Objective To evaluate the effects of inhaled bronchodilators on respiratory mechanics in moderate and severe chronic obstructive pulmonary disease（COPD） patients during eupnea.Methods Twenty moderate to severe COPD subjects were divided into three groups.Lung function，Borg score，breathing pattern and respiratory mechanics indexes were measured at baseline and 30 min after inhaled placebo，salbutamol 400 μg (or ipratropium 80 μg)，and ipratropium 80 μg (or salbutamol 400 μg) in sequence at interval as specified in different groups.Results In all groups，inhaled bronchodilators improved lung function (FEV1，FVC，IC) (Plt;0.05)，decreased Pdi，Peso，PTPdi，PTPeso and Raw (Plt;0.05，respectively)，in comparison with placebo.The reduction of PTPeso was positively correlated with the reduction of Peso (r=0.713，Plt;0.01）and Raw (r=0.602，Plt;0.01).Borg score decreased after inhaled bronchodilators (Plt;0.05).The reduction of dyspnea was positively correlated with the reduction of inspiratory work of breathing (ΔPTPeso%) (r=0.339，Plt;0.05) and Raw (ΔRaw) (r=0.358，Plt;0.05)，while was not associated with the changes of FEV1，FVC and IC.Conclusions In COPD patients，inhaled bronchodilators can reduce inspiratory work of breathing and airway resistance，the reduction of inspiratory work of breathing contributed to the reduction of airway resistance.Alleviation of dyspnea by inhaled bronchodilators is suggested to be ascribed to reduction of airway resistance and inspiratory work of breathing.
Objective To investigate the lung involvement in Chinese patients with systemic sclerosis ( SSc) and its functional impact. Methods 68 patients with SSc were enrolled in Scleroderma study of PUMCH ( Peking Union Medical College Hospital) . All the patients underwent high resolution computed tomography ( HRCT) , pulmonary function testing, 6-minute walk testing, and echocardiography. And 36 patients filled in the Saint George’s Respiratory Questionnaire ( SGRQ) for assessment of healthrelated quality of life. Results HRCT revealed interstitial lung disease ( ILD) in 52 ( 76. 5% ) patients, 20 out of them without respiratory symptoms. Reticular opacification, ground-glass opacity ( GGO) , traction bronchiectasis, and honeycomb were presented respectively in 80.8% , 73.1% , 59.6% , and 30.8% of patients with SSc-ILD. Fibrosis was the predominant HRCT finding, and pure GGO ( in the absence of reticulation or architectural distortion) was only present in 8 ( 15. 7% ) patients. 57 (83.8% ) patients presented with diffusion defect, with most of them having moderate to severe impairent. Reduced FVC or TLC presented in 20 ( 29.4% ) and 28 ( 41.2% ) of patients respectively. The significant correlation was observed between the DLCO and the extent of ILD on HRCT ( rs = -0.476, P =0.000) . DLCO showed significant correlations with all the four components of the SGRQ ( Plt;0.05) . Significant correlations were also observed among the SGRQ scores and SpO2 ( maximum desaturation) or Borg index. Stepwise multiple regression analysis confirmed that the DLCO, SpO2 , and Borg index contributed to the SGRQ. Conclusions Lung involvement in Chinese SSc patients is common and insidious. The HRCT features of SSc-ILD are predominant fibrosis plus GGO, indicating little reversibility. Thus HRCT should be performed routinely in newly diagnosed SSc patients for early screening of lung involvement. The lung function defect of SSc is characterized by reduced diffusing capacity, and DLCO show better correlations with HRCT abnormities or SGRQ than FVC or TLC. Thus DLCO is of great value for early detection or severity assessment of SSc-ILD. SGRQ can be used to examine the health related quality of life of SSc patients and may reflect severity of lung involvement.
Objective To explore the prognostic significance of baseline clinical and pulmonary physiological variables on idiopathic pulmonary fibrosis ( IPF) . Methods Patients diagnosed with IPF according to 2011 ATS/ERS/JRS/ALAT statementwere selected from Nanjing DrumTower Hospital between January 1, 2002 and July 31, 2010. The baseline characteristics were abstracted, including age, gender, smoking history, corticosteroid, delay before diagnosis, body mass index, finger clubbing, oxygenation index ( PaO2 /FiO2 ) , C-reaction protein, erythrocyte sedimentation rate ( ESR) , serum lactate dehydrogenase ( LDH) , albumin, vital capacity ( VC) , forced vital capacity ( FVC) , total lung capacity ( TLC) , and singlebreath diffusing capacity of the lung for carbon monoxide ( DLCO) . The relationships between all factors and survival were examined with a univariate Cox proportional-hazard model. Kaplan-Meier method was used to assess the survival probabilities between groups with different baseline characteristics. Results Eighty-four patients were included in this study, with the median survival time of 34. 7 months. PaO2 /FiO2 , FVC% pred, VC% pred, TLC% pred, and DLCO% pred showed significant associations with the mortality of IPF ( hazard ratios 0. 940-0. 994, P lt; 0. 01) . The Kaplan-Meier analyses for above variables also showed significant differences ( P lt;0. 05) . Besides, the statistical difference of survival probability could be found between the patients with elevated serumLDH and those with normal LDH ( 27. 0 months vs. 43. 1 months, P =0. 014) . Conclusions Baseline oxygenation and pulmonary function parameters may indicate the prognosis of IPF patients. Serum LDH may provide clinicians with additional prognostic information.
Objective To investigate the differences between six parts of China in prediction models of lung function.Methods The predicted values of 360 healthy volunteers underwent pulmonary functiontest in east China were compared with that of north China, northeast China, northwest China, southwest China, south China and Asian American. Results In the male group, the prediction values of east China were as follows: VC ( 4. 19 ±0. 33) L, coefficient correlation( r) to the other five regions were 0. 803-0. 983,the differences to the other five regions were 1. 90% -4. 30% ; FVC ( 4. 06 ±0. 35) L, r to the others were 0. 912-0. 981, the differences to the other four regions were 0-2. 46% except for south China of 8. 10% , to Asian American ×0. 88 and Asian American ×0. 94 were 1. 97% and 4. 68% ; FEV1 ( 3. 34 ±0. 40) L, r to the others were 0. 963-0. 992, the differences to north China and east China were 0. 9% and 3. 59% , to southwest China and south China were gt;5% , to Asian American ×0. 88 and Asian American×0. 94 were 6. 89% and 0. 6% ; FEV1 /FVC ( 80. 87 ±3. 84) % , r to the others were 0. 989-0. 999, the differences to north China, northeast China and south China were 0. 42% -3. 04% , to the others were gt;5% . In the female group, the prediction values of east China were as follows: VC ( 3. 00 ±0. 33) L, r to the other five regions were 0. 899-0. 993, the differences to the other five regions were 0. 33% -3. 67% ; FVC( 2. 92 ±0. 34) L, r to the other five regions were 0. 929-0. 990, the differences to the other five regions were 1. 02% -2. 40%, to Asian American ×0. 88 and Asian American ×0. 94 were 4. 79% and 6. 16% ; FEV1 ( 2. 38 ±0. 39) L, r to the other five regions were 0. 958-0. 994, the differences to northeast China, southwest China, south China were 0. 84% -3. 36% , to north china was 7. 19% , to Asian American ×0. 88 and Asian American ×0. 94 were 2. 10% and 4. 62% ; FEV1 /FVC ( 82. 04 ±3. 94) % , r to the others were 0. 991-1. 000, the differences to the other four regions were 1. 34% -4. 55% except for southwest China was 7. 59% . Conclusions VC and FVC predicted values are coincident between six parts of China. FEV1 /FVC predicted values are coincident in the four parts of China except for westnorth and westsouth China. FEV1 predicted values are different. The oversea predicted values should be used with appropriate conversion factors.
Objective To determine the efficacy of forced expiratory volume in six seconds( FEV6 ) as an alternative for forced vital capacity( FVC) in the diagnosis for mild-moderate chronic obstructive pulmonary disease( COPD) .Methods A total of 402 mild-moderate COPD and 217 non-COPD patients’ spirometric examinations were retrospectively analyzed. The correlation between FEV6 and FVC, FEV1 /FVC and FEV1 /FEV6 was evaluated by the Spearman test. Considering FEV1 /FVC lt;70% as being the ‘golden standard’ for airway obstruction, a ROC curve was used to determine the best cut-off point for the FEV1 /FEV6 ratio in the diagnosis for COPD. Results The Spearman correlation test revealed the FEV1 and FEV6 , FEV1 /FEV6 and FEV1 /FVC ratios were highly correlated ( r = 0. 992, 0. 980, respectively, P = 0. 000) . Using FEV1 /FEV6 lt; 70% as the diagnosis standard, 12. 69% of the 402 patients could not be diagnosed as COPD. The FEV1 /FVC ratio of these patients was very close to 70% . The best cut-off point for the FEV1 /FEV6 ratio in the diagnosis of mild-moderate COPD was 72% while the sensitivity and specificity were 94. 7% and 92. 2% , respectively. Conclusions There is a b correlation between FEV1 /FVC and FEV1 /FEV6 . The FEV6 can be a valid alternative for FVC in the diagnosis for mild-moderate COPD, although it may result in false negative. The best cut-off point for the FEV1 /FEV6 ratio is 72% .
Objective To analyze the quality control results of forced vital capacity ( FVC) test in elderly patients. Methods 534 lung function test reports of the elderly patients ( ≥ 80 years old) from January 2010 to December 2010 were collected from pulmonary function testing laboratory in Shougang Hospital of Peking University. Based on the report results, the selected patients were divided into four groups, ie. a normal group, a restricted group, an obstructed group, and a mixed group. The results of lung function tests that met the criteria of quality control in each group were statistically analyzed. Results A total of 534 reports were collected, of which 36 were not credible and treated as test failure. Of the 498 credible reports, 99.6% ( 496 /498) met the start-of-test criteria for quality control. 95. 8% ( 477/498) met the exhalation process test criteria for quality control with the highest rate of 98.6% ( 217 /220) in the obstructed group and the lowest rate of 85. 9% ( 55 /64) in the restricted group. The difference between two groups was significant (Plt;0.01) . 68.1% ( 339/498) met the end-of-test criteria for quality control with the highest rate of 88.6% ( 195/220) in the obstructed group and the lowest rate of 18.8% ( 12/64) in the restricted group. The difference between two groups was significant (Plt;0.01) . 16.7% (88/498) of the reports could be analyzed for repeatability, and the obstructed group had the highest rate of 22.3% (49/220) while the restricted group had the lowest rate of 6.3% ( 4/64) . The difference between two groups was significant too (Plt;0.01) . Only 14.6% (73/498) of the reports met all of the criteria listed above. Conclusions Elderly patients can also complete FVC test but the result may be not credible. There are still lots to be improved in FVC test for elderly patients.
0bjective To evaluate the efficacy of FEV6 and FEV1／FEV6 as surrogates for FVC and FEV1／FVC in the spirometric diagnosis of airway obstruction，and to determine the fixed cut-off point of FEV1／FEV6 which can be used as an alternative for FEV1／FVC lt; 70％.Methods Spirometry measurements were perform ed in 128 participants．FEV1，FEV6，FVC，FEV1％pred，FVC％pred，FEV1／FVC and FEV1／FEV6 were measured and analyzed.FEV1／FVClt;70％ was used as the“gold standard”。Severity of obstruction was based on FEV ％ pred．From ROC curve analysis，the FEV1／FEV6 ratio，which corresponded to optimal combination of sensitivity and specificity，was determined．Correlation between FEV1／FVC and FEV1／FEV6 was studied．Results Of 128 participants，there were 65(51％)with FEV1／FVC ≥70％ ．Of the 63 participants with FEV1／FVC lt;70％ ，there were 5 with FEV1／FEV6 between 70.09％ to 71％。There was no significant difference between the mean value of FVC and that of FEV ．Lifear correlation was revealed between FEV1／FVC and FEV1／FEV6 with the value close to 1(r=0.9979，Plt;0.0001)．From ROC curve analysis，the FEV1／FEV6lt;71.14％ was the best cut-off point coresponding to FEV1／FVC lt;70％ ．Conclusion These results suggest that FEV1／FEV6 is a valid alternative to FEV1／FVC for spirometric diagnosis of airw ay obstruction．There is a b corelation between FEV1／FEV6 and FEV1／FVC．
ObjectiveTo analyze the clinical characteristics of patients with amyopathic dermatomyositis with organizing pneumonia (ADM-OP).MethodsThe clinical data of 8 patients hospitalized with ADM-OP from June 2014 to June 2018 were retrospectively reviewed and simultaneously compared with those of 8 patients of cryptogenic organizing pneumonia (COP).ResultsThe incidence of skin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies in the ADM-OP patients were 87.5%, 87.5% 75.0% and 87.5% respectively. Gender, smoking, respiratory symptoms and signs, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide and treatment strategy were no statistical difference between ADM-OP and COP patients, but the onset age and Chest CT fibrosis scores (CTFS) on admission existed differences. After treatment for 3 months, CTFS, rate of change and forced vital capacity (FVC) existed differences. After treatment for 6 months, CTFS, rate of change, FVC and diffusing capacity of the lung for carbon monoxide existed differences.ConclusionsSkin lesion, Gottron’s sign, mechanic’s hand and positive anti-synthase antibodies are more common in ADM-OP patients. Their response to treatment is good but the improvement rates in CTFS and pulmonary function are slower than those of COP patients.
Objective To investigate the rate of pulmonary function test, medication treatment, and relevant factors among patients with chronic obstructive pulmonary disease (COPD) aged 40 years or older in community of Guangdong Province, and to provide evidences for targeted intervention of COPD. Methods A multistage stratified cluster sampling was conducted in the community residents, who participated in the COPD surveillance project of in Guangdong Province during 2019 to 2020. A total of 3384 adults completed questionnaire and pulmonary function test. The Rao-Scott χ2 test based on complex sampling design, and non-conditional Logistic regression were used to explore possible influencing factors of pulmonary function test and medication treatment in COPD patients. Results Out of the 3384 adults, 288 patients with COPD were confirmed, including 253 males (87.8%) and 35 females (12.2%), and 184 patients (60.4%) were over 60 years old or more. The pulmonary function test rate was 10.7% [95% confidence interval (CI) 6.8% - 14.6%], and medication treatment rate was 10.6% (95%CI 7.0% - 14.1%). The results showed that wheezing, awareness of COPD related knowledge and pulmonary function test were related to whether COPD patients had pulmonary function test (P<0.05). Wheezing and personal history of respiratory diseases were related to medication treatment rate (P<0.05). Conclusions The rates of pulmonary function test and medication treatment among COPD patients aged 40 years or older are low. Health education about COPD should be actively carried out, and the screening of individuals with a history of respiratory diseases and respiratory symptoms should be strengthened so as to reduce the burden of COPD diseases.
In 2005, interpretative strategies for pulmonary function tests were issued jointly by the American Thoracic Society (ATS) and the European Respiratory Society (ERS), and they have since been updated in 2021. In this article, we introduced the updated key points, including reference equations and normal limits, natural changes in lung function over time, bronchodilator responsiveness testing, the classification of physiological impairments, and the severity of lung function impairment. We also put forward some suggestions from the viewpoint of our national conditions. We expected it to provide useful references for those concerned with the application of pulmonary function tests in China.