Factors in childhood associated with lung function decline to adolescence in cystic fibrosis

BackgroundDespite improvements in general health and life expectancy in people with cystic fibrosis (CF), lung function decline continues unabated during adolescence and early adult life.MethodsWe examined factors present at age 5-years that predicted lung function decline from childhood to adolescence in a longitudinal study of Australasian children with CF followed from 1999 to 2017.ResultsLung function trajectories were calculated for 119 children with CF from childhood (median 5.0 [25%-75%=5.0–5.1]) years) to early adolescence (median 12.5 [25%-75%=11.4–13.8] years). Lung function fell progressively, with mean (standard deviation) annual change -0.105 (0.049) for forced vital capacity (FVC) Z-score (p<0.001), -0.135 (0.048) for forced expiratory volume in 1-second (FEV₁) Z-score (p<0.001), -1.277 (0.221) for FEV₁/FVC% (p<0.001), and -0.136 (0.052) for forced expiratory flow between 25% and 75% of FVC Z-score (p<0.001). Factors present in childhood predicting lung function decline to adolescence, in multivariable analyses, were hospitalisation for respiratory exacerbations in the first 5-years of life (FEV₁/FVC p = 0.001, FEF_25–75 p = 0.01) and bronchoalveolar lavage neutrophil elastase activity (FEV₁/FVC% p = 0.001, FEV₁ p = 0.05, FEF_25–75 p = 0.02). No examined factor predicted a decline in the FVC Z-score.ConclusionsAction in the first 5-years of life to prevent and/or treat respiratory exacerbations and counteract neutrophilic inflammation in the lower airways may reduce lung function decline in children with CF, and these should be targets of future research.     

高海拔地区脊柱侧凸患者心肺功能变化

目的评估高寒缺氧环境对脊柱侧凸患者心肺功能的影响。方法回顾分析2006年1月~2012年12月本院收治的高海拔地区特发性脊柱侧凸患者31例,并选取同时期来自平原地区的其他特征(年龄、性别、侧凸角、后凸角)相似特发性脊柱侧凸患者31例作配对研究。收集并分析62例患者术前站立位全脊柱正侧位X线片、术前肺功能和心脏彩超检查结果。结果高海拔地区脊柱侧凸患者心脏彩超结果中每搏输出量(stroke volume,SV)、射血分数(ejection fraction,EF)、左房内径(left atrial internal diameter,LAID)、左室内径(left ventricular internal diameter,LVID)、右房内径(right atrial internal diameter,RAID)以及肺功能检查中肺活量(vital capacity,VC)、肺总量(total lung capacity,TLC)、用力肺活量(forced vital capacity,FVC)、一秒率(FEV1/FVC%)大小与平原地区脊柱侧凸患者检查结果相比差异无统计学意义(P0.05)。而高海拔地区与平原地区脊柱侧凸患者的右室内径(right ventricular internal diameter,RVID)、第一秒用力呼气容积(forced expiratory volume in one second,FEV1)实测值相比,差异具有统计学意义(P0.05)。结论高海拔地区与平原地区脊柱侧凸患者的心肺功能总体上无明显差异,在进行术前评估、准备和围手术期处理上,高海拔地区脊柱侧凸患者与平原地区脊柱侧凸患者相比并无特殊。     

Pulmonary function after posterior retroperitoneoscopic surgery

Pulmonary function tests were performed in 12 patients who underwent posterior retroperitoneoscopic surgery, before and on the 3rd and 7th days after operation. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FCV, vital capacity (VC), total lung capacity (TLC), residual volume (RV) and functional residual capacity (FRC) were not significantly different between before and after surgery. It is assumed that posterior retroperitoneoscopic surgery could be performed without impairment of pulmonary function after surgery.     

64层螺旋CT低剂量双相扫描测定肺体积评价慢性阻塞性肺疾病患者肺功能

目的探讨64层CT低剂量双相扫描肺体积测量指标评估慢性阻塞性肺疾病(COPD)患者肺功能的价值。方法选择经临床肺功能检查确诊的36例COPD患者(COPD组)及30名健康体检者(正常对照组),采用64层CT行深吸气末、深呼气末全肺低剂量(50mAs)及常规剂量(100mAs)吸气末扫描,得出每次扫描的容积CT剂量指数(CTDIvol)和剂量长度乘积(DLP),并换算出有效剂量(ED)。以配对样本t检验比较两组间不同扫描剂量及不同呼吸状态下的CT-DIvol、DLP、ED;应用Fisher确切概率法比较CT图像质量。按扫描层数将全肺分为上、中、下3个肺区,应用Pulmo软件测量和计算COPD组与正常对照组的各体积指标:深吸气末体积(Vin)、深呼气末体积(Vex)、体积差(Vin-Vex)、体积比(Vex/Vin)、体积变化百分比(Vin-Vex)/Vin×100%。于CT检查前后3天完成PFT检查,对比研究指标为第1秒用力肺活量(FEV1)的实测值与预计值的比值(FEV1%)及FEV1与用力肺活量(FVC)的比值(FEV1/FVC)。结果所有图像均成功用于自动分割技术与数据处理。与正常对照组比较,COPD组除各肺区的Vin及上肺区Vin-Vex外,其余各体积指标差异均有统计学意义(P均<0.05);Vex、Vex/Vin、(Vin-Vex)/Vin×100%均与FEV1%、FEV1/FVC存在相关性(P<0.01)。结论 64层CT低剂量双相扫描肺体积指标可较好评价COPD患者肺功能,临床应用价值较高。     

Six-minute walking and pulmonary function test outcomes during the early period after lung cancer surgery with special reference to patients with chronic obstructive pulmonary disease

Objective: To evaluate physical dysfunction during the early period after lung resection in patients with lung cancer and coexisting chronic obstructive pulmonary disease (COPD), we examined the relationship between the ratio of the forced expiratory volume in 1 second to the forced vital capacity (FEV₁/FVC%) and the results of a 6-minute walk (6MW) test before and after surgery. Methods: Eighty-three patients who underwent lobectomy for lung cancer were classified into three groups according to their preoperative FEV₁/FVC: more than 70% (non-COPD, n=61), 60–69% (mild COPD, n=15), and 40–59% (moderate COPD, n=7). The 6MW and pulmonary function tests were performed before surgery and repeated 1 and 2 weeks after surgery. During the 6MW test, the distance covered during a 6MW test (6MWD) and the decrease in oxygen saturation (SpO₂) were measured. Results: During both the preoperative and postoperative 6MW tests, the decrease in SpO2 correlated significantly with the preoperative FEV₁/FVC% (p<0.001). The percentage decrease in 6MWD at 1 and 2 weeks after surgery correlated significantly with the preoperative FEV₁/FVC% (p<0.001 and p=0.04, respectively), but not with the concomitant percentage reduction in vital capacity (VC). The differences of the decreases in postoperative 6MWD and SpO₂ during the 6MW test were significant between the moderate and mild COPD patients and between the mild COPD and non-COPD patients (p<0.01–0.001). Conclusion: The decreases in 6MWD and SpO₂ after surgery were significantly influenced by the preoperative FEV₁/FVC%, but not by the decrease in VC. COPD patients have a limited capacity for walking during the early period after surgery due to significant oxygen desaturation.     

Measurement of respiratory function: ventilation

Measurement of ventilatory function is often impeded by poor technique when individuals perform tests of respiratory function. Static lung volumes (with the exception of residual volume and other capacities that contain residual volume) can be easily measured with spirometry. Residual volume and functional residual capacity can be measured using helium dilution or body plethysmography, although neither of these techniques is used in daily clinical practice. Dead space (the volume of gas not participating in gas exchange) can be measured using a single-breath nitrogen washout technique, or by application of the Bohr equation. Dynamic volumes measure airflow through the lungs, and often require individuals to perform a forced vital capacity (FVC) manoeuvre. Data generated from such tests include peak expiratory flow rate, forced expiratory volume in 1 second (FEV₁) and the ratio FEV₁:FVC, which may be used in the diagnosis, assessment and management of respiratory disease. Flow–volume loops provide more detailed analysis of dynamic airflow in the lungs and are often displayed on anaesthetic machines. Measurement of the maximum voluntary ventilation (MVV) provides a global assessment of respiratory system function because it is influenced by airway resistance, respiratory muscle function, ventilation control mechanisms and compliance of lungs or chest wall. An approximation of MVV can be made by multiplying the FEV₁ by 35.     

Measurement of respiratory function: ventilation

Measurement of ventilatory function is often impeded by poor technique when individuals perform tests of respiratory function. Static lung volumes (with the exception of residual volume and other capacities that contain residual volume) can be easily measured with spirometry. Residual volume and functional residual capacity can be measured using helium dilution or body plethysmography, although neither of these techniques are used in daily clinical practice. Dead space (the volume of gas not participating in gas exchange) can be measured using a single-breath nitrogen washout technique, or by application of the Bohr equation. Dynamic volumes measure airflow through the lungs, and often require individuals to perform a forced vital capacity (FVC) manoeuvre. Data generated from such tests include peak expiratory flow rate, forced expiratory capacity in 1 second (FEV₁) and the ratio FEV₁:FVC, which may be used in the diagnosis, assessment and management of respiratory disease. Flow–volume loops provide more detailed analysis of dynamic airflow in the lungs and are often displayed on anaesthetic machines. Measurement of the maximum voluntary ventilation (MVV) provides a global assessment of respiratory system function because it is influenced by airway resistance, respiratory muscle function, ventilation control mechanisms and compliance of lungs or chest wall. An approximation of MVV can be made by multiplying the FEV₁ by 35.     

Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders

Background contextNeuromuscular disorders (NMD) are characterized by loss of lung volume and respiratory muscle weakness, but the effects of scoliosis on lung function are unclear.PurposeTo compare pulmonary function and respiratory muscle strength in patients with NMD with and without scoliosis as well as in healthy controls.Study design/settingProspective comparison of pulmonary function testing and respiratory muscle strength were made at the pediatric pulmonology and cardiopulmonary rehabilitation units of a university hospital.Patient sampleTwenty-two patients with NMD and scoliosis, 17 patients with NMD without scoliosis, and 24 age- and sex-matched healthy controls. Outcome measures were compared in patients with NMD with and without scoliosis and healthy subjects using Student t test, Mann-Whitney U test, chi-square test, one-way analysis of variance (ANOVA), Kruskal-Wallis one-way ANOVA, Pearson correlation coefficients, and Spearman rank correlation, as appropriate.Outcome measures1) Pulmonary function: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow rate (PEF), forced expiratory flow between 25% and 75% of FVC (FEF_25–75%), and maximum expiratory flows at 75%, 50%, and 25% of FVC (MEF₇₅, MEF₅₀, and MEF₂₅, respectively); 2) oxygen saturation: pulse oxymeter reading; and 3) respiratory muscle strength: maximal inspiratory mouth pressure (MIP) and maximal expiratory mouth pressure (MEP).MethodsPulmonary function, oxygen saturation, MIP, and MEP were measured and compared in patients with NMD, patients with and without scoliosis, and in healthy subjects.ResultsThe patients with NMD, both with and without scoliosis, had significantly lower PEF, MIP, MEP, % predicted MIP (%MIP), and % predicted MEP (%MEP) than those of healthy subjects (p<.05). The patients with NMD and scoliosis had significantly lower values than those with NMD without scoliosis and controls (p<.05) for FVC, FEV₁, and FEF_25–75%.ConclusionBoth inspiratory and expiratory muscle strength were diminished in patients with NMD compared with healthy controls. Significant differences were also noted in pulmonary function in patients with NMD with or without scoliosis. This suggests that NMD may impact respiratory function independently of the effects of scoliosis. Clinicians treating patients with NMD should be aware of the possibility of compromised respiratory function in these patients to address possible complications.     

Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division,Australia

Summary

Given limited information available regarding associations between lung function and bone mineral density among healthy subjects, we undertook these analyses in the Hertfordshire Cohort Study. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC were not associated with bone mineral density at any site; associations with bone mineral content were removed by adjustment for body size.

Purpose

There is limited information available regarding the association between lung function and bone mineral density among healthy elderly subjects. We addressed this issue in the Hertfordshire Cohort Study.

Methods

From the above cohort, 985 subjects (496 men and 489 women) aged 60–72 years were recruited. All subjects underwent bone density measurements using dual energy X-ray absorptiometry and lung function tests using standardised spirometry. Chronic obstructive pulmonary disease (COPD) was defined as a FEV₁/FVC ratio Results

Measures of lung function (FEV₁, FVC and FEV₁/FVC) were not associated with bone mineral density at the lumbar spine, femoral neck and total hip in men or women; associations with bone mineral content and bone area were removed by adjustment for body size and lifestyle confounders. In this cohort, there were no associations observed between COPD and any measure of bone mass.

Conclusions

There was no association between lung function and bone mass in this community dwelling cohort after adjustment for body size and other confounders.

     

Lung function tests and a `vertical'' P wave axis in the electrocardiogram

Chapman, T. T. (1974).Thorax, 29, 106-109. Lung function tests and a `vertical' P wave axis in the electrocardiogram. The relationship between a vertical P wave axis and impaired lung function was studied in 1,144 patients with chronic non-specific lung disease. There was a significant relationship between a vertical P wave axis and reduction in forced expiratory volume (FEV₁), FEV₁ as a percentage of vital capacity (FEV₁%VC), residual volume (RV), and transfer factor (TF); this relationship was closest in the case of the FEV₁%VC. There was no significant correlation between P wave axis and the forced inspiratory volume (FIV₁).     

The value of 99mTc macroaggregated albumin lung perfusion scanning in the prediction of postpneumonectomy function and pulmonary artery pressure

^99mTc macroaggregated albumin lung perfusion scans were performed with assessment of pulmonary hemodynamics in 14 male patients with a centrally located lung tumor, subjected to pneumonectomy. In 7 patients perfusion of the affected lung was less than one third of total perfusion. However, all tumors were resectable. Results show that predictive value of the perfusion scan was significant (p<0.02) with regard to forced expiratory volume in the first second (FEV₁, r=0.80). A fair but not significant correlation existed in the prediction of vital capacity (VC, r=0.64) and total lung capacity (TLC, r=0.71). No correlation was found between perioperative change in mean pulmonary artery pressure (MPAP) and either relative radionuclide uptake of the affected lung or predicted FEV₁. So, the lung perfusion scan cannot be used in preoperative estimation of postoperative MPAP.     

The effect of antibiotic changes during treatment of cystic fibrosis pulmonary exacerbations

BackgroundAntibiotics are often changed during treatment of pulmonary exacerbations (PEx) in people with cystic fibrosis (CF) who have a poor clinical response. We aimed to characterize the reasons CF providers change antibiotics and examined the effects of antibiotic changes on lung function recovery.MethodsThis was a retrospective cohort study using the Toronto CF Database from 2009 to 2015 of adults and children with CF PEx treated with intravenous antibiotics. The co-primary outcome measure was absolute and relative change in forced expiratory lung volume in 1 s (FEV₁) at end of treatment and follow-up. Secondary outcome assessed the proportion of patients returning to > 90% or > 100% previous baseline FEV₁.ResultsA total of 399 PEx were included of which 105 had antibiotic changes. Reasons for antibiotic changes included change in antibiotic route prior to discharge (26%), drug reactions (20%), poor FEV₁ response (25%), targeting additional microbes (16%) and lack of symptom improvement (13%). In our multivariable analysis, among non-responders (< 90% FEV₁ recovery to baseline or lack of symptom improvement at the interim time point), a change in antibiotics was not associated with any significant difference in absolute or relative FEV₁ at end of treatment or at follow-up. Antibiotic change in non-responders was not associated with improved return to 90% or 100% baseline FEV₁ at end of treatment or follow-up.ConclusionsChanging antibiotics during CF PEx treatment in those with poor clinical response was not associated with any improved FEV₁ response or return to baseline lung function.     

Infant spirometry as a predictor of lung function at early childhood in cystic fibrosis patients

BackgroundInfant pulmonary function testing using the raised volume rapid thoracoabdominal compression (RVRTC) technique requires sedation and is time consuming. Many cystic fibrosis (CF) centers do not have access to equipment and the utility of routine testing remains to be determined. We aimed to assess whether RVRTC tests performed during infancy predict spirometry at early school age.MethodsThe RVRTC-based forced expiratory flow measures in infants were compared to the first adequately performed spirometry at school age. All tests were carried out during routine clinic visits and expressed as age related z-scores; only test occasions where patients were considered stable were included in the analysis.Results47 patients had useable infant RVRTC as well as matching school age spirometry data. There was weak correlation between infant FEV_0.5 and early school age FEV₁ (R = 0.29, p = 0.05). Four infants had significantly low zFEV_0.5 (zFEV_0.5 < -1.96), of which one of those remained under that limit at childhood. Changes in spirometry between infancy and early childhood were negatively correlated to baseline FEV_0.5 (R = 0.61 p<0.001) reflecting that the change was driven by where individuals started off with. There was no difference in clinical characteristics between those improving, those with stable or deteriorating in lung function.ConclusionInfant RVRTC measures were not predictive of pulmonary function in early school age, likely due to the high proportion of measures of forced expiratory flows within the normal range at both time points.     

青少年特发性脊柱侧凸患者术前肺功能与肺容积相关性研究：利用CT三维重建肺容积

目的 搜集三维CT重建下青少年特发性脊柱侧凸患者术前总肺容积（total lung volume,Vt）、右肺容积（volume of right lung,Vr ）、左肺容积（volume of left lung,Vl ）和左侧肺容积/右侧肺容积比值（Vl/Vr）与年龄相关对照值比较是否存在差异,并且回顾性研究术前肺容积和肺功能参数相关性.方法 共24例患者,平均Cobb角52°.所有患者术前行肺功能检查（通气和弥散）,胸部CT扫描,并进行肺实质三维重建.Vt、Vr、Vl、Vl/Vr和右侧与左侧肺容积差值绝对值（︱Vr-Vl︱）分别与肺功能测量结果进行相关性分析.以肺活量（vital capacity,VC）、用力肺活量（forced vital capacity,FVC）和肺总量（total lung capacity,TLC）为因变量,与肺容积数据建立多元线性回归分析模型,获得回归方程.结果 Vt与VC、FVC呈正相关（P＜0.05）,Vt与TLC近似正相关（P=0.055）,与50%肺活量时最大呼气流量（forced expiratory flow of 50% forced vital capacity,FEF50%）、FEF75%呈负相关,与其他参数均无相关性（P＞0.05）.︱Vr-Vl︱与最大通气量占预计值百分比（percentages of maximal ventilatory volume to predicted values,MVV%）呈负相关,与弥散参数无相关性（P＞0.05）;男性和女性患者Vt与Vr较对照值均减小,女性患者Vl/Vr和对照值差异有统计学意义.结论 青少年特发脊柱侧凸术前Vt与VC、FVC、TLC呈明显正相关;侧凸患者Vt、Vr较正常对照值减小.从单纯的保存肺功能角度,建议后路手术尽量减少两侧肺容积不对称性,可以阻止MVV%继续下降.     

Cross-sectional associations of pulmonary function with systemic inflammation and oxidative stress in individuals with chronic spinal cord injury

Context/Objective: Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. Our objective was to evaluate the associations between biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and novel makers of global oxidative stress (fluorescent oxidation products (FLOx)) with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI).

Design: Cross-sectional study.

Setting: Veterans Affairs Medical Center.

Participants: One-hundred thirty-seven men with chronic SCI participating in an epidemiologic study.

Methods: Participants provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure, after adjustment for a number of potential confounders.

Outcome Measures: Percent-predicted forced vital capacity in one second (FEV₁), percent-predicted forced vital capacity (FVC), FEV₁/FVC, percent-predicted residual volume (RV), percent-predicted FRC, and percent-predicted total lung capacity (TLC).

Results: After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV₁ and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures.

Conclusion: Increased systemic inflammation was associated with reductions in FEV₁ and FVC independent of a number of covariates. Although the mechanism is uncertain, these results suggest that reductions in pulmonary function in SCI are associated with systemic inflammation.     

Respiratory function among Malaysian aboriginals

Respiratory function tests have been performed on 43 Malaysian aboriginals. The forced vital capacity and forced expiratory volume in one second (FEV₁) were considerably below, and the peak expiratory flow rate (PEFR) slightly below, the predicted values. The FEV₁ and PEFR decreased more rapidly with advancing age than predicted from western standards. These findings may be due to physiological differences or may be the result of chronic purulent bronchitis which is common among the aboriginals.     

Lung Function after the Minimal Invasive Pectus Excavatum Repair (Nuss Procedure)

Background The Nuss procedure was introduced at our center in 1999. The operation was mainly performed for cosmesis. Little information is available regarding the influence of this operation on lung function. Methods The aim of this study, a prospective analysis, was to analyze the effect of the Nuss procedure on lung function variables. Between 1999 and 2007 a total of 203 patients with pectus excavatum were treated with the Nuss procedure, of whom 145 (104 male, 41 female) were located at Emma Children’s Hospital. In the latter subset of consecutive patients, static lung function variables [total lung capacity (TLC), functional residual capacity (FRC), vital capacity (VC)] and dynamic lung function variables [forced expired volume in 1 s (FEV₁), maximum expiratory flow (MEF₅₀)] were performed using spirometry and body box measurements at four time points: prior to operation (T0), 6 months after the Nuss procedure (T1, n = 111), prior to removal of the Nuss bar (T2, n = 74), and 6 months after removal (T3, n = 53). All values were expressed as a percent of normal values for sex, age, and height. Results were compared with a paired-samples t-test, with the level of significance at p = 0.05. Results At 6 months after bar insertion the TLC, FRC, VC, FEV₁, and MEF₅₀ showed a significant increase; and prior to bar removal the FRC and MEF₅₀ showed significantly increased values. At 6 months after Nuss bar removal, none of the lung function variables showed any significant change compared to the preoperative values. Conclusion After the Nuss procedure for pectus excavatum, there was no improvement of pulmonary function, but neither was the patient’s pulmonary function harmed by resolving a largely cosmetic problem. Some of these data were presented at the International Surgical Week, 41st World Congress of Surgery of ISS/SIC, Durban, South Africa.     

Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy

Open in a separate window OBJECTIVESWe compared the computed tomographic (CT) volumetric analysis and anatomical segment counting (ASC) for predicting postoperative forced expiratory volume in 1 s (FEV₁) and diffusing capacity for carbon monoxide (D_LCO) in patients who had segmentectomy for early-stage lung cancer.METHODSA total of 175 patients who had segmentectomy for lung cancer and had postoperative pulmonary function test were included. CT volumetric analysis was performed by software, which could measure total lung and target segment volume from CT images. ASC and CT volumetric analysis were used to determine predicted postoperative (PPO) values and the concordance and difference of these values were assessed. The relationship between PPO values and actual postoperative values was also investigated.RESULTSThe PPO-FEV₁ and PPO-D_LCO showed high concordance between 2 methods (concordance correlation coefficient = 0.96 for PPO-FEV₁ and 0.95 for PPO-D_LCO). There was no significant difference between PPO values as determined by 2 methods (P = 0.53 for PPO-FEV₁, P = 0.25 for PPO-D_LCO) and actual postoperative values [P = 0.77 (ASC versus actual) and P = 0.20 (CT versus actual) for FEV₁; P = 0.41 (ASC versus actual) and P = 0.80 (CT versus actual) for D_LCO]. We subdivided the patients according to poor pulmonary function test, the number of resected segments and the location of the resected lobe. All subgroup analyses revealed no significant difference between PPO values and actual postoperative values.CONCLUSIONSBoth CT volumetric analysis and ASC showed high predictability for actual postoperative FEV₁ and D_LCO in segmentectomy.     

Changes in Pulmonary Functions of Adolescents with Pectus Excavatum Throughout the Nuss Procedure

BackgroundWe aimed to determine the longitudinal changes in pulmonary functions of adolescents with Pectus Excavatum who underwent the Nuss procedure, the minimally invasive repair of pectus excavatum (MIRPE).MethodsLung function measurements were performed before bar implantation (T₀), at least six weeks to ten months after implantation (T_1a), at least eleven months to sixty-one months after bar implantation (T_1b) and at least two weeks after bar explantation (T₂).ResultsData of 114 patients (83.3% male) whose median age at implantation was 15.6 years and at explantation 18.7 years were analyzed. Shortly after implantation at T_1a a significant decline of vital capacity (VC; n = 82), forced vital capacity (FVC; n = 78) and forced expiratory volume in 1 second (FEV₁; n = 80) compared to T₀ was seen. At T_1b a significant decline for the residual volume (RV; n = 83), the residual volume/total lung capacity ratio (RV/TLC; n = 81), the total specific airway resistance (sRaw; n = 80) and the total airway resistance (Raw; n = 84) also compared to T₀ was measured. In the comparison of T_1b to T₂ a significant increase of VC, FVC (n = 67), FEV₁ (n = 69), TLC (n = 67) and a significant decrease of Raw (n = 66), sRaw, RV (n = 65) and the RV/TLC (n = 64) ratio could be observed. In the direct analysis between T₀ and T₂, after the explantation of the bar a significant increase in VC (n = 54), FVC (n = 52), and TLC (n = 55) and a significant decrease of RV (n = 51) and the RV/TLC index (n = 50), and in airway resistance parameters like Raw (n = 52) and sRaw (n = 51) could be detected.ConclusionsLung function values along with markers of airway resistance improve in patients after the complete procedure of MIRPE.Level of EvidenceLevel II.     

Prediction of pulmonary function after lobectomy

Aim-Background

Lung cancer is the most common cause of cancer death in both men and women in our country. It has been estimated that there will be 7,000 lung cancer deaths every year in Greece. However, many patients with bronchogenic carcinoma also have coexistent obstructive lung disease. In these patients, preoperative prediction of functional status after lung resection is mandatory. The aim of our study was to determine the effect of lobectomy on postoperative spirometric lung function.

Methods

Seventy-two patients underwent spirometric pulmonary tests preoperatively, and at three and six months after surgery. The predicted postoperative forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) were calculated using the following formula suggested by Juhl and Frost.

Results

The functional percentage loss at six months for lobectomies was 7.34% for FVC and 7.72% for FEV₁ respectively. The linear regression analysis derived from the correlation between predicted and measured FEV₁ revealed the following equation: FEV ₁ POSTOP = 0.00211+0.896660 X FEV ₁ PREOP.

Conclusions

We conclude that our formula is a reliable method for predicting postoperative respiratory function of the patients with lung cancer.