Effect of low altitude at the Dead Sea on exercise capacity and cardiopulmonary response to exercise in cystic fibrosis patients with moderate to severe lung disease
Bareket FalkAsaph NiniLevana ZigelYaacov YahavMicha AviramJoseph RivlinLea BenturAvraham AvitalRaffy DotanHannah Blau
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Abstract Oxygen supplementation may improve exercise tolerance and the physiological response to exercise in cystic fibrosis (CF) patients. Elevated barometric pressure at low altitude is a simple means of increasing the quantity of inspired oxygen. Our objectives were to examine the effect of natural oxygen enrichment (at the Dead Sea, 396 m below sea level) on exercise capacity, and the physiological responses to maximal and submaximal exercise in CF patients. Patients were tested twice: at sea level (barometric pressure, 754 ± 6 mmHg, mean ± SD), and at the Dead Sea (barometric pressure, 791 ± 3 mmHg), in a randomized crossover design. We studied 14 CF patients (6 females, 8 males), aged 15–45 years, with moderate to severe lung disease (mean forced expired volume in 1 sec = 50.0 ± 11.2% predicted). Tests at each site included resting spirometry, anthropometry, a graded submaximal exercise test, a maximal exercise test on a treadmill, and a 6‐min walk test. Tests were performed in identical order at both sites. Tests at the Dead Sea were performed 72 hr after arrival. No differences between sites were observed in lung function at rest. Peak oxygen consumption was significantly improved at the Dead Sea compared with sea level (1.68 ± 0.73 vs. 1.57 ± 0.74 l/min, respectively, P = 0.05), along with an improvement in the ventilatory equivalent for oxygen (41.2 ± 6.3 vs. 46.1 ± 7.1, respectively, P < 0.05). During submaximal exercise, blood oxygen saturation improved at the Dead Sea compared with sea level at all exercise intensities ( P < 0.05). In conclusion, these results suggest that even a brief stay at the Dead Sea area may have physiological benefits for CF patients with moderate to severe lung disease. Pediatr Pulmonol. © 2006 Wiley‐Liss, Inc.Keywords:
Crossover study
Vital capacity
Oxygen Saturation
Treadmill
Most of the studies carried out in India to develop regression equations for spirometry in children are now several years-to-decades old and had used equipment and measurement protocols that have since changed. Prediction equations using the current standardisation protocols for spirometry are not available. The lung health of the population may have changed too.To develop regression equations for spirometry for children aged 6 to 17 years of north Indian origin in Delhi region.School children of north Indian origin, as determined by mother tongue and parentage, aged 6 to 17 years were screened by a health questionnaire and physical examination and those found "normal" underwent spirometry according to the standardised procedure recommended by the American Thoracic Society/European Respiratory Society (ATS/ERS) task force in 2005. Pearson's correlation analysis was carried out to identify the predictor variables for spirometric parameters. Prediction equations were developed using the multiple linear regression procedure. The independent variables were entered in sequence of height, age and weight. R2, adjusted R2 and R2 change, standard errors of the estimate (SEE), and estimates of regression coefficients were obtained and the goodness of fit was examined.Data was obtained in 365 boys and 305 girls. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1) peak expiratory flow rate (PEFR), forced expiratory flow rate at 50% and 75% exhalation of vial capacity (F50 and F75) and mean forced expiratory flow rate over the middle 50% of the vital capacity (F25-75) showed moderate to strong correlations with age, height and weight in both boys and girls. In both genders, the equations explained very high variability of FVC, FEV1 and PEFR as shown by the R2 values. The explained variability for flow rates was lesser, with that for F75 being the least.Regression equations for spirometry variables for children of north Indian origin in Delhi region have been developed. These represent the first such effort from India after the publication of the ATS/ERS task force 2005 guidelines on standardisation of spirometry.
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Lung function measurements play an essential role in early diagnosis and monitoring of bronchial asthma in children. For clinical evaluation, measurements are commonly compared to reference values. However, these reference values are calculated based on measurements performed in groups of mostly older children and young adults two or three decades ago. In the present, cross-sectional study, lung function measurements were performed in 518 children (241 boys and 277 girls; mean age 6.0+/-0.3 years) at a regular medical check prior to school enrollment. Spirometry was done using the MasterScreen IOS (Cardinal Health, Wurzburg). We recorded forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), maximal expiratory flow (PEF), and maximal expiratory flow at 75, 50, and 25% of vital capacity (MEF(75), MEF(50), MEF(25)). We found that FEV(1) and FVC corresponded to reference values (101.0+/-14.9% and 95.4+/-13.6%, in boys and girls, respectively). In maneuvers satisfying ATS/ERS criteria (T(E) >1 sec), forced expiratory (parameters (PEF, MEF(50)) reached only 68.9+/-13.6 and 75.9+/-26.6% of reference values, in boys and girls, respectively). There was no significant correlation of lung function parameters to BMI. In conclusion, the hitherto reference values largely overestimate the maximal flow rates of preschool children performing a forced spirometry with T(E) >1 sec. At the age of 6, forced expiratory flow values are not (yet) impaired by an increased BMI. Standardized spirometry starting in preschool children allows closely evaluating the individual development of lung function during follow-up measurements.
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The practicality of office spirometry has been established. Two basic parameters can be quickly and accurately measured in the physician's office or clinic: forced vital capacity (FVC) as a test of volume, indicative of restrictive lung disease, and forced expiratory volume in one second (FEV1) as a test of flow, indicative of obstructive lung disease. The ratio of FEV1 to FVC (FEV1/FVC%) is a valuable screening tool. Test results are compared with normal values, and abnormalities must be interpreted in the context of the individual patient's history and condition. Office spirometry provides a simple, noninvasive, inexpensive tool for assessing and managing respiratory disease.
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Seventy-five adult asthmatic patients with clinical remission underwent spirometry. Only 8.3% of the subjects demonstrated normal spirometry. The others had reduced vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum mid-expiratory flow rate (MMF) and peak flow rate (PEFR). This study demonstrates that asthma can cause irreversible airflow obstruction and there is a poor relationship between symptoms in asthmatics and their respiratory function test results.
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Lung function measured at work is used to make important employment decisions. Improving its quality will reduce misclassification and allow more accurate longitudinal interpretation over time.To assess the amount by which lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]) values will be underestimated if recommended spirometry testing guidance is not followed.Lung function was measured in a population of workers. Knowledge of the final reproducible FEV1 and FVC for each worker allowed estimation of the underestimates that would have occurred if less forced manoeuvres than recommended had been performed.A total of 667 workers (661 males, mean age 43 years, range 18-66) participated. Among them, 560 (84%) achieved reproducible results for both FEV1 and FVC; 470 (84%) of these did so after three technically acceptable forced expiratory manoeuvres, a cumulative total of 533 after four, 548 after five, 557 after six, 559 after seven and 560 after eight blows. If only one (or first two) technically acceptable blow(s) had been performed, mean underestimates were calculated for FEV1 of 115.1 ml (35.4 ml) and for FVC of 143.4 ml (42.3 ml).In this study, reproducible spirometry was achievable in most workers. Not adhering to standards underestimates lung function by clinically significant amounts.
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The prevalence of asthma and other respiratory diseases has grown in the recent decades. In this study, we aimed to assess the relation between serum TNF-α as a inflammatory cytokine with some spirometry makers as respiratory function in a group of males with asthma. For this purpose twenty seven adult men with mild to moderate asthma were participated in this study by accessible sampling. Fasting serum TNFα were measured and pulmonary function test (spirometry) was performed in order to measuring forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC in each subject. Pearson’s correlation coefficients were used to evaluate the correlations between -α concentration and all spirometry markers. P<0.05 was considered significant. No significant correlation was found in serum TNF-α with FEV1 (p=0.87, r=0.032), FVC (p=0.61, r=0.10) and FEV1/FVC (p=0.35, r=0.19) in studied subjects. In conclusion, our findings indicate that TNF-α as an inflammatory cytokine can not affect pulmonary function in asthma patients directly. Future studies will be needed to address the relative importance of inflammatory cytokines in airway inflammation.
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The accuracy of a simple, pneumatic, direct-recording spirometer suitable for office use was evaluated by comparing spirometry on a water-sealed, 13.5-liter, water-filled spirometer for 120 patients. Good correlation between the two spirometers was seen through a wide range of values for forced vital capacity, forced expiratory volume in one second, and forced expiratory flow during 25% to 75% of forced vital capacity, with coefficients of correlation being 988, 988, and 948, respectively. All correlations were significant. The pneumatic spirometer is accurate, simple to operate, and suitable for spirometry in the office and clinic. (JAMA240:2754-2755, 1978)
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The comparative ability to detect early abnormalities in smokers by commonly used lung function tests was studied. Sixty-five healthy male nonsmokers served as a reference group and provided standards for 1-sec forced expiratory volume, vital capacity, end-tidal spirometry, spirometric forced mid-and end-expiratory flows, single-breath diffusing capacity, static lung volumes (helium method), and single-breath N2 closing volume measurements, In the present series of 80 male smokers, the measurements of forced mid-expiratory flow and forced end-expiratory flow did not improve the ability of the more conventional indices, 1-sec forced expiratory volume and the ratio of 1-sec forced expiratory volume to vital capacity, to detect obstructive lung disease. In 71 smokers with normal 1-sec forced expiratory volume and ratio of 1-sec forced expiratory volume to vital capacity, the end-tidal spirometry, diffusing capacity, and residual volume indices revealed 14,20, and 21 per cent of abnormalities. respectively. The single-breath N2 closing volume test (Phase IV/vital capacity and slope of Phase III) detected the greatest number of subtle changes in lung function; this was abnormal in 32 per cent of smokers with normal conventional spirometry. In young or light smokers, Phase IV/vital capacity was more frequently increased than the slope of Phase III; an incerse trend was observed in older or heavier smokers. The single-breath N2 closing volume test also provided the greatest number of abnormal results when other indices were impaired in the same subjects.
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We aimed to ascertain the fit of the European Respiratory Society Global Lung Initiative 2012 reference ranges to contemporary Australasian spirometric data. Z-scores for spirometry from Caucasian subjects aged 4-80 years were calculated. The mean (SD) Z-scores were 0.23 (1.00) for forced expirtory volume in 1 s (FEV(1)), 0.23 (1.00) for forced vital capacity (FVC), -0.03 (0.87) for FEV(1)/FVC and 0.07 (0.95) for forced expiratory flows between 25% and 75% of FVC. These results support the use of the Global Lung Initiative 2012 reference ranges to interpret spirometry in Caucasian Australasians.
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