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11.
Brent Doney Eva Hnizdo Monica Graziani Greg Kullman Cecil Burchfiel Sherry Baron 《COPD》2014,11(4):368-380
Introduction: The contribution of occupational exposure to the risk of chronic obstructive pulmonary disease COPD in population-based studies is of interest. We compared the performance of self-reported exposure to a newly developed JEM in exposure-response evaluation. Methods: We used cross-sectional data from Multi-Ethnic Study of Atherosclerosis (MESA), a population-based sample of 45–84 year olds free of clinical cardiovascular disease at baseline. MESA ascertained the most recent job and employment, and the MESA Lung Study measured spirometry, and occupational exposures for 3686 participants. Associations between health outcomes (spirometry defined airflow limitation and Medical Research Council-defined chronic bronchitis) and occupational exposure [self-reported occupational exposure to vapor-gas, dust, or fumes (VGDF), severity of exposure, and a job-exposure matrix (JEM)-derived score] were evaluated using logistic regression models adjusted for non-occupational risk factors. Results: The prevalence of airflow limitation was associated with self-reported exposure to vapor-gas (OR 2.6, 95%CI 1.1–2.3), severity of VGDF exposure (P-trend < 0.01), and JEM dust exposure (OR 2.4, 95%CI 1.1–5.0), and with organic dust exposure in females; these associations were generally of greater magnitude among never smokers. The prevalence of chronic bronchitis and wheeze was associated with exposure to VGDF. The association between airflow limitation and the combined effect of smoking and VGDF exposure showed an increasing trend. Self-reported vapor-gas, dust, fumes, years and severity of exposure were associated with increased prevalence of chronic bronchitis and wheeze (P < 0.001). Conclusions: Airflow limitation was associated with self-reported VGDF exposure, its severity, and JEM-ascertained dust exposure in smokers and never-smokers in this multiethnic study. 相似文献
12.
Youn Ho Shin Sun Jung Jang Jung Won Yoon Hye Mi Jee Sun Hee Choi Hye Yung Yum David Warburton Man Yong Han 《Canadian respiratory journal》2012,19(4):273-277
BACKGROUND:
Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children.OBJECTIVES:
To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children.METHODS:
Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed.RESULTS:
Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV1], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs5], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV1 % initial versus ΔRrs5 % initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV1 ≥9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV1 ≥9% or ΔRrs5 ≥29% was considered as an additional criterion for the diagnosis of asthma.CONCLUSION:
The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR. 相似文献13.
《Allergologia et immunopathologia》2014,42(6):553-559
BackgroundAsthma diagnosis in preschoolers is mostly based on clinical evidence, but a bronchodilator response could be used to help confirm the diagnosis. The objective of this study is to evaluate the utility of bronchodilator response for asthma diagnosis in preschoolers by using spirometry standardised for this specific age group.MethodsA standardised spirometry was performed before and after 200 mcg of salbutamol in 64 asthmatics and 32 healthy control preschoolers in a case-control design study.ResultsThe mean age of the population was 4.1 years (3–5.9 years) and 60% were females. Almost 95% of asthmatics and controls could perform an acceptable spirometry, but more asthmatics than controls reached forced expiratory volume in one second (FEV1) (57% vs. 23%, p = 0.033), independent of age. Basal flows and FEV1 were significantly lower in asthmatics than in controls, but no difference was found between groups in forced vital capacity (FVC) and FEV in 0.5 s (FEV0.5). Using receiver operating characteristic (ROC) curves, the variable with higher power to discriminate asthmatics from healthy controls was a bronchodilator response (% of change from basal above the coefficient of repeatability) of 25% in forced expiratory flow between 25% and 75% (FEF25–75) with 41% sensitivity, 80% specificity. The higher positive likelihood ratio for asthma equalled three for a bronchodilator response of 11% in FEV0.5 (sensitivity 30%, specificity 90%).ConclusionsIn this sample of Chilean preschoolers, spirometry had a very high performance and bronchodilator response was very specific but had low sensitivity to confirm asthma diagnosis. 相似文献
14.
Nahye Choi Suhyun Jang Kwang Ha Yoo Chin Kook Rhee Younhee Kim 《Journal of Korean medical science》2022,37(14)
BackgroundThis study aimed to perform meta-analyses to update a previous systematic review (SR) conducted by the US Preventive Services Task Force (USPSTF) to evaluate the benefits and harms of screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults.MethodsMEDLINE, EMBASE, Cochrane Library, and regional databases were searched from their inception to January 2020. Studies for diagnostic accuracy, preventive services effect, treatment efficacy, and treatment harms were included.ResultsEighteen studies were included, and twelve of these were newly added in this update. In meta-analyses, the pooled sensitivity and specificity for COPD diagnosis using spirometry were 73.4% and 89.0%, respectively. The relative effect of smoking cessation intervention with screening spirometry, presented as abstinence rate, was not statistically significant (risk ratio [RR], 1.21; 95% confidence interval [CI], 0.87–1.67) when all selected studies were pooled, but screening on smoking cessation was effective (RR, 1.58; 95% CI, 1.14–2.19) when limited to studies with smoking cessation programs that provided smoking cessation medicines or intensive counseling at public health centers or medical institutions.ConclusionIn this study, no direct evidence for the impact on health outcomes of screening asymptomatic adults for COPD was identified similar to the previous SR. Further research is necessary to confirm the benefits of COPD screening. 相似文献
15.
The aim of this retrospective study was to determine the utility of the spirometric measurements FVC, FEV1, and FEV1/FVC in diagnosing pulmonary restriction. Spirometry and lung volume measurements performed on the same patient visit were
analyzed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (1) FVC <
lower limit of normal (LLN) (NHANES III reference values) and (2) FVC < LLN and FEV1/FVC ≥ LLN were compared to diagnose restriction based on lung volume measurements. In all, 18,282 pulmonary function tests
from 8,315 patients were analyzed. Twenty-six percent of the patients (n = 2,213) had restriction based on lung volume measurements. The sensitivity, specificity, PPV, and NPV of FVC < LLN to diagnose
restriction based on lung volume measurement criteria were 88.6%, 56.8%, 39.9%, and 93.9%, respectively. The sensitivity,
specificity, PPV, and NPV of FVC < LLN and FEV1/FVC ≥ normal to diagnose restriction based on lung volume criteria were 72.4%, 87.1%, 64.4%, and 90.7%, respectively. Analysis
of ROC curves showed that spirometric criteria based on FVC alone performed better (area under the curve = 0.817) than those
based on the combined criteria of FVC and FEV1/FVC (area under the curve = 0.584). Consistent with earlier findings, the negative predictive value for a normal FVC (≥ LLN)
to exclude pulmonary restriction was high in this series (up to 95.7%). Also, a spirometric diagnosis of “restriction” (FVC
< LLN and FEV1/FVC ≥ LLN) had a positive predictive value of 26.3–73.9%. On this basis, normal FVC can be regarded as excluding restriction
with high reliability.
Saiprakash B. Venkateshiah and Octavian C. Ioachimescu authors contributed equally to this work. 相似文献
16.
Ludovic Moreau Dominique Crenesse Frederic Berthier Marc Albertini 《Acta paediatrica (Oslo, Norway : 1992)》2009,98(6):1019-1023
Background: The aim of our retrospective study was to determine the relationship between impulse oscillometry ( IOS) data and spirometric tests in cystic fibrosis (CF) children.
Methods : Thirty CF children aged 4–19 years have performed lung function tests (LFT). A subset of 15 patients repeated LFT on five separate occasions. IOS parameters were respiratory resistance (Rrs), reactance (Xrs) and impedance at 5 Hz (R5, X5, Zr) and the resonant frequency (Fres). Spirometry indices (SI) included forced expiratory volume in 1 sec (FEV1 ), forced expiratory flow during the middle half of FVC (FEF25–75 ) and forced vital capacity (FVC).
Results: An inverse relationship was observed between raw values of R5, Zr, Fres and SI respectively, and X5 correlated positively with SI. Although significant, these correlations were poor. Receiver operating characteristic curves (ROC) were constructed to identify cutoff points for IOS parameters to discriminate between children according to predefined FEV1 thresholds (percent predicted), generally used to categorize the level of lung function impairment. No acceptable cutoff points can be found for IOS parameters. Trends analyses in the subgroup of 15 patients showed a significant decline of FEV1 between the first and the fifth evaluation. None of the IOS indices demonstrated a consistent tendency, apart from a slight decrease of Fres.
Conclusion: IOS measurements presented an insufficient sensitivity to detect and follow bronchial obstruction in CF patients. 相似文献
Methods : Thirty CF children aged 4–19 years have performed lung function tests (LFT). A subset of 15 patients repeated LFT on five separate occasions. IOS parameters were respiratory resistance (Rrs), reactance (Xrs) and impedance at 5 Hz (R5, X5, Zr) and the resonant frequency (Fres). Spirometry indices (SI) included forced expiratory volume in 1 sec (FEV
Results: An inverse relationship was observed between raw values of R5, Zr, Fres and SI respectively, and X5 correlated positively with SI. Although significant, these correlations were poor. Receiver operating characteristic curves (ROC) were constructed to identify cutoff points for IOS parameters to discriminate between children according to predefined FEV
Conclusion: IOS measurements presented an insufficient sensitivity to detect and follow bronchial obstruction in CF patients. 相似文献
17.
目的探讨25-羟维生素D血浆浓度与吸人性糖皮质激素对COPD患者肺功能影响的关系。方法120例重度COPD患者于初人院时进行气量测定以及清晨禁食采集血样标本,用高效液相色谱法检测25(OH)D水平;而后每日2次,每次使用500μg氟替卡松,50μg沙美特罗,疗程4周。4周后再检测第1秒用力通气量及其改变,抽取血样,检测25(OH)D水平。治疗前后测量第1秒用力呼气容积(FEV1),与25(OH)D血浆水平进行相关性分析。结果25(OH)D血浆浓度水平平均为(23.3±9.3)ng/mL.在COPD患者中普遍维生素D缺乏,约占40%。对氟替卡松起效的患者体内25(OH)D水平偏高,在使用氟替卡松4周后,第1秒用力通气量有明显改善。结论25(OH)D血浆水平与患者对氟替卡松的敏感性有关,并可提高第1秒用力通气量,提高1秒率,改善肺功能。 相似文献
18.
Steiner D Jeggli S Tschopp A Bernard A Oppliger A Hilfiker S Hotz P 《International archives of occupational and environmental health》2005,78(3):189-197
Objectives: Inhalation of bioaerosols has been hypothesised to cause toxic pneumonitis that should increase lung epithelial permeability at the bronchioloalveolar level. Serum Clara cell protein (CC16) and serum surfactant protein B (SPB) have been proposed as sensitive markers of lung epithelial injury. This study was aimed at looking for increased lung epithelial permeability by determining CC16 and SPB in workers exposed to bioaerosols from wastewater or garbage. Methods: Subjects (778 wastewater, garbage and control workers; participation 61%) underwent a medical examination, lung function tests [American Thoracic Society (ATS) criteria], and determination of CC16 and SPB. Symptoms of endotoxin exposure and several potential confounders (age, gender, smoking, kidney function, obesity) were looked for. Results were examined with multiple linear or logistic regression. Results: Exposure to bioaerosols increased CC16 concentration in the wastewater workers. No effect of exposure on SPB was found. No clue to work-related respiratory diseases was found. Conclusions: The increase in CC16 in serum supports the hypothesis that bioaerosols cause subclinical toxic pneumonitis, even at low exposure. 相似文献
19.
Vital capacity (VC) and its subdivisions (IC and ERV), total lung capacity (TLC), residual volume (RV), peak expiratory flow
(PEF), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximum flow volume curve (MEF75, MEF50, MEF25, MMEF, FEF75–85), airway resistance (Rtot, Reff) and the thoracic gas volume at resting expiratory position (FRC) were measured in 187 girls and 213 boys (hospital normals)
aged 6 to 16 years. The measurements were carried out consecutively on the same subjects in the morning using a volume-constant
plethysmograph (MasterLab, E. Jaeger; programs: body plethysmography, spirometry and flow volume). Using multiple regression
analysis the best fitting curves for the prediction of normal values for boys and girls were selected. Analyses of covariance
were performed to compare the adjusted means of the spirometric and body plethysmographic variables of the male and female
subjects. As expected, we found higher static and dynamic (FVC, FEV1, PEF) lung volumes in boys than in girls relating to height. The flows (MMEF, MEF50, MEF25, FEF75–85) were significantly lower in the male than in the female subjects of the same age justifying separate prediction equations,
but the same equation for both genders may be used for the resistance variables Rtot and Reff. Our results are compared with those of previous studies.
Conclusion Lung volumes and flows differ significantly between girls and boys calling for separate reference values for female and male
subjects of the same age.
Received: 21 August 2000 and in revised form: 20 December 2000 / Accepted: 22 December 2000 相似文献
20.
Sixty-five patients with severe alpha1-antitrypsin (AAT) deficiency (phenotype PiZ) were followed with spirometry at regular intervals of one year and a median
observation period of four years.
The annual decline in pulmonary function was adjusted for sex, age and height by division with the predicted normal pulmonary
function. The median decline in FEV1 was 1.9% predicted/year. The rate of decline was independent of age and pulmonary function, except for patients with FEV1 below 25% of predicted normal.
There was a tendency towards a slower median decline in FEV1 in exsmokers (1.7% predicted/year) compared to smokers (3.8% predicted/year) and never-smokers (3.7% predicted/year), however,
this difference was not significant (p > 0.1). At the time of diagnosis smokers and ex-smokers had a lower FEV1 (44 and 38% predicted) than never-smokers (85% predicted) (p < 0.02), and smokers and ex-smokers were generally younger (median age 44 and 42 years, respectively) than never smokers
(median age 55 years) (p > 0.1).
Our data indicate that smokers as well as nonsmokers with severe AAT deficiency are at risk of developing pulmonary emphysema.
The disease seems to appear later in nonsmokers, though once initiated it progresses at the same rate.
Presented at the Satellite Expert Meeting: α1-Antitrypsin Deficiency, Bürgenstock/Luzern, Switzerland, June 9–11, 1989. 相似文献