Waist circumference associated with pulmonary function in children

In adults abdominal obesity is related to lung dysfunction and waist circumference (WC) predicts pulmonary function. It is not known how WC affects pulmonary function in children. A cross‐sectional study of 718 children 6–17 years of age was conducted in a rural community to determine the predictability of WC for pulmonary function in children. Height, weight, WC, and pulmonary function were measured. Multivariate analysis was conducted. WC was positively associated with FVC and FEV₁ and was more strongly associated with FVC than with FEV₁. Increase in WC significantly predicted a reduction in FEV₁/FVC. After adjustment for sex, age, and height, an increase of 1 cm for WC was associated with an increase of 7 ml of FVC and 4 ml of FEV₁, and with an increase of 4 ml of FVC and 2 ml of FEV₁ with an additional adjustment for weight. Height and weight were not significantly associated with FEV₁/FVC. WC but not body mass index predicted a decline of FEV₁/FVC. WC had a larger impact on FVC than FEV₁. WC, but not BMI, was negatively associated with FEV₁/FVC in children. Pediatr Pulmonol. 2009; 44:216–221. © 2009 Wiley‐Liss, Inc.     

Effects of posture on lung function in obese children

Forced expiratory manoeuvres are recommended performed in sitting posture; however, standing posture has been reported to be usually more advantageous since any diaphragmatic restriction associated with obesity is reduced. Information on the effect of posture on forced expiratory manoeuvres in obese children is lacking. Aim: To determine whether lung function measured in standing compared with sitting posture is increased in overweight and obese children. Methods: One hundred fifteen overweight (n = 23) and obese (n = 92) children (7–17 years old) performed forced expiratory flow‐volume manoeuvres in sitting and standing posture in random order. Results: Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and forced expiratory flow after 50% of FVC (FEF₅₀) was significantly higher in sitting compared with standing posture [0.8, 1.1 and 2.2 percentage change in absolute values (all with P < 0.05)]. FEV₁/FVC and peak expiratory flow were not significantly different measured in sitting and standing posture; 95%–99% of the variance were explained by differences among individuals (all with P < 0.0001). Conclusions: In conclusion, FEV₁, FVC and FEF₅₀ were all significantly higher when measured in sitting compared with standing posture; however, the improvements were of little clinical significance. These findings confirm that sitting posture is appropriate in obese children when performing forced expiratory flow‐volume manoeuvres. Please cite this paper as: Berntsen B, Edvardsen E, Carlsen K‐H, Kolsgaard MLP and Carlsen KCL. Effects of posture on lung function in obese children. Clin Respir J 2011; 5: 252–257.     

Ratio of waist circumference to chest circumference is inversely associated with lung function in Chinese children and adolescents

Background and objective: In White children, waist circumference (WC) is positively correlated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV₁). Because fat distribution differs among different races, the relationship between WC and lung function in Asian children may differ from that in White children. The present study aimed to examine the effect of WC on ventilatory function in Chinese children. Methods: A cross‐sectional study was performed on 1572 healthy subjects aged 9–18 years. Height, weight, chest circumference (CC), WC and lung function (FVC, FEV₁, peak expiratory flow (PEF) and maximal mid‐expiratory flow (MMEF)) were measured. To avoid the problem of colinearity, a model that combined CC and WC as the waist‐to‐chest ratio (WCR) was used. The relative contributions of WCR and body mass index (BMI) to spirometric parameters were determined by linear regression analysis. Results: WCR was inversely associated with all spirometric parameters. On average, each 0.01 increase in WCR was associated with decreases of 8.14 mL for FVC, 9.36 mL for FEV₁, 6.54% for FEV₁/FVC, 19.81 mL/s for PEF and 17.25 mL/s for MMEF. BMI was positively associated with all spirometric parameters except FEV₁/FVC. These results suggest that WC was inversely associated with lung function parameters. Conclusions: Inverse associations were identified between WCR, as well as WC, and lung function in a population of Chinese children. The underlying mechanisms need to be further explored.     

Spirometric pulmonary function parameters of healthy Chinese children aged 3–6 years in Taiwan

Spirometry is a well‐known technique for evaluating pulmonary function, but few studies have focused on preschool children. The aim of this study was to determine reference values of forced spirometric parameters in young Chinese children, aged 3–6 years, in Taiwan. Spirometric measurements were performed at day care centers by experienced pediatricians. Of 248 children without a history of chronic respiratory illness, at least two valid spirometric attempts were obtained from 214 children (109 boys and 105 girls; age: 36–83 [mean = 61] months; height: 90–131 [mean = 111] cm). Values of forced expiratory volume in 1 sec (FEV₁) and 0.5 sec (FEV_0.5), forced vital capacity (FVC), peak expiratory flow rate (PEF), forced expiratory between 25% and 75% FVC (FEF_25–75), and forced expiratory flow rate at 25%, 50%, and 75% of FVC (FEF₂₅, FEF₅₀, and FEF₇₅) were derived and analyzed. There were significant positive correlations between study parameters and body height, body weight, and age. Height was the most consistently correlated measurement in both boys and girls. Although boys tended to have higher spirometric values than girls, we found significant differences only in FVC and FEV₁ between boys and girls aged 6 years. The regression equations of each parameter were obtained. In conclusion, spirometric pulmonary function tests are feasible in 3‐ to 6‐year‐old children. The obtained values and regression equations provide a reference for Chinese preschool children and may be of value in evaluating pulmonary function of children with respiratory problems in this age group. Pediatr Pulmonol. 2009; 44:676–682. © 2009 Wiley‐Liss, Inc.     

Relación entre las calcificaciones ateroscleróticas en el tórax detectadas mediante tomografía computarizada y la función pulmonar

Background and objectives

A few recent epidemiological findings indicate a link between atherosclerosis and some lung functions. We studied further the relation between calcified chest atherosclerosis as seen in computed tomography (CT) and several lung functional parameters.

Patients and methods

Male construction workers originally screened for occupational lung cancer with CT had their chest atherosclerosis (aorta, the origins of its cervical branches, the coronary arteries and heart valves) visually classified. The relation between the atherosclerotic calcification scores and lung function (total lung capacity [TLC], forced expiratory volume in one second [FEV₁%], forced vital capacity [FVC%], maximal expiratory flow when 50% of FVC remains to be exhaled, total and specific diffusing capacities; all above expressed as percent of predicted value, and the FEV₁/FVC% ratio) were studied with the general linear model adjusted for smoking, exposure years for asbestos, and body mass index (n=432).

Results

All lung functions except TLC showed significant negative associations with calcifications in aorta and in its branches. TLC showed such association only with atherosclerosis in the ascending aorta.

Conclusions

Aortic atherosclerosis seems to be related with poor lung function. This may be due to deteriorated bronchial circulation, but other mechanisms can also be involved. Lung function poorer than would be expected due to pulmonary reasons may indicate aortic atherosclerosis.     

No relationship between lung function and high-sensitive C-reactive protein in adolescence

Introduction: Several studies on adults have indicated that lower spirometric lung function may be associated with increased systemic inflammation, but no studies have investigated if this association is already present in adolescence. Objective: We explored the temporal relationship between changes in lung function and concentrations of plasma C‐reactive protein (CRP) in a population‐based cohort study at ages 14 and 20 years using a high‐sensitivity CRP assay. Methods: CRP measurements were performed in a total of 420 subjects at mean age of 13.9 years. Of these, 262 subjects (62%) participated in the follow‐up investigation at mean age of 20.1 years. Results: Levels of log‐CRP at age 14 were not significantly associated with forced expiratory volume (FEV₁) or FEV₁/ forced vital capacity (FVC) ratio at age 20, nor with the change in FEV₁, FVC or FEV₁/FVC ratio between 14 and 20 years after controlling for body mass index (BMI), airway hyperresponsiveness (AHR), eosinophil cationic protein (ECP), asthma, smoking, sex, and height at 14 years, and change in height between 14 and 20 years. Sex, BMI, AHR, ECP and change in height between 14 and 20 years were identified as independent factors associated with the change in FEV₁, FVC and FEV₁/FVC ratio in adolescence. Conclusion: We did not find an association between CRP levels at age 14 and change in lung function by age 20; whereas, sex, change in height, BMI, AHR and ECP were associated with lung function change in adolescence. Our findings indicate that systemic inflammation is of less importance for change in lung function in adolescence. Please cite this paper as: Nybo M, Hansen HS, Siersted HC and Rasmussen F. No relationship between lung function and high‐sensitive C‐reactive protein in adolescence. The Clinical Respiratory Journal 2010; 4: 230–236.     

Off-Line Fractional Exhaled Nitric Oxide Measurement Is Useful to Screen Allergic Airway Inflammation in an Adult Population

To determine whether off-line fractional exhaled nitric oxide (FeNO) measurement is applicable to screen allergic airway inflammation for epidemiologic studies, we examined 280 adults, measuring off-line FeNO samplings, pulmonary function, and serum immunoglobulin E (IgE). Subjects with recurrent wheeze (recurrent wheezers) had significantly higher FeNO and IgE levels and significantly lower forced expiratory volume in 1 second/forced vital capacity (FEV₁/FVC) than non-wheezers. Statistical analysis showed that FeNO and FEV₁/FVC were significant predictors for recurrent wheezers, independent of smoking. The cut-off FeNO level for screening allergic airway inflammation was 38 ppb in non-smokers and 32.9 ppb in smokers. Thus, off-line FeNO can be used as a good marker to screen allergic airway inflammation, regardless of smoking.     

Effects of Pseudomonas aeruginosa colonization on lung function and anthropometric variables in children with cystic fibrosis

The aim of this study was to evaluate how lung function and growth changed over time in children with cystic fibrosis (CF) colonized with Pseudornonas aeruginosa (Pa) compared with those free of the organism. A total of 192 children attended our cystic fibrosis clinic between 1982 and 1992. Sixty-two of these had three or more annual assessments for lung function, and 117 had three or more annual assessments for height and weight. When lung function was expressed as a standard deviation score (SDS), forced expiratory volume in 1 second (FEV₁) and forced expiratory flow at 25% of vital capacity (FEF₂₅) decreased significantly more with respect to height in colonized compared with noncolonized children: FEV₁ ?0.052 versus ?0.015 SDS/cm (P < 0.05); FEF₁, ?0.060 versus ?0.007 SDS/cm (P < 0.05); forced vital capacity (FVC), ?0.034 versus ?0.012 (NS). In actual values those patients colonized with Pa increased their FEV, by 16.4 versus 31.6 mL/cm (P < 0.01); FVC by 28.8 versus 41.4 ML/cm, P < 0.01; and FEF₂₅ by ?0.001 versus 0.015 mL/cm, P < 0.01. In terms of height, colonized children grew at 5.63 versus 6.96 cm/yr, P < 0.001, and height SDS decreased in colonized compared with noncolonized children at ?0.031 versus 0.08 SDS/yr, P < 0.05. Clinically, most children with CF, with or without Pa, grew within ± SD of the norm for weight and height. However, in terms of lung function despite optimum pulmonary management colonized children deteriorated significantly faster. © 1995 Wiley-Liss, Inc.     

Inspiratory flow limitation in children with bronchopulmonary dysplasia

The objective of this study was to compare pulmonary function tests of children with bronchopulmonary dysplasia (BPD) and asthma, and to evaluate children with BPD for evidence of upper airway obstruction. This is a case-control retrospective study of pulmonary function tests (PFTs) of 11 children with BPD between 5 and 8 years of age who were followed by pediatric pulmonologists, and of 32 age- and height-matched children with asthma. The median forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and peak expiratory flow (PEF) were significantly lower in the BPD group (0.86 L, 0.79 L, 120 L/min) than in the asthmatic group (1.34 L, 1.21 L, 155 L/min; P = 0.002, P = 0.007, P = 0.004, respectively). Both groups were equally hyperinflated (median thoracic gas volume 155% of predicted values in the BPD compared to 152% predicted in the asthma group; P = 0.67), and both groups showed decreases in air-trapping after a bronchodilator. The ratios of forced expiratory flow at 50% of the FVC to forced inspiratory flow at 50% of the FVC (FEF_50%/FIF_50%) and FEV₁ to PEF (FEV₁/PEF) were used to assess upper airway obstruction and were higher in children with BPD than asthma (P = 0.0001 and P = 0.035, respectively). We conclude that pulmonary function of children with BPD who are still symptomatic after 5 years of age is different from age-matched children with asthma, and the children with BPD demonstrate significant inspiratory flow limitations. Pediatr Pulmonol. 1998;26:167–172. © 1998 Wiley-Liss, Inc.     

Small for gestational age is associated with reduced lung function in middle age: A prospective study from first to fifth decade of life

Background and Objective

The association between birth weight, particularly relative to gestational age, and adult lung function is uncertain. We investigated the associations between birth weight relative to gestational age and measures of lung function in middle age, and mediation of these associations by adult height.

Methods

Participants in the Tasmanian Longitudinal Health Study who had both known birth weight and lung function assessment at age 45 years were included (n = 849). Linear regression models were fitted to investigate the association between small for gestational age and birth weight with post-bronchodilator lung function measures (forced expiratory volume in 1 second [FEV₁], forced vital capacity [FVC], FEV₁/FVC, diffusing capacity for carbon monoxide [D_Lco], residual volume [RV] and total lung capacity [TLC]), adjusting for potential confounders. The contribution of adult height as a mediator of these associations was investigated.

Results

Compared with infants born with normal weight for gestational age, those born small for gestational age had reduced FEV₁ (coefficient: −191 ml [95%CI: −296, −87]), FVC (−205 ml [−330, −81]), TLC (−292 ml [−492, −92]), RV (−126 ml [−253, 0]) and D_Lco (−0.42 mmol/min/kPa [−0.79, −0.041]) at age 45 years. However, they had comparable FEV₁/FVC. For every 1 kg increase in birth weight, lung function indices increased by an average of 117 ml (95%CI: 40, 196) for FEV₁, 124 ml (30, 218) for FVC, 215 ml (66, 365) for TLC and 0.36 mmol/min/kPa (0.11, 0.62) for D_Lco, independent of gestational age, but again not for FEV₁/FVC. These associations were significantly mediated by adult height (56%–90%).

Conclusion

Small for gestational age was associated with reduced lung function that is likely due to smaller lungs with little evidence of any specific parenchymal impairment.     

Ciclesonide in wheezy preschool children with a positive asthma predictive index or atopy

Background

Few large-scale studies have examined inhaled corticosteroid treatment in preschool children with recurrent wheeze. We assessed the effects of ciclesonide in preschool children with recurrent wheeze.

Methods

We included children 2–6 yrs with recurrent wheeze and a positive asthma predictive index or aeroallergen sensitization to, excluding patients with episodic viral wheezing. After a 2–4-week baseline period, patients with ongoing symptoms or rescue medication use were randomised to once-daily ciclesonide 40, 80, 160 μg or placebo for 24 weeks.

Results

The number of wheeze exacerbations requiring systemic corticosteroids was unexpectedly low in all groups: 25 (10.2%) in placebo group, as compared to 11 (4.4%), 18 (7.3%), and 17 (6.7%) in ciclesonide 40, 80, and 160 μg, respectively. The difference in time to first exacerbation was not significantly different between groups (p = 0.786), but the difference in exacerbation rates between placebo and the pooled ciclesonide groups was (p = 0.03). Large and significant (p < 0.0001) improvements in symptom scores and rescue medication use occurred in all groups, including placebo. Improvements in FEV₁ and FEF_25–75 (measured in 284 4–6 yr olds) were larger in the ciclesonide than in the placebo group. No differences in safety parameters (adverse events, height growth, serum and urinary cortisol levels) between ciclesonide and placebo were observed.

Conclusions

In preschool children with recurrent wheeze and a positive asthma predictive index, ciclesonide modestly reduces wheeze exacerbation rates and improves lung function. A large placebo response and unexpected selection of patients with mild disease may have affected outcomes, highlighting the heterogeneity of preschool wheezing disorders.     

Medición del patrón ventilatorio mediante tomografía por impedancia eléctrica en pacientes con EPOC

Background and Objective

The measurement of breathing pattern in patients with chronic obstructive pulmonary disease (COPD) by electrical impedance tomography (EIT) requires the use of a mathematical calibration model incorporating not only anthropometric characteristics (previously evaluated in healthy individuals) but probably functional alterations associated with COPD as well. The aim of this study was to analyze the association between EIT measurements and spirometry parameters, static lung volumes, and carbon monoxide diffusing capacity (DLCO) in a group of male patients to develop a calibration equation for converting EIT signals into volume signals.

Materials and Methods

We measured forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), FEV₁/FVC, residual volume, total lung capacity, DLCO, carbon monoxide transfer coefficient (KCO) and standard anthropometric parameters in 28 patients with a FEV₁/FVC ratio of <70%. We then compared tidal volume measurements from a previously validated EIT unit and a standard pneumotachometer.

Results

The mean (SD) lung function results were FVC, 72 (16%); FEV₁, 43% (14%); FEV₁/FVC, 42% (9%); residual volume, 161% (44%); total lung capacity, 112% (17%); DLCO, 58% (17%); and KCO, 75% (25%). Mean (SD) tidal volumes measured by the pneumotachometer and the EIT unit were 0.697 (0.181) L and 0.515 (0.223) L, respectively (P<.001). Significant associations were found between EIT measurements and CO transfer parameters. The mathematical model developed to adjust for the differences between the 2 measurements (R²=0.568; P<.001) was compensation factor=1.81?− 0.82?× height (m)?−0.004×KCO (%).

Conclusions

The measurement of breathing pattern by EIT in patients with COPD requires the use of a previously calculated calibration equation that incorporates not only individual anthropometric characteristics but gas exchange parameters as well.     

Age is a predictor of a small decrease in lung function in children with sickle cell anemia

The longitudinal pattern of lung function in children with sickle cell anemia (SCA) has shown a decrease in FEV₁% predicted, a risk factor for death in adults with SCA, but predictors for this decline are poorly characterized. In a prospective longitudinal multi‐center cohort of children with SCA, we tested the hypotheses that: (1) FEV₁% predicted declines over time; and (2) SCA‐specific characteristics and therapy predict this decline. At three clinical centers, children with SCA (HbSS or HbSβ⁰ thalassemia), unselected for respiratory disease, were enrolled in the Sleep and Asthma Cohort (SAC) study. Study‐certified pulmonary function technicians performed spirometry and lung volumes. Each assessment was reviewed centrally. Predicted values were determined for TLC, FEV₁, FVC, and FEV₁/FVC ratio. A total of 197 participants, mean age 11.0 years at first testing (range 4‐19.3 years), had a minimum of three spirometry measurements, over an average of 4.4 years (range 1.1‐6.5 years) from baseline to endpoint. In a multivariable model, FEV₁% predicted declines by 0.3% for every additional year of age (95% CI ?0.56 to ?0.05, P = .020). Sex, asthma history, hemoglobin, reticulocyte count, white blood cell count, incidence rate of severe acute pain and acute chest syndrome episodes, and hydroxyurea therapy were not associated with a decline in FEV₁% predicted. In a large, rigorously evaluated, prospective cohort of an unselected group of children with SCA, FEV₁% predicted declines minimally over an average of 4 years, and none of the examined disease features predict the decline.     

Determinants of reproducibility of lung function tests in children aged 7 to 10 years

Lung function (LF) tests are part of many investigations in childhood lung disease. However, individual reproducibility of LF will confound between-subject differences. At the same time, increased LF variability has been linked to respiratory disease. In a sample of 598 children, two LF tests, separated by a 5-min interval, were recorded, and reliability (Rel) of forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and maximal expiratory flow at 50% of FVC (MEF₅₀) was determined. Rel was also assessed in children trained and untrained in the performance of LF. To investigate determinants of reproducibility for FEV₁, the absolute difference between two repeated tests was calculated. Whenever this difference was >120 ml, a child was considered to demonstrate excessive variability (poor reproducibility) in FEV₁. For volume parameters coefficients of reliability (C_rel) were found to be better than for MEF₅₀ (FEV₁: 0.96; FVC: 0.94, MEF₅₀: 0.91). In untrained children C_rel for FEV₁ was only 0.91, but it was increased in subsequent visits (0.98, 0.97, and 0.97 at the second, third, and fourth tests, respectively). Excessive variability in FEV₁ was observed in 10% of children and was related to the presence of wheeze (odds ratio (OR) 6.31; 95% confidence interval (CI) 1.78–22.4), shortness of breath (OR 3.14; 95% CI 1.00–9.93), a diagnosis of asthma (OR 6.25; 95% CI 1.76–22.1), and bronchial hyperresponsiveness (OR 4.30; 95% CI 2.07–8.94). We conclude that increased variability of LF is likely to be present in young children not accustomed to the testing procedure and in children with respiratory symptoms. Therefore, before guidelines for LF testing are applied, children should be trained to perform the tests and we should be cautious in the interpretation of test results in children who present with symptoms. Pediatr Pulmonol. 1998; 25:238–243. © 1998 Wiley-Liss, Inc.     

Bronchial Hyperresponsiveness in Farmers: Relation to Respiratory Symptoms, Lung Function, and Atopy

There is only limited information on the factors associated with nonspecific bronchial hyperresponsiveness (BHR) in farmers. Our purpose was to examine the relationship between BHR and respiratory symptoms, atopy, and abnormalities of lung function in a sample of French farmers. Farmers scheduled for a preventive medicine check-up in northeastern France were examined. Occupational exposure, respiratory symptoms, and work-related symptoms were assessed by questionnaire, sensitization to 34 common and agricultural allergens by skin prick tests, and BHR by the single-dose (1,200 μg) acetylcholine (ACh) challenge test. Data were obtained from 741 farmers (95% of those invited). Seventy-seven subjects (10.3%) had BHR defined as a fall in forced expiratory volume in 1 s (FEV₁) ≥ 10% after the inhalation of ACh or, for those with a poor lung function, an increase in FEV₁ > 10% and > 200 ml after the inhalation of 200 μg of salbutamol. The proportion of asthmalike symptoms, especially wheeze during work, positive skin tests to acarian (storage mites) and cereal dust allergens, and low levels of lung function was significantly greater among reactors than among nonreactors. Stepwise logistic regression analysis showed a significant and independent association between BHR and wheezing during work (OR = 4.99; 95% CI = 2.29–10.89; p= 0.0001) and baseline FEV₁ (OR = 1.49; 95% CI = 1.05–2.20; p= 0.026). In conclusion, hyperreactive farmers had significantly more asthmalike symptoms, positive skin tests, and abnormal lung function than normoreactive farmers. Work-related wheeze and low baseline FEV₁ were significantly and independently associated with BHR. Accepted for publication: 26 January 1999     

Early smoke exposure is associated with asthma and lung function deficits in adolescents

Objective: Early life tobacco smoke exposure may influence asthma, lung function and lung function growth into adolescence. We aimed to determine the associations between perinatal smoke exposure and asthma and lung function up to 18 years of age. Methods: We prospectively recorded perinatal parental smoking and measured respiratory outcomes at 12 and 18 years in the Melbourne Atopy Cohort Study (MACS), a longitudinal birth cohort. Multiple logistic regression was used to analyse the associations between perinatal smoke exposure and asthma at 12 (n = 370) and 18 years (n = 411). Multiple linear regression was used to investigate the relationship between perinatal smoking and: lung function (12 and 18 years) and lung function growth (between 12 and 18 years). Results: At 18 years, girls exposed to parental smoking during the perinatal period had increased odds of asthma (OR: 3.45, 95%CI: 1.36, 8.77), reduced pre-bronchodilator Forced expiratory volume in one-second (FEV₁) (?272 ml/s; ?438, ?107); FEV₁/ forced vital capacity (FVC) (?0.038; ?0.065, ?0.010); mid expiratory flow (MEF_25-75) (?430 ml/s; ?798, ?61), and reduced post-bronchodilator FEV₁/FVC (?0.028, ?0.053, ?0.004). No associations were found for boys (pre-bronchodilator FEV₁ 26ml/s; ?202, 255; FEV₁/FVC 0.018; ?0.013, 0.049). Conclusions: Perinatal smoke may affect risk of asthma, reduce lung function and lung function growth in adolescence. Girls appear to be more susceptible than boys.     

Children’s lung function in relation to changes in socioeconomic,nutritional, and household factors over 20 years in Lanzhou

BackgroundLanzhou has experienced rapid urbanization, leading to changes in socioeconomic, nutritional, and household factors. These changes may affect children’s lung function.MethodsTwo cross-sectional studies of school-age children (6–13 years of age) from the urban (Chengguan) (Period 1 in 1996 with n=390; Period 2 in 2017 with n=192) and the suburban (Xigu) (Period 1 n=344; Period 2 n=492) district were conducted. Demographic information, household factors, and nutrition status were obtained via a questionnaire survey. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV₁) were measured in each period. Student’s t-test analysis of variance was used to assess the differences in FVC and FEV₁ between Periods 1 and 2. Generalized linear models were used to analyze the associations between questionnaire derived factors and lung function. Analyses were done separately for girls and boys.ResultsChildren had significantly lower mean FEV₁ and FVC measures in Period 2 than in Period 1. This reduction was greater in children living in the urban area than those living in the suburban area. Obese children had significantly lower lung function but this was only statistically significant in Period 1.ConclusionsChildren’s lung function (FVC and FEV₁) were lower in 2017 than in 1996. Rapid urbanization may have contributed to the decline of lung function. Obesity may be a risk factor for impaired lung function in children living in Lanzhou and possibly elsewhere.     

Relationships Between Respiratory Symptoms and FEV<Subscript>1</Subscript> in Men and Women with Normal Lung Function: The Korean Health and Genome Study

Although the prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with respiratory symptoms are well documented, few studies have focused on individuals with normal lung function, particularly in developed regions of Asia. The purpose of this report is to examine the relationship between respiratory symptoms and FEV₁ in a population-based sample of Korean men and women with normal lung function. Subjects comprised 7518 individuals aged 40–69 years without airflow obstruction based on spirometric testing and in the absence of a medical history of pulmonary disease. Respiratory symptoms included chronic cough, chronic phlegm, wheezing, and shortness of breath. In men, the age-adjusted mean FEV₁ was lower by 165 ml in smokers and 133 ml in nonsmokers in the presence versus the absence of wheezing (p < 0.05). While walking at a usual pace, FEV₁ in smoking men was 210 ml lower in the presence versus the absence of shortness of breath (p < 0.05). Among nonsmoking men, overall shortness of breath and shortness of breath while walking uphill were associated with a lower FEV₁ by 56 and 80 ml, respectively) versus those who reported having no shortness of breath (p < 0.05). Respiratory symptoms were unrelated to FEV₁ in women smokers, although only 3.5% smoked cigarettes. In nonsmoking women, FEV₁ was lower by an average of 89 ml in the presence versus the absence of wheezing (p < 0.001). Nonsmoking women also had a lower FEV₁ in the presence of shortness of breath (overall, while at rest, and while walking uphill or at a usual pace, p < 0.001). Our findings suggest that respiratory symptoms are associated with a lower FEV₁ in men and nonsmoking women with normal lung function. Whether respiratory symptoms can be used to identify individuals at risk for developing COPD needs further study.     

Pulmonary function changes in children after transcatheter closure of atrial septal defect

This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at 3 days and 6 months after procedure. Forced vital capacity (FVC), forced expired volume in 1 sec (FEV₁), FEV₁ to FVC ratio (FEV₁/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF_25–75) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF_25–75 (84 ± 24%, P = 0.040 and 76 ± 22%, P = 0.010, respectively) at baseline, with FEF_25–75 reduced significantly at 3 days and 6 months (78 ± 24%, P = 0.010 and 81 ± 24%, P = 0.040, respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 ± 19% vs. 98 ± 15%, P = 0.034) and FEV₁ (90 ± 20% vs. 96 ± 19%, P = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (χ² = 8.333, P = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops. Pediatr Pulmonol. 2009; 44:1025–1032. ©2009 Wiley‐Liss, Inc.     

Childhood measles contributes to post‐bronchodilator airflow obstruction in middle‐aged adults: A cohort study

Background and objective

Chronic obstructive pulmonary disease (COPD) has potential origins in childhood but an association between childhood measles and post‐bronchodilator (BD) airflow obstruction (AO) has not yet been shown. We investigated whether childhood measles contributed to post‐BD AO through interactions with asthma and/or smoking in a non‐immunized middle‐aged population.

Methods

The population‐based Tasmanian Longitudinal Health Study (TAHS) cohort born in 1961 (n = 8583) underwent spirometry in 1968 before immunization was introduced. A history of childhood measles infection was obtained from school medical records. During the fifth decade follow‐up (n = 5729 responses), a subgroup underwent further lung function measurements (n = 1389). Relevant main associations and interactions by asthma and/or smoking on post‐BD forced expiratory volume in 1 s/forced vital capacity (FEV₁/FVC; continuous variable) and AO (FEV₁/FVC < lower limit of normal) were estimated by multiple regression.

Results

Sixty‐nine percent (n = 950) had a history of childhood measles. Childhood measles augmented the combined adverse effect of current clinical asthma and smoking at least 10 pack‐years on post‐BD FEV₁/FVC ratio in middle age (z‐score: −0.70 (95% CI: −1.1 to −0.3) vs −1.36 (−1.6 to −1.1), three‐way interaction: P = 0.009), especially for those with childhood‐onset asthma. For never‐ and ever‐smokers of <10 pack‐years who had current asthma symptoms, compared with those without childhood measles, paradoxically, the odds for post‐BD AO was not significant in the presence of childhood measles (OR: 12.0 (95% CI: 3.4–42) vs 2.17 (0.9–5.3)).

Conclusion

Childhood measles infection appears to compound the associations between smoking, current asthma and post‐BD AO. Differences between asthma subgroups provide further insight into the complex aetiology of obstructive lung diseases for middle‐aged adults.