‐over study comparing the duration of action of 12 μg and 24 μg formoterol, 500 μg terbutaline and placebo, lung function tests were performed in 12 never‐smokers with non‐allergic bronchial asthma. All the patients were hyperreactive to methacholine, had normal serum IgE level, and negative skin or RAST results. The lung function tests were carried out over an 11‐h period and included measurements of lung volumes, airway resistance, dynamic spirometry, nitrogen single breath wash‐out test and single breath diffusion capacity for CO. The airway resistance and maximal forced expiratory flow tests indicated a pronounced bronchodilator effect without adverse effects of 12 μg and 24 μg formoterol on both large and peripheral airways. Improved intrapulmonary gas distribution measured by the nitrogen wash‐out test and more even distribution of the lung volumes indicating more homogeneous ventilation was seen for approx. 3h after terbutaline and approx. 11 h after 24 μg formoterol. Measurement of the CO diffusion capacity indicates more effective gas diffusion and a better ventilation‐perfusion ratio for at least 11 h, especially after inhalation of 24 μg formoterol.
Introduction: Many children are limited in their physical activity because of exercise induced dyspnea (EID). Aim: The aim was to investigate the prevalence of EID, asthma and physical activity level among a population of 12-13 year old children in Uppsala, Sweden. Method: A questionnaire was sent to 3815 parents asking them to answer the questionnaire together with their child. Results: The response rate was 61 % (n=2312). EID during the last 12 months was reported by14.3 % (n=330) (girls 16.9 vs. boys 11.8 %, p
Nitric oxide from the gas exchange area, but not from the airways, is increased in subjects with chronic obstructive pulmonary disease with low oxygen saturation after physical testinghttp://bit.ly/2ItUJy6
Background: The purpose of this study was to evaluate the longitudinal relationship between functional exercise capacity, assessed through standardized 12-minute walk test (12MWT), and various lung function parameters obtained using spirometry, body plethysmography and diffusing capacity (DLco) measurements in patients with COPD. Methods: Spirometry, body plethysmography and DLco-measurements were performed at baseline in 84 subjects with moderate to very severe COPD and at follow-up visit (n = 34) after 5 years. Functional exercise capacity was determined using standardized 12MWT. Results: Patients were characterized at baseline by FEV1 of 1.2 ± 0.4 L (41 ± 13% predicted), RV of 3.4 ± 1.0 L (187 ± 58% predicted) and DLco of 3.8 ± 1.2 mmol/min/kPa (51 ± 16% predicted). A decrease of 12MWD was found between baseline and follow-up (928 ± 193 m vs. 789 ± 273 m, p < 0.001). DLco and 12MWD at baseline were the only independent predictors of 12MWD at follow-up in a multiple logistic regression model that also included all other lung function parameters, gender, age and BMI. Decline in 12MWD was mainly explained by deterioration in DLco. Furthermore, DLco value at baseline had the highest explanatory value for the loss in 12MWD after 5 years (R2 = 0.18, p = 0.009). Conclusions: In a 5-year longitudinal study, DLco-measurements at baseline were the most important predictors of declining exercise capacity in COPD patients. These results suggest that integration of DLco in the clinical workup provides a more comprehensive assessment in patients with COPD.
Background: Breathing exercises are widely used after cardiac surgery. The duration of exercises in the immediate postoperative period is not fully evaluated and only limited data regarding the effects of home-based breathing exercises after discharge from hospital have been published.Aim: The overall aim of this thesis was to evaluate the effects of deep breathing exercises with positive expiratory pressure (PEP) and describe lung function and respiratory muscle strength in patients undergoing cardiac surgery.Participants and settings: Adult participants (n=131) were randomised to perform either 30 or 10 deep breaths with PEP per hour during the first postoperative days (Study I): the main outcome was oxygenation, assessed by arterial blood gases, on the second postoperative day. In Study III, 313 adult participants were randomly assigned to perform home-based deep breathing exercises with PEP for two months after surgery or not to perform breathing exercises with PEP after the fourth to fifth postoperative day. The main outcome was lung function, assessed by spirometry, two months after surgery. Studies II and IV were descriptive and correlative and investigated pre and postoperative lung function, assessed by spirometry, and respiratory muscle strength, assessed by maximal inspiratory pressure, and maximal expiratory pressure.Results: On the second postoperative day, arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2) was higher in the group randomised to 30 deep breaths with PEP hourly. There was no improved recovery of lung function in participants performing home-based deep breathing exercises two months after cardiac surgery, compared to a control group. Subjective experience of breathing or improvement in patient perceived quality of recovery or health-related quality of life did not differ between the groups at two months. Lung function and respiratory muscle strength were in accordance with predicted values before surgery. A 50% reduction in lung function was shown on the second postoperative day. High body mass index, male gender and sternal pain were associated with decreased lung function on the second postoperative day. Two months postoperatively, there was decreased lung function, but respiratory muscle strength had almost recovered to preoperative values.
Forty-five men with asbestos-related pleural plaques detected at a health screening centre were investigated with measurement of lung volumes, airways resistance, ventilatory capacity, transfer factor, gas distribution, closing volume and static recoil pressures of the lung. The men were subjectively healthy, had confirmed exposure to asbestos and had normal chest radiograms apart from the presence of pleural plaques. Most of the men had been exposed to small or moderate amounts of asbestos with a mean duration of 39 years since first exposure. Sixty-seven per cent of the men were smokers or ex-smokers. The lung function was evaluated using regression formulas which included smoking variables. The results clearly demonstrate the presence of lung parenchymal involvement with increased stiffness of the lungs and decreased lung volumes. The change in elastic recoil pressure of the lungs, in total lung capacity and residual volume show significant correlation with measures of asbestos exposure and extent of pleural changes. No synergistic effects between tobacco smoking and asbestos exposure on lung function could be demonstrated. Measurements of the static elastic lung recoil (Pst(max) and Cst/TLC) and total lung capacity were the most sensitive tests for separating the pleural plaque carriers from the controls.
