HASH(0x137186d0)

BACKGROUND Excessive FEV(1) loss in an individual or a group can reflect hazardous exposures and development of lung disease. However, multiple factors may affect FEV(1) measurements. METHODS Using medical screening data collected in 1884 chemical plant workers between 1973 and 2003, the influence of multiple factors on repeated measurements of FEV(1) was examined. RESULTS The FEV(1) level was associated with age, height, race, sex, cigarette smoking, changes in body weight, and spirometer model. After controlling for these factors, longitudinal FEV(1) decline averaged 23.8 ml/year for white males; an additional loss of 8.3 ml was associated with one pack-year smoking and 5.4 ml with a one pound weight gain. Depending on the spirometer model, FEV(1) differed by up to 95 ml. CONCLUSIONS The study results provide quantitative estimates of the effect of specific factors on FEV(1), and should be useful to health professionals in the evaluation of accelerated lung function declines.

Spirometry is a useful test of pulmonary function and can be safely performed in a variety of clinical situations. Although the technique for performing the maneuver is straightforward, there are many sources of variability in results. Specific criteria must be met in order for the test to be considered valid. For the best results, proper instruction and coaching is essential, and patient understanding and effort must be maximized. Appropriate interpretation of spirometry requires several steps, including recognition and reporting of technically sound maneuvers, comparison to an appropriate reference population, and finally application of a well-developed interpretation scheme utilized in the context of patient symptoms and findings. Failure at any point along this path from performance to interpretation can yield misleading results that may ultimately poorly impact patient care. A clear understanding by the provider of proper coding and billing for spirometry is necessary to receive appropriate reimbursement from payers.

BACKGROUND Even several days after surgery, obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications. Particularly in ambulatory surgery, rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient. In this study, we wanted to evaluate intensive short-term respiratory physical therapy treatment (incentive spirometry) in the postanesthesia care unit (PACU) and its impact on pulmonary function in the obese. METHODS After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-40) undergoing minor peripheral surgery, half of which were randomly assigned to receive respiratory physiotherapy during their PACU stay, while the others received routine treatment. Premedication, general anesthesia, and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry on air breathing. Inspiratory and expiratory lung functions were measured preoperatively (baseline) and at 10 min, 1, 2, 6, and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance and t test analysis. Statistical significance was considered to be P < 0.05. RESULTS There were no differences at the first assessment, but, during the PACU stay, pulmonary function in the physiotherapy group was significantly better than the controls'(p < 0.0001), an effect which persisted for at least 24 h after surgery (p < 0.009). CONCLUSION Short-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 h.

BACKGROUND AND OBJECTIVE Obesity aggravates the negative effects of general anaesthesia and surgery on the respiratory system, resulting in decreased functional residual capacity and expiratory reserve volume, and increased atelectasis and ventilation/perfusion (Va/Q) mismatch. High-inspired oxygen concentrations also promote atelectasis. This study compares the effects of perioperative inspired low-oxygen and high-oxygen concentrations on postoperative lung function and pulse oximetry values in moderately obese patients (BMI 25-35). METHODS We prospectively studied 142 overweight patients, BMI 25-35, undergoing minor peripheral surgery; they were randomly allocated to receive either low-inspired or high-inspired oxygen concentrations during general anaesthesia. Premedication, general anaesthesia and respiratory patterns were standardized. Arterial oxygen saturation (pulse oximetry) was measured on air breathing. Inspiratory and expiratory lung functions were measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance and t-test analysis. RESULTS The low-inspired oxygen group had significantly better arterial saturation during the first 24 h (P < 0.01). Mid-expiratory flow 25 values indicating small airway collapse were significantly better in the low-oxygen group at all measurements (P < 0.05). CONCLUSION We conclude that postoperative lung function and arterial saturation is better preserved by a low-oxygen strategy, although it is not clear whether this has clinical relevance for the prevention of postoperative pulmonary complications.

BACKGROUND Morbidly obese patients are at elevated risk of perioperative pulmonary complications, including airway obstruction and atelectasis. Continuous positive airway pressure may improve postoperative lung mechanics and reduce postoperative complications in patients undergoing abdominal surgery. METHODS Forty morbidly obese patients with known obstructive sleep apnea undergoing laproscopic bariatric surgery with standardized anesthesia care were randomly assigned to receive continuous positive airway pressure via the Boussignac system immediately after extubation (Boussignac group) or supplemental oxygen (standard care group). All subjects had continuous positive airway pressure initiated 30 min after extubation in the postanesthesia care unit via identical noninvasive ventilators. The primary outcome was the relative reduction in forced vital capacity from baseline to 24 h after extubation. RESULTS Forty patients were enrolled into the study, 20 into each group. There were no significant differences in baseline characteristics between the groups. The intervention predicted less reduction in all measured lung functions: forced expiratory volume in 1 s (coefficient 0.37, SE 0.13, P = 0.003, CI 0.13-0.62), forced vital capacity (coefficient 0.39, SE 0.14, P = 0.006, CI 0.11-0.66), and peak expiratory flow rate (coefficient 0.82, SE 0.31, P = 0.008, CI 0.21-0.1.4). CONCLUSIONS Administration of continuous positive airway pressure immediately after extubation maintains spirometric lung function at 24 h after laparoscopic bariatric surgery better than continuous positive airway pressure started in the postanesthesia care unit.

BACKGROUND Obesity is a well-established risk factor for perioperative pulmonary complications. Anaesthetic drugs and the effect of obesity on respiratory mechanics are responsible for these pathophysiological changes, but tracheal intubation with muscle relaxation may also contribute. This study evaluates the influence of airway management, i.e. intubation vs. laryngeal mask airway (LMA), on postoperative lung volumes and arterial oxygen saturation in the early postoperative period. METHODS We prospectively studied 134 moderately obese patients (BMI 30) undergoing minor peripheral surgery. They were randomly assigned to orotracheal intubation or LMA during general anaesthesia with mechanical ventilation. Premedication, general anaesthesia and respiratory settings were standardized. While breathing air, we measured arterial oxygen saturation by pulse oximetry. Inspiratory and expiratory lung function was measured preoperatively (baseline) and at 10 min, 0.5, 2 and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance (ANOVA) and t-test analysis. Statistical significance was considered to be P<0.05. RESULTS Postoperative pulmonary mechanical function was significantly reduced in both groups compared with preoperative values. However, within the first 24 h, lung function tests and oxygen saturation were significantly better in the LMA group (P<0.001; ANOVA). CONCLUSIONS In moderately obese patients undergoing minor surgery, use of the LMA may be preferable to orotracheal intubation with respect to postoperative saturation and lung function.

PURPOSE This study compared physiologic effects of position change on overweight (OW) and normal-weight (NW) children during a preventive appointment. METHODS A cross-sectional, case-controlled design assigned a convenience sample to either overweight (>85th percentile) or normal-weight groups (25th to 85th percentile) by body mass index (BMI). A trained examiner measured blood pressure (BP), heart rate (HR), oxygen saturation (SpO2), and 5 pulmonary functions in preoperative, upright seated, supine, and postoperative upright seated positions. Anxiety was measured using the Corah Dental Anxiety Scale. RESULTS NW and OW groups' anxiety scores did not differ (P=.69). Mean BMIs were 20.1 and 39.7 for NW and OW subjects, respectively. Overall, BP between groups was not different (P=.051), although systolic BP for OW subjects tended to be higher. Systolic and diastolic BP dropped for both groups with supine positioning (P< or =.001). During this change, HR did not change for NW, but dropped for OW subjects (P=.001). SpO2 was significantly different between groups following position change, but not within each group. Forced vital capacity and forced expiratory volume were higher in the OW group (P< or =.01), but 2 peak expiratory measures (PEF and PEF25-75 were not (P=.05). CONCLUSION Heart rate and oxygen saturation respond differently to positional changes in overweight patients.

Obesity as a common health risk is increasing all over the world. The aim of this study was evaluation of standing and sitting positions on spirometric values in obese asthmatic patients, in comparison with normal obese subjects. The study included 49 obese asthmatic patients with mean age of 42.63 years and body mass index of 36.06 kg/m2, and 51 control obese normal subjects with mean age of 39.86 years and body mass index of 36.69 kg/m2. Subjects with body mass index of (BMI)> or =30 kg/m2 were enrolled in the study. Spirometric values were measured according to American Thoracic Society (ATS) recommendation. In both groups forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were measured in sitting and standing positions, and the results were compared. The mean+/-SD of FVC in sitting and standing positions in obese asthmatic patients were: 3.04+/-0.93 lit and 3.03+/-0.96 lit, p=0.37; and in control group: 3.68+/-1.12 lit and 3.72+/- 1.11 lit, p=0.39, respectively. The mean+/-SD of FEV1 in the sitting position and standing positions in obese asthmatic patients were: 2.38+/- 0.75 lit and 2.40+/- 0.81 lit, p=0.20; and in control subjects: 3.17+/- 0.92 lit and 3.21+/- 0.93 lit, p=0.07. This study showed that spirometric values in obese asthmatic patients with BMI> or =30 are not affected by the standing and sitting positions.

BACKGROUND Although obese patients are thought to be susceptible to postoperative pulmonary complications, there are only limited data on the relationship between obesity and lung volumes after surgery. We studied how surgery and obesity affect lung volumes measured by spirometry. METHODS We prospectively studied 161 patients having either breast surgery (Group A, n=80) or lower abdominal laparotomy (Group B, n=81). Premedication and general anaesthesia were standardized. Spirometry was measured with the patient supine, in a 30 degrees head-up position. We measured vital capacity (VC), forced vital capacity, peak expiratory flow and forced expiratory volume in 1 s at preoperative assessment (baseline), after premedication (before induction of anaesthesia) and 10-20 min, 1 h and 3 h after extubation. RESULTS Baseline spirometric values were all within the normal range. All perioperative values decreased significantly with increasing body mass index (BMI). The greatest reduction of mean VC (expressed as percentage of baseline values) occurred after extubation, and was more marked after laparotomy than after breast surgery (23 (SD 14)% vs 20 (14)%). Considering patients according to BMI (<25, 25-30,>30), VC decreased after surgery by 12 (7)%, 24 (8)% and 40 (10)%, respectively. VC recovered more rapidly in Group A. CONCLUSION Postoperative reduction in spirometric volumes was related to BMI. Obesity had more effect on VC than the site of surgery.

SETTING The clinical differences between cryptogenic organising pneumonia (COP) and secondary organising pneumonia (OP) have not been studied well. OBJECTIVE To compare clinical features in COP and secondary OP. DESIGN Causes, clinical features, treatment, radiographic studies and pathology were studied. RESULTS After re-evaluation, 104 patients fulfilled the diagnostic criteria, 58 for COP and 46 for secondary OP. The mean age was 68 years. Most of the patients were smokers (79/104). Infections were the most common causes of secondary OP (21/46). Cough was the most common symptom and crackles the most common sign. Crackles were more common in patients with secondary OP (P = 0.02). Transbronchial biopsy was the diagnostic test in 81/104 cases. Most patients had lowered partial oxygen pressure (PO(2)) and mildly restrictive spirometry, with no differences between the two groups. Radiographic features were similar. Corticosteroids were the treatment in 70% of the patients, but 27% received no pharmacological treatment. The average initial dose of steroids was 42 mg prednisolone, and was similar for both groups. Relapses were seen in 20% of cases, with no difference between the two groups. CONCLUSION There were no major differences in clinical features of COP and secondary OP, except that crackles were more common in secondary OP.

Background. Microsurgical discectomies are an established procedure in spinal surgery. This operating technique was first used in the Department of Neurosurgery in Iceland in 1981 and has become standard operative treatment for herniated lumbar discs. There is a great variability in outcome reports regarding recurrence rate and re-operation rate. Few articles are based on follow-up of more than 10 years. This article presents the results of a 20 years follow-up study. Methods. A retrospective study of all patients undergoing microsurgical discectomy for herniated lumbar disc, from June 1, 1981 to December 31, 1984. Outcome, based on recurrence rate, return to work and patient satisfaction was determined by a self-evaluation questionnaire, phone interviews and patient medical records. Findings. Of the 170 patients, 134 (78.8%) were included in the study (M:F, 58:42%). Preoperative symptoms: back pain with sciatica 108 (80.6%), sciatica 20 (14.9%), back pain 2 (1.5%). Mean follow-up time was 20.7 years (19.5-22.8). Recurrence rate was 12.7%. 19 patients (14.2%) underwent a subsequent lumbar operation at a different level or side. A majority of patients 108 (80.6%) returned to previous level of work, 26 (19.4%) lost some or all working capabilities. Patient satisfaction was high, 91.1% reporting excellent (68.7%) or good (22.4%) results. 5.2% of patients rated the outcome fair and 3.7% poor. Women reported worse outcome than men, excellent M:F 74.7:60.7%, and poor 7.1:1.3%. There was no significant difference in patient satisfaction in patients undergoing additional operations or those with recurrence of the herniated disc. Conclusions. Outcome was very good with 92.0% return to work and 91.1% patient satisfaction. The recurrence rate was 12.7% with a substantial number of cases occuring 10-20 years after operation. To conclude, microsurgical discectomies maintain a high success rate in the long-term.

BACKGROUND Cryptogenic organising pneumonia (COP) has also been called idiopathic bronchiolitis obliterans organising pneumonia. In secondary organising pneumonia (SOP) the causes can be identified or it occurs in a characteristic clinical context. The aim of this study was to determine the incidence and epidemiological features of COP and SOP nationwide in Iceland over an extended period. METHODS A retrospective study of organising pneumonia (OP) in Iceland over 20 years was conducted and the epidemiology and survival were studied. All pathological reports of patients diagnosed with or suspected of having COP or SOP in the period 1984-2003 were identified and the pathology samples were re-evaluated using strict diagnostic criteria. RESULTS After re-evaluation, 104 patients fulfilled the diagnostic criteria for OP (58 COP and 46 SOP). The mean annual incidence of OP was 1.97/100 000 population (1.10/100 000 for COP and 0.87/100 000 for SOP). The mean age at diagnosis was 67 years with a wide age range. The most common causes of death were lung diseases other than OP, and only one patient died from OP. Patients with OP had a lower rate of survival than the general population, but there was no statistical difference between COP and SOP. CONCLUSIONS The incidence of OP is higher than previously reported, suggesting that OP needs to be considered as a diagnosis more often than has been done in the past.

The aim of the present study was to analyse the risk of rehospitalisation in patients with chronic obstructive pulmonary disease and associated risk factors. This prospective study included 416 patients from a university hospital in each of the five Nordic countries. Data included demographic information, spirometry, comorbidity and 12 month follow-up for 406 patients. The hospital anxiety and depression scale and St. George's Respiratory Questionnaire (SGRQ) were applied to all patients. The number of patients that had a re-admission within 12 months was 246 (60.6%). Patients that had a re-admission had lower lung function and health status. A low forced expiratory volume in one second (FEV1) and health status were independent predictors for re-admission. Hazard ratio (HR; 95% CI) was 0.82 (0.74-0.90) per 10% increase of the predicted FEV1 and 1.06 (1.02-1.10) per 4 units increase in total SGRQ score. The risk of rehospitalisation was also increased in subjects with anxiety (HR 1.76 (1.16-2.68)) and in subjects with low health status (total SGRQ score >60 units). When comparing the different subscales in the SGRQ, the closest relation between the risk of rehospitalisation was seen with the activity scale (HR 1.07 (1.03-1.11) per 4 unit increase). In patients with low health status, anxiety is an important risk factor for rehospitalisation. This may be important for patient treatment and warrants further studies.

BACKGROUND: Splenic irradiation is routinely used in the supportive treatment of lymphoepithelial and hemopoietic diseases associated with splenomegaly. A new short-time irradiation schedule with conventional dosage (Group A: 2 Gy/fract.) was compared retrospectively with low-dose prolonged treatment schedules (Group B:< or = 1 Gy/fract.) to establish its tolerance and its efficacy in terms of relieving splenomegaly-associated symptoms. PATIENTS AND METHOD: Between 12/1996 and 3/2002 49 patients (6 with CLL, 14 with CML, 6 with NHL, 16 with MPD, 6 with OMF and 1 with AML) underwent 85 treatment courses (13 courses low-dose prolonged treatment and 72 courses short-time treatment).The spleens had been exposed to pretreatment doses of 3-70 Gy (mean 20.75 Gy). Splenic size was 12-35 cm (mean 22.76 cm). One treatment was done with 60Co. 9-20 MeV electron beams were used in 23 treatments and 6 MV photons in 61 treatments. Blood counts were monitored daily. Clinical improvement (pain relief, improvement of splenomegaly-associated symptoms), spleen volume reduction and effects on blood counts were evaluated and documented at the end of the treatment. RESULTS: Of the 85 treated patients, 55 (Group A: 47/72, Group B: 8/13) showed a > 10% reduction of spleen volume and 62 (Group A: 57/72, Group B: 5/13) clinical improvement. 15 of 49 patients underwent multiple irradiation (2-8 courses) without clinical or hematologic complications. The intervals between the courses were 2-19 months. Rapid response in terms of reduction in splenic size in 23 patients permitted field reduction during treatment. Significant hematologic abnormalities were absent throughout. CONCLUSION: The short-time treatment schedule ensured a rapid response with relief of pain and improvement of gastrointestinal and pulmonary symptoms at an overall treatment time shorter than that of low-dose prolonged treatment schedules. No differences in terms of hematologic abnormalities were found between single doses of 2 Gy and < or = 1 Gy.

PURPOSE To determine the cause-specific mortality relative to that expected in a population-based incidence cohort of people with unprovoked seizures. METHODS The cohort comprises 224 inhabitants of Iceland first diagnosed as suffering from unprovoked seizures during a 5-year period from 1960 to 1964. The expected number of deaths was calculated by multiplying person-years of observation within 5-year age categories for each year from diagnosis through 1995 by cause-specific and sex-specific national death rates for those aged 20 years and above. The standardized mortality ratio (SMR) and 95% confidence intervals (95% CI) were calculated. RESULTS All-cause mortality was increased among men (SMR 2.25, 95% CI 1.56-3.14) but not women (SMR 0.79, 95% CI 0.38-1.46). Among men, there were 8 deaths from accidents, poisoning and violence observed versus 2.82 expected (SMR 2.84, 95% CI 1.22-5.59) and 4 deaths from suicide versus 0.69 expected (SMR 5.80, 95% CI 1.56-14.84). All-cause mortality for men was still elevated after restriction of analysis to those with seizures of unknown etiology (SMR 1.73, 95% CI 1.05-2.67) with the excess deaths attributable to suicide (SMR 5.26, 95% CI 1.06-15.38). Both males and females with remote symptomatic unprovoked seizures had an increase in all-cause mortality due to excess mortality from all cancers, cerebrovascular disease and accidents. CONCLUSION When compared with the age-, time-period- and gender-specific mortality in the general population, there is excess mortality in men but not women. The increased mortality for men is partly attributable to excess mortality from accidents and suicides.

A variant of the normal extracellular cysteine protease inhibitor cystatin C (L68Q-cystatin C), is the amyloid precursor in hereditary cystatin C amyloid angiopathy (HCCAA). It has been suggested that the mutation causes cellular entrapment of L68Q-cystatin C in vivo and that the variant protein is not secreted to extracellular fluids. In order to test this hypothesis, we used matrix-assisted laser desorption ionization time-of-flight mass spectrometry in an effort to demonstrate the presence of L68Q- along with wildtype cystatin C in plasma and cerebrospinal fluid (CSF) of HCCAA-patients. Plasma from all five investigated HCCAA-patients contained both L68Q- and wildtype cystatin C. The presence of approximately equal amounts of cystatin C dimers and monomers was demonstrated in plasma from HCCAA-patients, whereas only monomers could be found in normal plasma. L68Q-wildtype-cystatin C heterodimers seem to be present in the dimeric cystatin C population. CSF from six HCCAA-patients also contained cystatin C-dimers and monomers, but the dimeric fraction was minute. CSF from control patients did not contain dimeric cystatin C. These results suggest that the milieu of L68Q-cystatin C is important for its stability and dimerization status and that certain milieus might hinder its further development into oligomers, amyloid fibrils and other precipitating aggregates.

Antibacterial peptides are active defense components of innate immunity. Several studies confirm their importance at epithelial surfaces as immediate barrier effectors in preventing infection. Here we report that early in Shigella spp. infections, expression of the antibacterial peptides LL-37 and human beta-defensin-1 is reduced or turned off. The downregulation is detected in biopsies from patients with bacillary dysenteries and in Shigella- infected cell cultures of epithelial and monocyte origin. This downregulation of immediate defense effectors might promote bacterial adherence and invasion into host epithelium and could be an important virulence parameter. Analyses of bacterial molecules causing the downregulation indicate Shigella plasmid DNA as one mediator.

BACKGROUND Spirometry has become an essential tool for general practices to diagnose and monitor chronic airways diseases, but very little is known about the performance of the spirometry equipment that is being used in general practice settings. The use of invalid spirometry equipment may have consequences on disease diagnosis and management of patients. OBJECTIVES To establish the accuracy and precision of desktop spirometers that are routinely used in general practices. METHODS We evaluated a random sample of 50 spirometers from Dutch general practices by testing them on a certified waveform generator using 8 standard American Thoracic Society waveforms to determine accuracy and precision. Details about the brand and type of spirometers, year of purchase, frequency of use, cleaning and calibration were inquired with a study-specific questionnaire. RESULTS 39 devices (80%) were turbine spirometers, 8 (16%) were pneumotachographs, and 1 (2%) was a volume displacement spirometer. Mean age of the spirometers was 4.3 (SD 3.7) years. Average deviation from the waveform generator reference values (accuracy) was 25 ml (95% confidence interval 12-39 ml) for FEV(1) and 27 ml (10-45 ml) for FVC, but some devices showed substantial deviations. FEV(1) deviations were larger for pneumotachographs than for turbine spirometers (p < 0.0031), but FVC deviations did not differ between the two types of spirometers. In the subset of turbine spirometers, no association between age and device performance was observed. CONCLUSIONS On average, desktop spirometers in general practices slightly overestimated FEV(1) and FVC values, but some devices showed substantial deviations. General practices should pay more attention to the calibration of their spirometer.

BACKGROUND AND OBJECTIVES The change from the sitting position to supine position, general anesthesia, and surgical procedure reduce lung volumes and this effect can be greater in obese patients. The objective of the present study was to evaluate the influence of the sitting position, 30 dorsal inclination, and horizontal dorsal decubitus on spirometry of grade III obese patients. METHODS Twenty-six adult patients in the preoperatory period were selected according to the following criteria: BMI>40kg.m(-2), age between 18 years and 60 years, and female gender. Variables analyzed included: age, weight, height, BMI, percentage of predictive values of FVC, FEV(1), and VEF(1)/FVC in the sitting position (90°), 30° dorsal elevation, and horizontal dorsal decubitus (0°). ANOVA, followed or not by Tukey test were used to compare mean predicted values on the different positions, considering significant a p value lower than 0.05. RESULTS Percentage values of FVC, FEV(1), and FEV(1)/FVC ratio regarding predicted values in the sitting position (90°), 30° dorsal elevation, and horizontal dorsal decubitus (0°), and p value of the corresponding statistical analysis were, respectively: FVC=92.8%, 88.2%, and 86.5%, p=0.301 (ANOVA); FEV(1): 93.1%, 83.8%, and 83.3%, p=0.023 (ANOVA), p=0.038 (Tukey test - 90°×0°); FEV(1)/FVC: 100,8%, 95.5%, and 96.8%, p=0.035 (ANOVA), p=0.035 (Tukey test - 90°×30°). CONCLUSIONS Changes in position produced changes in spirometry results of patients with grade III obesity.

OBJECTIVE One of the major issues in the use of spirometry is the evaluation of the values obtained in comparison with standardized reference values. Such reference values should be determined by studying populations similar to the population in which they are intended to be used. Considering the anthropometric differences among races and the effect of regional issues, such as climate and air quality, it is recommended that these standards be set and used regionally. The objective of this study was to measure the spirometric values in residents of the Mazandaran province in Iran, as well as to determine which standardized reference values most closely correlate with the values obtained and to devise predictive equations for the target population. METHODS This was a cross-sectional study of 1,499 volunteers, from whom demographic and anthropometric data were collected. After having been instructed in the correct procedure, each volunteer underwent spirometry. From each volunteer, we obtained three spirometry curves that met the acceptability criteria established by the American Thoracic Society. The test with the highest values of FEV1 and FVC was employed in the analysis. RESULTS We observed significant correlations between the measured values and the reference values, for both genders. The strongest correlations were with the European Respiratory Society reference values and with the 18-20 year age bracket. The predictive equations devised were based on the regression coefficients obtained and the demographic data collected. CONCLUSIONS Our results show that the European Respiratory Society standard is the most appropriate standard for use in the population studied.

OBJECTIVE To assess the distance covered by both eutrophic individuals and individuals with different grades of obesity and correlate the data obtained with spirometric values. This study is justified by the existing difficulty in assessing the functional capacity in obese individuals, and by the low cost and good specificity of six-minute walk test (6MWT) in predicting reduced capacity for activities of daily living for any individual. METHODS One hundred fifty-four individuals of both genders were assessed after being divided into two groups: G1, obese individuals (n = 93, BMI ≥ 30 kg/m²) and G2, eutrophic individuals (n = 61, BMI 18.5 to 24.99 kg/m²). The 6MWT was performed using the methodology described by the American Thoracic Society (ATS-2002). Spirometry was performed both before and after the application of a bronchodilator agent (BDA) in accordance with the Guidelines for Pulmonary Function Tests by the Brazilian Society of Pneumology and Phthisiology (SBPT-2002). The statistical analysis, consisting of mean, standard deviation, Pearson's correlation, Student's t test and Spearman's correlation, considered p < 0.05. RESULTS The 6MWT analysis with spirometry for G1 was positively correlated only with pre- and post-BDA peak expiratory flow rate (PEFR). CONCLUSION The present study showed a positive correlation between pre- and post-BDA PEFR and the distance covered in the 6MWT in obese subjects, that is, the higher the PEFR, the higher the physico-functional capacity of the individual, and consequently, the greater the distance covered.

The need for ethnic-specific reference values of lung function variables (LFs) is acknowledged. Their estimation requires expensive and laborious examinations, and therefore additional exploitation of results in physiology and epidemiology would be profitable. To make possible such exploitation we proposed a form of prediction equations with physiologically-interpretable coefficients: a baseline, the onset age (A0) and rate (S) of LF decline, a height coefficient. The form was tested with the use of data for healthy, non-smoking Poles aged 18-85 (1120 males, 1625 females) who performed spirometry manoeuvre according to ATS/ERS criteria. The values of all the coefficients (also A0) for several LFs were determined with regression of a LF on patient's age and deviation of patient's height from the mean height in the year group of this patient. S values for forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow, and maximal expiratory flow at 75% of FVC (MEF75) were very similar in both genders (1.03+/-0.07%/yr). FEV1/FVC declines 4-5 times slower. S for MEF25 appeared age-dependent. A0 was smallest (28-32 yrs) for MEF25 and FEV1. About 50% of each age subgroup (18-40, 41-60, 61-85 yrs) exhibited LFs below the mean, and 4-6% were below the 5th percentile lower limits of normal, and thus the form of equations proposed in the paper appeared appropriate for spirometry. Additionally, if this form is accepted, epidemiological and physiological comparison of different LFs and populations will be possible by means of direct comparison of the equation coefficients. Key words: FEV1, height, obesity, lung function decline.

Repercussions of obesity on the lung function have been widely studied. The effect of serious malnutrition is less well known. The aim of study was to determine spirometric parameters in 102 malnourished girls with anorexia nervosa. Among these patients, only 71 aged 12-18 years (mean 15.6), mean BMI 15.8 kg/m(2), met the ATS/ERS forced expiratory maneuver criteria for spirometry. The most frequently observed abnormalities were: decreased IC seen in 33 (46%) girls and decreased PEF in 45 (63%) patients. Maximum voluntary ventilation was within the normal range in all but 2 subjects. Diminished values of FEV(1), FVC, FEV(1)/FVC, MEF(50) were observed in 10 (14%), 13 (18%), 3 (4%), and 3 (4%) patients, respectively. We found strong positive correlations between weight and absolute values of the examined parameters. We assume that spirometric abnormalities in anorexia are probably a result of respiratory muscle weakness and body mass loss.

Background: Forced expiratory time (FET) has gained new interest in the joint recommendation of the American Thoracic Society (ATS) and the European Respiratory Society (ERS) for the assessment of spirometry. Interpretation of FET is, however, difficult as limited information is available on spirometric and anthropometric determinants of FET in populations. Methods: We studied a non-selected population sample including healthy non-smokers with a structured interview and flow-volume spirometry. Regular medication, if any, was continued. Spirometry of 603 individuals (248 men, 355 women) fulfilled predefined quality criteria based on modified ATS recommendations. FET from the flow-volume curve with the largest sum of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) was used in analyses. Results: The mean FET in the population sample was 10.7 (95% CI 10.4-11.1) s and in healthy non-smokers 9.8 (9.2-10.4) s. Men had on average longer FET (11.3 s versus 10.3 s), but the gender difference was not significant when FEV1/FVC was used as a covariate. FEV1/FVC (r =-0.613, P<0.01) and maximal mid-expiratory flow (MMEF) correlated negatively and age (r = 0.279, P<0.01), body mass index (BMI) and smoking pack-years positively with FET. Conclusions: The findings indicate that mean FET is around 11 s in a non-selected adult population and around 10 s in healthy non-smokers. FET increases slightly with age and BMI, suggesting age- and weight-related changes in pulmonary mechanics. The negative correlation of FET with FEV1/FVC and MMEF even in healthy non-smokers indicates that airflow limitation, either pathological or physiological, tends to prolong FET.

Obesity as a common health risk is increasing all over the world. The aim of this study was evaluation of standing and sitting positions on spirometric values in obese asthmatic patients, in comparison with normal obese subjects. The study included 49 obese asthmatic patients with mean age of 42.63 years and body mass index of 36.06 kg/m2, and 51 control obese normal subjects with mean age of 39.86 years and body mass index of 36.69 kg/m2. Subjects with body mass index of (BMI)> or =30 kg/m2 were enrolled in the study. Spirometric values were measured according to American Thoracic Society (ATS) recommendation. In both groups forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were measured in sitting and standing positions, and the results were compared. The mean+/-SD of FVC in sitting and standing positions in obese asthmatic patients were: 3.04+/-0.93 lit and 3.03+/-0.96 lit, p=0.37; and in control group: 3.68+/-1.12 lit and 3.72+/- 1.11 lit, p=0.39, respectively. The mean+/-SD of FEV1 in the sitting position and standing positions in obese asthmatic patients were: 2.38+/- 0.75 lit and 2.40+/- 0.81 lit, p=0.20; and in control subjects: 3.17+/- 0.92 lit and 3.21+/- 0.93 lit, p=0.07. This study showed that spirometric values in obese asthmatic patients with BMI> or =30 are not affected by the standing and sitting positions.

This study was carried out to obtain normal lung function values for women in south eastern Nigeria with a view to establishing prediction equations for forced vital capacity (FVC), forced expiratory volume at the first second (FEV(1)) and peak expiratory flow rate (PEFR). Lung function values were measured in 600 apparently healthy Nigerian women aged between 18 and 57 years. FVC and FEV1 were significantly related to height [P < 0.001] and [P < 0.01] respectively) and body weight [P < 0.01], PEFR was also related to age [P < 0.01] and height [P < 0.001]. Prediction equations for the various lung function indices were as follows: FVC = 0.145 +(1.390Ht)-(0.0076age)+(0.0089wt); FEV1 = 0.240 +(1.045Ht)-(0.0055age)+(0.0064wt); PEFR =-38.80 +(210.83Ht)+(1.650age)+(0.252wt). Ht is height in meters, wt. is body weight in kilograms and age is age in years. The ventilatory function indices were directly proportional to weight, height and to age. All the observed or measured lung function indices were not significantly different from their predicted values using the above prediction equations. Therefore, we conclude that lung function indices are influenced by the anthropometric parameters viz: age, body weight and height, and the prediction equations stated for FVC, FEV1 and PEFR for Nigerian women between the ages 18 and 57 years are reliable.

The purpose of the study was to evaluate the validity of an air-displacement plethysmography system (AP) within the general population, while wearing (1) a racing-type swimsuit (AP(SS)) and (2) participant's personal undergarments (AP(UG)), against hydrodensitometry (HW). Fifty women and 50 men were measured for body volume, density, and fat percentage by HW and compared with AP(SS) and AP(UG). For women, AP(UG) and AP(SS) were similar, although significant differences (p < 0.001) were observed between AP(UG) and HW and between AP(SS) and HW. For men, there was no significant difference between AP(UG) and HW; however, significant differences (P < or = 0.01) were found between AP(UG) and AP(SS) and between AP(SS) and HW. The small discrepancy in measured values between AP and HW are within the measurement error for the instrumentation and these data support the use of AP for determination of body composition in adults across a wide range of body size (body mass index [BMI] 17.7-35.2 kg.m(-2)) and age (18-57 y). Participants' personal undergarments provide a practical alternative to a spandex swimsuit when measuring body composition by AP in women but not in men.