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Collins SÉ, Kirby M, Smith BM, Tan W, Bourbeau J, Thompson S, van Diepen S, Jensen D, Stanojevic S, Stickland MK. Relationship of Pulmonary Vascular Structure and Function With Exercise Capacity in Health and COPD. Chest 2025; 167:402-413. [PMID: 39368737 PMCID: PMC11867894 DOI: 10.1016/j.chest.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND Although it is generally accepted that aerobic exercise training does not change lung structure or function, some work suggests that greater pulmonary vascular structure and function are associated with higher exercise capacity (peak rate of oxygen consumption [V˙o2peak]). RESEARCH QUESTION Is there a cross-sectional association between the pulmonary vasculature and V˙o2peak? We hypothesized that those with higher CT blood vessel volumes and pulmonary diffusing capacity for carbon monoxide (Dlco) would have higher V˙o2peak, independent of airflow limitation. STUDY DESIGN AND METHODS Participants from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study were categorized as follows: participants with normal spirometry who had never smoked (n = 263), participants with normal spirometry who had ever smoked (n = 407), and COPD: individuals with spirometric airflow obstruction (n = 334). Total vessel volume (TVV), volume for vessels < 5 mm2 in cross-sectional area (BV5), and volume for vessels between 5 and 10 mm2 in cross-sectional area (BV5-10) were generated from CT scans and used as indices of pulmonary vascular structure. Dlco was used as an index of pulmonary microvascular function. V˙o2peak was evaluated via incremental cardiopulmonary exercise testing. RESULTS General linear regression models revealed that even after controlling for FEV1, emphysema severity, and body morphology, Dlco, TVV, BV5, and BV5-10, were independently associated with V˙o2peak. Interaction effects were observed between COPD and TVV, BV5, and BV5-10, indicating a weaker association between pulmonary vascular volumes and V˙o2peak in COPD. INTERPRETATION Our results suggest that pulmonary vascular structure and Dlco are independently associated with V˙o2peak, regardless of severity of airflow limitation and emphysema, suggesting that these associations are not limited to COPD.
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Affiliation(s)
- Sophie É Collins
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Benjamin M Smith
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada; Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Wan Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada
| | - Stephanie Thompson
- Division of Nephrology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sean van Diepen
- Division of Critical Care, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Dennis Jensen
- Research Institute of the McGill University Health Centre and McGill University, Montreal, QC, Canada; Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada.
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Elmaagacli S, Thiele C, Meister F, Menne P, Truhn D, Olde Damink SWM, Bickenbach J, Neumann U, Lang SA, Vondran F, Amygdalos I. Preoperative three-dimensional lung volumetry predicts respiratory complications in patients undergoing major liver resection for colorectal metastases. Sci Rep 2024; 14:10594. [PMID: 38719953 PMCID: PMC11079043 DOI: 10.1038/s41598-024-61386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024] Open
Abstract
Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer and liver resection with complete tumor removal is the best treatment option for these patients. This study examines the predictive ability of three-dimensional lung volumetry (3DLV) based on preoperative computerized tomography (CT), to predict postoperative pulmonary complications in patients undergoing major liver resection for CRLM. Patients undergoing major curative liver resection for CRLM between 2010 and 2021 with a preoperative CT scan of the thorax within 6 weeks of surgery, were included. Total lung volume (TLV) was calculated using volumetry software 3D-Slicer version 4.11.20210226 including Chest Imaging Platform extension ( http://www.slicer.org ). The area under the curve (AUC) of a receiver-operating characteristic analysis was used to define a cut-off value of TLV, for predicting the occurrence of postoperative respiratory complications. Differences between patients with TLV below and above the cut-off were examined with Chi-square or Fisher's exact test and Mann-Whitney U tests and logistic regression was used to determine independent risk factors for the development of respiratory complications. A total of 123 patients were included, of which 35 (29%) developed respiratory complications. A predictive ability of TLV regarding respiratory complications was shown (AUC 0.62, p = 0.036) and a cut-off value of 4500 cm3 was defined. Patients with TLV < 4500 cm3 were shown to suffer from significantly higher rates of respiratory complications (44% vs. 21%, p = 0.007) compared to the rest. Logistic regression analysis identified TLV < 4500 cm3 as an independent predictor for the occurrence of respiratory complications (odds ratio 3.777, 95% confidence intervals 1.488-9.588, p = 0.005). Preoperative 3DLV is a viable technique for prediction of postoperative pulmonary complications in patients undergoing major liver resection for CRLM. More studies in larger cohorts are necessary to further evaluate this technique.
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Affiliation(s)
- Suzan Elmaagacli
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christoph Thiele
- Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Franziska Meister
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Philipp Menne
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Daniel Truhn
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Johannes Bickenbach
- Department of Operative Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Neumann
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Sven Arke Lang
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Florian Vondran
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Iakovos Amygdalos
- Department of General, Visceral, Pediatric, and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
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Mraz T, Asgari S, Karimi A, Breyer MK, Hartl S, Sunanta O, Ofenheimer A, Burghuber OC, Zacharasiewicz A, Lamprecht B, Schiffers C, Wouters EFM, Breyer-Kohansal R. Updated reference values for static lung volumes from a healthy population in Austria. Respir Res 2024; 25:155. [PMID: 38570835 PMCID: PMC10988832 DOI: 10.1186/s12931-024-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Reference values for lung volumes are necessary to identify and diagnose restrictive lung diseases and hyperinflation, but the values have to be validated in the relevant population. Our aim was to investigate the Global Lung Function Initiative (GLI) reference equations in a representative healthy Austrian population and create population-derived reference equations if poor fit was observed. METHODS We analysed spirometry and body plethysmography data from 5371 respiratory healthy subjects (6-80 years) from the Austrian LEAD Study. Fit with the GLI equations was examined using z-scores and distributions within the limits of normality. LEAD reference equations were then created using the LMS method and the generalized additive model of location shape and scale package according to GLI models. RESULTS Good fit, defined as mean z-scores between + 0.5 and -0.5,was not observed for the GLI static lung volume equations, with mean z-scores > 0.5 for residual volume (RV), RV/TLC (total lung capacity) and TLC in both sexes, and for expiratory reserve volume (ERV) and inspiratory capacity in females. Distribution within the limits of normality were shifted to the upper limit except for ERV. Population-derived reference equations from the LEAD cohort showed superior fit for lung volumes and provided reproducible results. CONCLUSION GLI lung volume reference equations demonstrated a poor fit for our cohort, especially in females. Therefore a new set of Austrian reference equations for static lung volumes was developed, that can be applied to both children and adults (6-80 years of age).
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Affiliation(s)
- Tobias Mraz
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Sanatoriumstrasse 2, Vienna, 1140, Austria.
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.
| | - Shervin Asgari
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Ahmad Karimi
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Marie-Kathrin Breyer
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Sanatoriumstrasse 2, Vienna, 1140, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Owat Sunanta
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Alina Ofenheimer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Otto C Burghuber
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Sanatoriumstrasse 2, Vienna, 1140, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | | | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | | | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Hietzing, Vienna, Austria
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Johnson MJ, Pitel L, Currow DC, Forbes C, Soyiri I, Robinson L. Breathlessness limiting exertion in very old adults: findings from the Newcastle 85+ study. Age Ageing 2023; 52:afad155. [PMID: 37658750 PMCID: PMC10474592 DOI: 10.1093/ageing/afad155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/09/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Long-term breathlessness is more common with age. However, in the oldest old (>85 years), little is known about the prevalence, or impact of breathlessness. We estimated breathlessness limiting exertion prevalence and explored (i) associated characteristics; and (ii) whether breathlessness limiting exertion explains clinical and social/functional outcomes. METHODS Health and socio-demographic characteristics were extracted from the Newcastle 85+ Study cohort. Phase 1 (baseline) and follow-up data (18 months, Phase 2; 36 months, Phase 3; 60 months, Phase 4 after baseline) were examined using descriptive statistics and cross-sectional regression models. RESULTS Eight hundred seventeen participants provided baseline breathlessness data (38.2% men; mean 84.5 years; SD 0.4). The proportions with any limitation of exertion, or severe limitation by breathlessness were 23% (95% confidence intervals (CIs) 20-25%) and 9% (95%CIs 7-11%) at baseline; 20% (16-25%) and 5% (3-8%) at Phase 4. Having more co-morbidities (odds ratio (OR) 1.34, 1.18-1.54; P < 0.001), or self-reported respiratory (OR 1.88, 1.25-2.82; P = 0.003) or cardiovascular disease (OR 2.38, 1.58-3.58; P < 0.001) were associated with breathlessness limiting exertion. Breathlessness severely limiting exertion was associated with poorer self-rated health (OR 0.50, 029-0.86; P = 0.012), depression (beta-coefficient 0.11, P = 0.001), increased primary care contacts (beta-co-efficient 0.13, P = 0.001) and number of nights in hospital (OR 1.81; 1.02-3.20; P = 0.042). CONCLUSIONS Breathlessness limiting exertion appears to become less prevalent over time due to death or withdrawal of participants with cardio-respiratory illness. Breathlessness severely limiting exertion had a wide range of service utilisation and wellbeing impacts.
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Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lukas Pitel
- Hull Health Trials Unit, Hull York Medical School, University of Hull, Hull, UK
| | - David C Currow
- Department of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Cynthia Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Alter P, Orszag J, Wouters EFM, Vogelmeier CF, Jörres RA. Differences in the Measurement of Functional Residual Capacity Between Body Plethysmographs of Two Manufacturers. Int J Chron Obstruct Pulmon Dis 2022; 17:1477-1482. [PMID: 35774592 PMCID: PMC9239195 DOI: 10.2147/copd.s363493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/09/2022] [Indexed: 12/03/2022] Open
Abstract
Body plethysmography is a fundamental method for the assessment of static lung volumes. Although equipment is provided by several manufacturers, there are no established cross-vendor tools for quality control. In the process of quality control and analysis of data on hyperinflation from the large COPD cohort COSYCONET, hints appeared that plethysmographs of different vendors might yield different values for static lung volumes. Functional residual capacity (FRC) differed about 0.67 litres between plethysmographs of the manufacturer Vyaire and Ganshorn. Absolute differences of residual lung volume (RV) and total lung capacity (TLC) were similar. It appears undeniable that differences of this magnitude have an impact on clinical interpretation. Thus, device harmonization seems to be required.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
- Correspondence: Peter Alter, Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Baldingerstrasse, Marburg, 35033, Germany, Email
| | - Jan Orszag
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Germany, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Hall GL, Filipow N, Ruppel G, Okitika T, Thompson B, Kirkby J, Steenbruggen I, Cooper BG, Stanojevic S. Official ERS technical standard: Global Lung Function Initiative reference values for static lung volumes in individuals of European ancestry. Eur Respir J 2021; 57:57/3/2000289. [PMID: 33707167 DOI: 10.1183/13993003.00289-2020] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/27/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Measurement of lung volumes across the life course is critical to the diagnosis and management of lung disease. The aim of the study was to use the Global Lung Function Initiative methodology to develop all-age multi-ethnic reference equations for lung volume indices determined using body plethysmography and gas dilution techniques. METHODS Static lung volume data from body plethysmography and gas dilution techniques from individual, healthy participants were collated. Reference equations were derived using the LMS (lambda-mu-sigma) method and the generalised additive models of location shape and scale programme in R. The impact of measurement technique, equipment type and being overweight or obese on the derived lung volume reference ranges was assessed. RESULTS Data from 17 centres were submitted and reference equations were derived from 7190 observations from participants of European ancestry between the ages of 5 and 80 years. Data from non-European ancestry populations were insufficient to develop multi-ethnic equations. Measurements of functional residual capacity (FRC) collected using plethysmography and dilution techniques showed physiologically insignificant differences and were combined. Sex-specific reference equations including height and age were developed for total lung capacity (TLC), FRC, residual volume (RV), inspiratory capacity, vital capacity, expiratory reserve volume and RV/TLC. The derived equations were similar to previously published equations for FRC and TLC, with closer agreement during childhood and adolescence than in adulthood. CONCLUSIONS Global Lung Function Initiative reference equations for lung volumes provide a generalisable standard for reporting and interpretation of lung volumes measurements in individuals of European ancestry.
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Affiliation(s)
- Graham L Hall
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia .,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Nicole Filipow
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Gregg Ruppel
- Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Tolu Okitika
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Australia
| | - Bruce Thompson
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jane Kirkby
- Respiratory Medicine, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | | | - Brendan G Cooper
- Lung Function and Sleep, University Hospital Birmingham and Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Sanja Stanojevic
- Translational Medicine, Hospital for Sick Children, Toronto, ON, Canada
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Ioachimescu OC, Stoller JK, Garcia-Rio F. Area under the expiratory flow-volume curve: predicted values by artificial neural networks. Sci Rep 2020; 10:16624. [PMID: 33024243 PMCID: PMC7538954 DOI: 10.1038/s41598-020-73925-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/23/2020] [Indexed: 01/08/2023] Open
Abstract
Area under expiratory flow-volume curve (AEX) has been proposed recently to be a useful spirometric tool for assessing ventilatory patterns and impairment severity. We derive here normative reference values for AEX, based on age, gender, race, height and weight, and by using artificial neural network (ANN) algorithms. We analyzed 3567 normal spirometry tests with available AEX values, performed on subjects from two countries (United States and Spain). Regular linear or optimized regression and ANN models were built using traditional predictors of lung function. The ANN-based models outperformed the de novo regression-based equations for AEXpredicted and AEX z scores using race, gender, age, height and weight as predictor factors. We compared these reference values with previously developed equations for AEX (by gender and race), and found that the ANN models led to the most accurate predictions. When we compared the performance of ANN-based models in derivation/training, internal validation/testing, and external validation random groups, we found that the models based on pooling samples from various geographic areas outperformed the other models (in both central tendency and dispersion of the residuals, ameliorating any cohort effects). In a geographically diverse cohort of subjects with normal spirometry, we computed by both regression and ANN models several predicted equations and z scores for AEX, an alternative measurement of respiratory function. We found that the dynamic nature of the ANN allows for continuous improvement of the predictive models’ performance, thus promising that the AEX could become an essential tool in assessing respiratory impairment.
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Affiliation(s)
- Octavian C Ioachimescu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, School of Medicine, Emory University, Atlanta VA Sleep Medicine Center, 250 N Arcadia Ave, Decatur, GA, 30030, USA.
| | - James K Stoller
- Jean Wall Bennett Professor of Medicine, Chair-Education Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
| | - Francisco Garcia-Rio
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ-Departamento de Medicina, Universidad Autónoma de Madrid-Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Kubo H, Asai T, Fukumoto Y, Oshima K, Koyama S, Monjo H, Tajitsu H, Oka T. Comparison of voluntary cough function in community - dwelling elderly and its association with physical fitness. Phys Ther Res 2020; 23:47-52. [PMID: 32850278 DOI: 10.1298/ptr.e10007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the association of cough peak flow (CPF) with aging in community-dwelling older adults and to investigate the relationship between physical fitness and CPF in these individuals. METHOD Two hundred twenty two community-dwelling older adults were enrolled. CPF was assessed as a cough function parameter. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0) were assessed as respiratory function. Maximal expiratory pressure (MEP) and inspiratory pressure (MIP) were assessed as respiratory muscle strength. The 3-minute walk test (3MWT) performance was assessed as a physical fitness. Participants were divided into the following age groups: 60-64, 65-69, 70-74, 75-79 and 80-89 years. One way analysis of variance were computed for comparison between age group, sex and CPF. Multivariate regression analyses were used to investigate the association of CPF with 3MWT. RESULTS The value of CPF significantly decreased in the 75-79 and 80-89 years group than 60-64 years group in men and in the 80-89 years group than 65-69 years group in women. The value of CPF were 545.5, 497.2, 403.3, 354.8 and 325.4 L/min in the 60-64, 65-69, 70-74, 75-79 and 80-89-year group in men and 263.4, 278.8, 264.5, 214.0, and 193.6 L/min in the corresponding age groups in women, respectively. 3MWT (p = 0.041) was significantly associated with CPF. CONCLUSIONS Cough function tends to decrease with aging in community-dwelling elderly. Physical fitness is associated with cough function.
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Affiliation(s)
- Hiroki Kubo
- Graduate School of Rehabilitation, Kobe Gakuin University.,Department of Rehabilitation, Itami Kousei Neurosurgical Hospital
| | - Tsuyoshi Asai
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University
| | - Yoshihiro Fukumoto
- Department of Physical Medicine and Rehabilitation, Kansai Medical University
| | - Kensuke Oshima
- Graduate School of Rehabilitation, Kobe Gakuin University
| | - Shota Koyama
- Department of Rehabilitation, Saiseikai Hyogoken Hospital
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9
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Bowdish DM. The Aging Lung. Chest 2019; 155:391-400. [DOI: 10.1016/j.chest.2018.09.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/13/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023] Open
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Yamaguchi K, Omori H, Tsuji T, Aoshiba K. Classical regression equations of spirometric parameters are not applicable for diagnosing spirometric abnormalities in adipotic adults. World J Respirol 2018; 8:1-12. [DOI: 10.5320/wjr.v8.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/29/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Kazuhiro Yamaguchi
- Department of Respiratory Medicine, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| | - Takao Tsuji
- Department of Respiratory Medicine, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University, Ibaraki Medical Center, Ibaraki 300-0395, Japan
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Alter P, Rabe KF, Schulz H, Vogelmeier CF, Jörres RA. Influence of body mass on predicted values of static hyperinflation in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2551-2555. [PMID: 30197511 PMCID: PMC6112801 DOI: 10.2147/copd.s164096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction For interpretation of body plethysmographic static hyperinflation, reference values are of crucial importance. Earliest reference values have been published by the European Coal and Steel Community (ECSC) and are based on sex, body height and age as predictors. As obesity can lead to a reduction of functional residual capacity (FRC) in lung-healthy subjects, more recent approaches included body weight or body surface area. This raises the question whether these models are appropriate in patients with COPD-induced hyperinflation. Method Several FRC prediction models and their relation to body weight were analyzed in 1513 patients with stable COPD (mean [SD] age: 64.5 [8.2] years; GOLD grades 1–4: 219/722/484/88), a subset of the multicenter COPD and Systemic Consequences – Comorbidities Network cohort. Results Absolute values of FRC were inversely related to body mass index (p<0.001). Applying the ECSC equations to calculate predicted values, this pattern was maintained (p<0.001). By contrast, an inverted, ie, positive, relation occurred when using equations that include body weight or surface area (p<0.001). The present analysis confirmed the inverse relation of body mass and FRC in COPD, resulting from a restrictive ventilatory pattern by diaphragm elevation and decreased chest wall compliance in obesity. The weight influence in the prediction models, as obtained from lung-healthy controls, appears to lead to an overcorrection and consequently to an inappropriate overestimation of hyperinflation as indicated by FRC %predicted in COPD. Conclusion It is concluded that models not including body weight as predictor, like the classical ECSC equations, could be superior in the interpretation of FRC in COPD.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany,
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Member of the German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany.,Christian-Albrechts University, Airway Research Center North (ARCN), Kiel, Germany
| | - Holger Schulz
- Helmholtz-Zentrum München, Institute of Epidemiology, German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany,
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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12
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Poor HD, Kawut SM, Liu CY, Smith BM, Hoffman EA, Lima JA, Ambale-Venkatesh B, Michos ED, Prince MR, Barr RG. Pulmonary hyperinflation due to gas trapping and pulmonary artery size: The MESA COPD Study. PLoS One 2017; 12:e0176812. [PMID: 28463971 PMCID: PMC5413010 DOI: 10.1371/journal.pone.0176812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 04/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary hypertension is associated with increased morbidity and mortality in chronic obstructive pulmonary disease (COPD). Since pulmonary artery (PA) size increases in pulmonary hypertension, we measured PA cross-sectional area using magnetic resonance imaging (MRI) to test the hypothesis that pulmonary hyperinflation due to gas trapping is associated with PA cross-sectional area in COPD. METHODS The MESA COPD Study recruited participants with COPD and controls from two population-based cohort studies ages 50-79 years with 10 or more pack-years and free of clinical cardiovascular disease. Body plethysmography was performed according to standard criteria. Cardiac MRI was performed at functional residual capacity to measure the cross-sectional area of the main PA. Percent emphysema was defined as the percentage of lung voxels less than -950 Hounsfield units as assessed via x-ray computed tomography. Analyses were adjusted for age, gender, height, weight, race-ethnicity, the forced expiratory volume in one second, smoking status, pack-years, lung function, oxygen saturation, blood pressure, left ventricular ejection fraction and percent emphysema. RESULTS Among 106 participants, mean residual volume was 1.98±0.71 L and the mean PA cross-sectional area was 7.23±1.72 cm2. A one standard deviation increase in residual volume was independently associated with an increase in main PA cross-sectional area of 0.55 cm2 (95% CI 0.18 to 0.92; p = 0.003). In contrast, there was no evidence for an association with percent emphysema or total lung capacity. CONCLUSION Increased residual volume was associated with a larger PA in COPD, suggesting that gas trapping may contribute to pulmonary hypertension in COPD.
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Affiliation(s)
- Hooman D. Poor
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Steven M. Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Chia-Ying Liu
- Department of Radiology Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Benjamin M. Smith
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States of America
| | - João A. Lima
- Department of Radiology Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Erin D. Michos
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Martin R. Prince
- Department of Radiology, Columbia University Medical Center, New York, New York, United States of America
| | - R. Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York, United States of America
- Department of Epidemiology, Columbia University Medical Center, New York, New York, United States of America
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Battaglia S, Benfante A, Spatafora M, Scichilone N. Asthma in the elderly: a different disease? Breathe (Sheff) 2016; 12:18-28. [PMID: 27064568 PMCID: PMC4818235 DOI: 10.1183/20734735.002816] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
KEY POINTS Asthma in the elderly can be difficult to identify due to modifications of its clinical features and functional characteristics.Several comorbidities are associated with asthma in the elderly, and this association differs from that observed in younger patients.In clinical practice, physicians should treat comorbidities that are correlated with asthma (i.e. rhinitis or gastro-oesophageal reflux), assess comorbidities that may influence asthma outcomes (i.e. depression or cognitive impairment) and try to prevent comorbidities related to -'drug-associated side-effects (i.e. cataracts, arrhythmias or osteoporosis)."Geriatric asthma" should be the preferred term because it implies the comprehensive and multidimensional approach to the disease in the older populations, whereas "asthma in the elderly" is only descriptive of the occurrence of the disease in this age range. EDUCATIONAL AIMS To present critical issues in performing differential diagnosis of asthma in the elderly.To offer the instrument to implement the management of asthma in the most advanced ages. Asthma is a chronic airway disease that affects all ages, but does this definition also include the elderly? Traditionally, asthma has been considered a disease of younger age, but epidemiological studies and clinical experience support the concept that asthma is as prevalent in older age as it is in the young. With the ever-increasing elderly population worldwide, the detection and proper management of the disease in old age may have a great impact from the public health perspective. Whether asthma in the elderly maintains the same characteristics as in young populations is an interesting matter. The diagnostic process in older individuals with suspected asthma follows the same steps, namely a detailed history supported by clinical examination and laboratory investigations; however, it should be recognised that elderly patients may partially lose reversibility of airway obstruction. The correct interpretation of spirometric curves in the elderly should take into account the physiological changes in the respiratory system. Several factors contribute to delaying the diagnosis of asthma in the elderly, including the age-related impairment in perception of breathlessness. The management of asthma in advanced age is complicated by the comorbidities and polypharmacotherapy, which advocate for a comprehensive approach with a multidimensional assessment. It should be emphasised that older age frequently represents an exclusion criterion for eligibility in clinical trials, and current asthma medications have rarely been tested in elderly asthmatics. Ageing is associated with pharmacokinetic changes of the medications. As a consequence, absorption, distribution, metabolism and excretion of antiasthmatic medications can be variably affected. Similarly, drug-to-drug interactions may reduce the effectiveness of inhaled medications and increase the risk of side-effects. For this reason, we propose the term "geriatric asthma" be preferred to the more generic "asthma in the elderly".
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Affiliation(s)
- Salvatore Battaglia
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Alida Benfante
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Mario Spatafora
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy; Istituto Euro-Mediterraneo di Scienza e Tecnologia, Palermo, Italy
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14
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Soriano JB, García-Rio F. Global Lung Function Initiative Equations: The Legacy Starts. Respiration 2016; 92:131-3. [DOI: 10.1159/000448251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Topalovic M, Derom E, Osadnik CR, Troosters T, Decramer M, Janssens W. Airways resistance and specific conductance for the diagnosis of obstructive airways diseases. Respir Res 2015; 16:88. [PMID: 26194099 PMCID: PMC4509748 DOI: 10.1186/s12931-015-0252-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/08/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Airway resistance (RAW) and specific airway conductance (sGAW) are measures that reflect the patency of airways. Little is known of the variability of these measures between different lung diseases. This study investigated the contribution of RAW and sGAW to a diagnosis of obstructive airways disease and their role in differentiating asthma from COPD. METHODS 976 subjects admitted for the first time to a pulmonary practice in Belgium were included. Clinical diagnoses were based on complete pulmonary function tests and supported by investigations of physicians' discretion. 651 subjects had a final diagnosis of obstructive diseases, 168 had another respiratory disease and 157 subjects had no respiratory disease (healthy controls). RESULTS RAW and sGAW were significantly different (p < 0.0001) between obstructive and other groups. Abnormal RAW and sGAW were found in 39 % and 18 % of the population, respectively, in which 81 % and 90 % had diagnosed airway obstruction. Multiple regression revealed sGAW to be a significant and independent predictor of an obstructive disorder. To differentiate asthma from COPD, RAW was found to be more relevant and statistically significant. In asthma patients with normal FEV1/FVC ratio, both RAW and sGAW were more specific than sensitive diagnostic tests in differentiating asthma from healthy subjects. CONCLUSIONS RAW and sGAW are significant factors that contribute to the diagnosis and differentiation of obstructive airways diseases.
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Affiliation(s)
- Marko Topalovic
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eric Derom
- Respiratory Division, University Hospital Ghent, University of Ghent, Ghent, Belgium
| | - Christian R Osadnik
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physiotherapy, Monash University, Victoria, Australia
- Institute for Breathing and Sleep, Victoria, Australia
- Monash Health, Monash Lung and Sleep, Victoria, Australia
| | - Thierry Troosters
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marc Decramer
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Wim Janssens
- Department of Clinical and Experimental Medicine, Laboratory of Respiratory Diseases, University Hospital Leuven, KULEUVEN University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
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16
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Variation in the percent of emphysema-like lung in a healthy, nonsmoking multiethnic sample. The MESA lung study. Ann Am Thorac Soc 2015; 11:898-907. [PMID: 24983825 DOI: 10.1513/annalsats.201310-364oc] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Computed tomography (CT)-based lung density is used to quantitate the percentage of emphysema-like lung (hereafter referred to as percent emphysema), but information on its distribution among healthy nonsmokers is limited. OBJECTIVES We evaluated percent emphysema and total lung volume on CT scans of healthy never-smokers in a multiethnic, population-based study. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) Lung Study investigators acquired full-lung CT scans of 3,137 participants (ages 54-93 yr) between 2010-12. The CT scans were taken at full inspiration following the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) protocol. "Healthy never-smokers" were defined as participants without a history of tobacco smoking or respiratory symptoms and disease. "Percent emphysema" was defined as the percentage of lung voxels below -950 Hounsfield units. "Total lung volume" was defined by the volume of lung voxels. MEASUREMENTS AND MAIN RESULTS Among 854 healthy never-smokers, the median percent emphysema visualized on full-lung scans was 1.1% (interquartile range, 0.5-2.5%). The percent emphysema values were 1.2 percentage points higher among men compared with women and 0.7, 1.2, and 1.2 percentage points lower among African Americans, Hispanics, and Asians compared with whites, respectively (P < 0.001). Percent emphysema was positively related to age and height and inversely related to body mass index. The findings were similar for total lung volume on CT scans and for percent emphysema defined at -910 Hounsfield units and measured on cardiac scans. Reference equations to account for these differences are presented for never, former and current smokers. CONCLUSIONS Similar to lung function, percent emphysema varies substantially by demographic factors and body size among healthy never-smokers. The presented reference equations will assist in defining abnormal values for percent emphysema and total lung volume on CT scans, although validation is pending.
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17
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Michailopoulos P, Kontakiotis T, Spyratos D, Argyropoulou-Pataka P, Sichletidis L. Reference Equations for Static Lung Volumes and TL CO from a Population Sample in Northern Greece. Respiration 2015; 89:000371469. [PMID: 25721220 DOI: 10.1159/000371469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 12/01/2014] [Indexed: 02/28/2024] Open
Abstract
Background: The most commonly used reference equations for the measurement of static lung volumes/capacities and transfer factor of the lung for CO (TLCO) are based on studies around 30-40 years old with significant limitations. Objectives: Our aim was to (1) develop reference equations for static lung volumes and TLCO using the current American Thoracic Society/European Respiratory Society guidelines, and (2) compare the equations derived with those most commonly used. Methods: Healthy Caucasian subjects (234 males and 233 females) aged 18-91 years were recruited. All of them were healthy never smokers with a normal chest X-ray. Static lung volumes and TLCO were measured with a single-breath technique according to the latest guidelines. Results: Curvilinear regression prediction equations derived from the present study were compared with those that are most commonly used. Our reference equations in accordance with the latest studies show lower values for all static lung volume parameters and TLCO as well as a different way of deviation of those parameters (i.e. declining with age total lung capacity, TLCO age decline in both sex and functional residual capacity age rise in males). Conclusions: We suggest that old reference values of static lung volumes and TLCO should be updated, and our perception of deviation of some spirometric parameters should be revised. Our new reference curvilinear equations derived according to the latest guidelines could contribute to the updating by respiratory societies of old existing reference values and result in a better estimation of the lung function of contemporary populations with similar Caucasian characteristics. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Pavlos Michailopoulos
- Pulmonary Department, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
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18
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Smith BM, Hoffman EA, Basner RC, Kawut SM, Kalhan R, Barr RG. Not all measures of hyperinflation are created equal: lung structure and clinical correlates of gas trapping and hyperexpansion in COPD: the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study. Chest 2014; 145:1305-1315. [PMID: 24481056 DOI: 10.1378/chest.13-1884] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Hyperinflation refers to a nonspecific increase in absolute lung volumes and has a poor prognosis in COPD. The relative contribution of increased airways resistance and increased parenchymal compliance to hyperinflation of each absolute lung volume is poorly understood. We hypothesized that increased residual volume (RV) and RV/total lung capacity (TLC) would be associated with reduced airway lumen dimensions, whereas increased functional residual capacity (FRC), TLC, and reduced inspiratory capacity (IC)/TLC would be associated with emphysema on CT scan. We examined whether clinical characteristics differed accordingly. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. Gas trapping was defined as RV or RV/TLC greater than the upper limit of normal and hyperexpansion as FRC or TLC greater than the upper limit of normal or IC/TLC less than the lower limit of normal. Airway lumen diameters and percent emphysema < -950 Hounsfield units were quantified on CT images. Analyses were adjusted for age, sex, body size, race/ethnicity, education, and smoking. RESULTS Among 116 participants completing plethysmography, 15% had gas trapping, 18% has hyperexpansion, and 22% had both. Gas trapping was associated with smaller airway lumen diameters (P = .001), greater dyspnea (P = .01), and chronic bronchitis (P = .03). Hyperexpansion was associated with percent emphysema (P < .001), lower BMI (P = .04), and higher hemoglobin concentration (P = .001). CONCLUSIONS Gas trapping and hyperexpansion on plethysmography were associated with distinct differences in lung structure and clinical characteristics. Absolute lung volumes should not be considered equivalent in their estimation of hyperinflation and provide insight into the extent of airway and parenchymal abnormalities in COPD.
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Affiliation(s)
- Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Robert C Basner
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ravi Kalhan
- Asthma and COPD Program, Division of Pulmonary and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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He J, Ge M, Wang C, Jiang N, Zhang M, Yun P. Predictive models and spatial variations of vital capacity in healthy people from 6 to 84 years old in China based on geographical factors. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2014; 58:769-779. [PMID: 23686109 DOI: 10.1007/s00484-013-0658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 02/25/2013] [Accepted: 03/05/2013] [Indexed: 06/02/2023]
Abstract
The aim of this study was to provide a scientific basic for a unified standard of the reference value of vital capacity (VC) of healthy subjects from 6 and 84 years old in China. The normal reference value of VC was correlated to seven geographical factors, including altitude (X1), annual duration of sunshine (X2), annual mean air temperature (X3), annual mean relative humidity (X4), annual precipitation amount (X5), annual air temperature range (X6) and annual mean wind speed (X7). Predictive models were established by five different linear and nonlinear methods. The best models were selected by t-test. The geographical distribution map of VC in different age groups can be interpolated by Kriging's method using ArcGIS software. It was found that the correlation of VC and geographical factors in China was quite significant, especially for both males and females aged from 6 to 45. The best models were built for different age groups. The geographical distribution map shows the spatial variations of VC in China precisely. The VC of healthy subjects can be simulated by the best model or acquired from the geographical distribution map provided the geographical factors for that city or county of China are known.
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Affiliation(s)
- Jinwei He
- Institute of Healthy Geography, College of Tourism and Environment, Shaanxi Normal University, 199 South Chang'an Road, Xi'an, 710062, Shaanxi, China,
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20
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Omori H, Onoue A, Katoh T, Ogata Y, Kawashima H, Miyao N, Tsuji T, Aoshiba K, Nagai A, Yamaguchi K. A large cohort study concerning age-dependent impacts of anthropometric variables on spirometric parameters in nonsmoking healthy adults. PLoS One 2014; 9:e100733. [PMID: 24955585 PMCID: PMC4067384 DOI: 10.1371/journal.pone.0100733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/30/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUNDS Although height (H) has been considered the principal anthropometric variable governing lung function, the age-dependent differences in its influences on determining spirometric parameters (SPs) have not been conclusively investigated. Moreover, there has been no study centered on age-dependent effects of other anthropometric variables, including body weight (BW) and body fat mass (BFM) on SPs. In addition, the age-dependent influences of these anthropometric variables are anticipated to differ quantitatively between male and female participants. METHODS A total of 16,919 nonsmoking healthy Japanese adults (men: 6,116, women: 10,803) were partitioned into six groups stratified by gender and age at intervals of 20-years: young-, middle-, and advanced-age groups of either gender. Using a model in which a SP was described by a logarithmic additive function of age, H, BW, and BFM, we determined the partial regression coefficients of the respective anthropometric variables to predict the reference means of SPs, including FVC, FEV1, FEV1/FVC, PEF, FEF50, and FEF75, in the six groups. RESULTS/DISCUSSION Although the impact of H on FVC and FEV1 was relatively homogeneous irrespective of gender and age, its homogeneity faded for flow parameters, particularly in the female middle- and advanced-age groups, indicating that the age-dependent contribution of H to SPs was enhanced more in women. The impact of BW on SPs differed depending on age, and this effect was also more conspicuous for female participants. H and BW generally exerted positive effects on SPs, whereas BFM had negative effects. Opposite effects of BW and BFM were observed in the female middle-age group in particular. CONCLUSIONS The effects of anthropometric variables on spirometric parameters are highly age-dependent, particularly in women, leading to the conclusion that the assumption of age-independent, constant partial regression coefficients of anthropometric variables while predicting the reference mean of a certain spirometric parameter may result in substantial errors.
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Affiliation(s)
- Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Kumamoto University, Kumamoto, Japan
| | - Ayumi Onoue
- Department of Public Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takahiko Katoh
- Department of Public Health Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Ogata
- Health Care Center, Japanese Red Cross Kumamoto, Kumamoto, Japan
| | | | - Naoki Miyao
- Internal Medicine, Nihon Koukan Hospital, Kawasaki, Japan
| | - Takao Tsuji
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Atsushi Nagai
- The First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiro Yamaguchi
- Comprehensive and Internal Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Incalzi RA, Scarlata S, Pennazza G, Santonico M, Pedone C. Chronic Obstructive Pulmonary Disease in the elderly. Eur J Intern Med 2014; 25:320-8. [PMID: 24183233 DOI: 10.1016/j.ejim.2013.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 06/21/2013] [Accepted: 10/04/2013] [Indexed: 11/21/2022]
Abstract
The prevalence of Chronic Obstructive Pulmonary Disease (COPD) dramatically increases with age, and COPD complicated by chronic respiratory failure may be considered a geriatric condition. Unfortunately, most cases remain undiagnosed because of atypical clinical presentation and difficulty with current respiratory function diagnostic standards. Accordingly, the disease is under-recognized and undertreated. This is expected to impact noticeably the health status of unrecognized COPD patients because a timely therapy could mitigate the distinctive and important effects of COPD on the health status. Comorbidity also plays a pivotal role in conditioning both the health status and the therapy of COPD besides having major prognostic implication. Several problems affect the overall quality of the therapy for the elderly with COPD, and current guidelines as well as results from pharmacological trials only to some extent apply to this patient. Finally, physicians of different specialties care for the elderly COPD patient: physician's specialty largely determines the kind of approach. In conclusion, COPD, in itself a complex disease, becomes difficult to identify and to manage in the elderly. Interdisciplinary efforts are desirable to provide the practicing physician with a multidisciplinary guide to the identification and treatment of COPD.
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Affiliation(s)
- Raffaele Antonelli Incalzi
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy; San Raffaele - Cittadella della Carità Foundation, Taranto, Italy.
| | - Simone Scarlata
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Giorgio Pennazza
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy
| | - Marco Santonico
- Center for Integrated Research - CIR, Unit of Electronics for Sensor Systems, Campus Bio-Medico University, Rome, Italy
| | - Claudio Pedone
- Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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22
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A novel supervised approach for segmentation of lung parenchyma from chest CT for computer-aided diagnosis. J Digit Imaging 2014; 26:496-509. [PMID: 23076539 DOI: 10.1007/s10278-012-9539-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Segmentation of lung parenchyma from the chest computed tomography is an important task in analysis of chest computed tomography for diagnosis of lung disorders. It is a challenging task especially in the presence of peripherally placed pathology bearing regions. In this work, we propose a segmentation approach to segment lung parenchyma from chest. The first step is to segment the lungs using iterative thresholding followed by morphological operations. If the two lungs are not separated, the lung junction and its neighborhood are identified and local thresholding is applied. The second step is to extract shape features of the two lungs. The third step is to use a multilayer feed forward neural network to determine if the segmented lung parenchyma is complete, based on the extracted features. The final step is to reconstruct the two lungs in case of incomplete segmentation, by exploiting the fact that in majority of the cases, at least one of the two lungs would have been segmented correctly by the first step. Hence, the complete lung is determined based on the shape and region properties and the incomplete lung is reconstructed by applying graphical methods, namely, reflection and translation. The proposed approach has been tested in a computer-aided diagnosis system for diagnosis of lung disorders, namely, bronchiectasis, tuberculosis, and pneumonia. An accuracy of 97.37 % has been achieved by the proposed approach whereas the conventional thresholding approach was unable to detect peripheral pathology-bearing regions. The results obtained prove to be better than that achieved using conventional thresholding and morphological operations.
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Smith BM, Austin JHM, Newell JD, D'Souza BM, Rozenshtein A, Hoffman EA, Ahmed F, Barr RG. Pulmonary emphysema subtypes on computed tomography: the MESA COPD study. Am J Med 2014; 127:94.e7-23. [PMID: 24384106 PMCID: PMC3882898 DOI: 10.1016/j.amjmed.2013.09.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/17/2013] [Accepted: 09/17/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary emphysema is divided into 3 major subtypes at autopsy: centrilobular, paraseptal, and panlobular emphysema. These subtypes can be defined by visual assessment on computed tomography (CT); however, clinical characteristics of emphysema subtypes on CT are not well defined. We developed a reliable approach to visual assessment of emphysema subtypes on CT and examined if emphysema subtypes have distinct characteristics. METHODS The Multi-Ethnic Study of Atherosclerosis COPD Study recruited smokers with chronic obstructive pulmonary disease (COPD) and controls ages 50-79 years with ≥ 10 pack-years. Participants underwent CT following a standardized protocol. Definitions of centrilobular, paraseptal, and panlobular emphysema were obtained by literature review. Six-minute walk distance and pulmonary function were performed following guidelines. RESULTS Twenty-seven percent of 318 smokers had emphysema on CT. Interrater reliability of emphysema subtype was substantial (K: 0.70). Compared with participants without emphysema, individuals with centrilobular or panlobular emphysema had greater dyspnea, reduced walk distance, greater hyperinflation, and lower diffusing capacity. In contrast, individuals with paraseptal emphysema were similar to controls, except for male predominance. Centrilobular, but not panlobular or paraseptal, emphysema was associated with greater smoking history (+21 pack-years P <.001). Panlobular, but not other types of emphysema, was associated with reduced body mass index (-5 kg/m(2); P = .01). Other than for dyspnea, these findings were independent of the forced expiratory volume in 1 second. Seventeen percent of smokers without COPD on spirometry had emphysema, which was independently associated with reduced walk distance. CONCLUSIONS Emphysema subtypes on CT are common in smokers with and without COPD. Centrilobular and panlobular emphysema, but not paraseptal emphysema, have considerable symptomatic and physiological consequences.
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Affiliation(s)
- Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - John H M Austin
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - John D Newell
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City
| | - Belinda M D'Souza
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Anna Rozenshtein
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Eric A Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City
| | - Firas Ahmed
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
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Koch B, Friedrich N, Völzke H, Jörres RA, Felix SB, Ewert R, Schäper C, Gläser S. Static lung volumes and airway resistance reference values in healthy adults. Respirology 2013; 18:170-8. [PMID: 23279785 DOI: 10.1111/j.1440-1843.2012.02268.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The assessment of static lung volumes and airway resistance is a frequently performed diagnostic procedure and considered as an important tool in medical surveillance to detect pulmonary diseases. The objectives of the study are to establish reference equations for body plethysmographic parameters in a representative adult population across a wide age range and to compare the normative values from this sample with previous ones. METHODS Body plethysmography was applied in 1809 participants (885 males) of a cross-sectional, population-based survey (Study of Health in Pomerania). Individuals with cardiopulmonary disorders and/or a pack-year smoking history >10 years and participants with a body mass index >30 kg/m(2) were excluded. In total, 686 healthy individuals (275 males) aged 25-85 years were assessed. RESULTS Prediction equations for both genders were established by quantile regression analysis taking into account the influence of age, height and weight. CONCLUSIONS The study provides a novel set of prediction equations for static lung volumes and airway resistance obtained using body plethysmography. Compared with our findings, existing equations underestimated some normal values. The results emphasize the need for up-to-date reference equations.
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Affiliation(s)
- Beate Koch
- Department of Internal Medicine B, Ernst-Moritz-Arndt University, Greifswald, Germany.
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Hueper K, Parikh M, Prince MR, Schoenfeld C, Liu C, Bluemke DA, Dashnaw SM, Goldstein TA, Hoffman E, Lima JA, Skrok J, Zheng J, Barr RG, Vogel-Claussen J. Quantitative and semiquantitative measures of regional pulmonary microvascular perfusion by magnetic resonance imaging and their relationships to global lung perfusion and lung diffusing capacity: the multiethnic study of atherosclerosis chronic obstructive pulmonary disease study. Invest Radiol 2013; 48:223-230. [PMID: 23385398 PMCID: PMC3952075 DOI: 10.1097/rli.0b013e318281057d] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the quantitative and semiquantitative measures of regional pulmonary parenchymal perfusion in patients with chronic obstructive pulmonary disease (COPD) in relationship to global lung perfusion (GLP) and lung diffusing capacity (DLCO). MATERIALS AND METHODS A total of 143 participants in the Multiethnic Study of Atherosclerosis COPD Study were examined by dynamic contrast-enhanced pulmonary perfusion magnetic resonance imaging (MRI) at 1.5 T. Pulmonary microvascular blood flow (PBF) was calculated on a pixel-by-pixel basis by using a dual-bolus technique and the Fermi function model. Semiquantitative parameters for regional pulmonary microvascular perfusion were calculated from signal intensity-time curves in the lung parenchyma. Intraoberserver and interobserver coefficients of variation (CVs) and correlations between quantitative and semiquantitative MRI parameters and with GLP and DLCO were determined. RESULTS Quantitative and semiquantitative parameters of pulmonary microvascular perfusion were reproducible, with CVs for all parameters of less than 10%. Furthermore, these MRI parameters were correlated with GLP and DLCO, and there was good agreement between PBF and GLP. Quantitative and semiquantitative MRI parameters were closely correlated (eg, r = 0.86 for maximum signal increase with PBF). In participants without COPD, the physiological distribution of pulmonary perfusion could be determined by regional MRI measurements. CONCLUSION Regional pulmonary microvascular perfusion can reliably be quantified from dynamic contrast-enhanced MRI. Magnetic resonance imaging-derived quantitative and semiquantitative perfusion measures correlate with GLP and DLCO.
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Affiliation(s)
- Katja Hueper
- Johns Hopkins University, Baltimore, MD
- Hannover Medical School, Hannover, Germany
| | - Megha Parikh
- Columbia University Medical Center, New York, NY
| | | | | | - Chia Liu
- Johns Hopkins University, Baltimore, MD
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | | | | | - Eric Hoffman
- University of Iowa Carver College of Medicine, Iowa City, IO
| | | | - Jan Skrok
- Johns Hopkins University, Baltimore, MD
| | - Jie Zheng
- Washington University School of Medicine, St Louis, Missouri
| | | | - Jens Vogel-Claussen
- Johns Hopkins University, Baltimore, MD
- Hannover Medical School, Hannover, Germany
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Garcia-Rio F, Dorgham A, Galera R, Casitas R, Martinez E, Alvarez-Sala R, Pino JM. Prediction Equations for Single-Breath Diffusing Capacity in Subjects Aged 65 to 85 Years. Chest 2012; 142:175-184. [DOI: 10.1378/chest.11-2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Løkke A, Marott JL, Mortensen J, Nordestgaard BG, Dahl M, Lange P. New Danish reference values for spirometry. CLINICAL RESPIRATORY JOURNAL 2012; 7:153-67. [DOI: 10.1111/j.1752-699x.2012.00297.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Pedone C, Scarlata S, Chiurco D, Conte ME, Forastiere F, Antonelli-Incalzi R. Association of Reduced Total Lung Capacity With Mortality and Use of Health Services. Chest 2012; 141:1025-1030. [DOI: 10.1378/chest.11-0899] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Scarlata S, Costanzo L, Giua R, Pedone C, Incalzi RA. Diagnosis and prognostic value of restrictive ventilatory disorders in the elderly: A systematic review of the literature. Exp Gerontol 2012; 47:281-9. [DOI: 10.1016/j.exger.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/09/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
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Eastwood PR, Maher TM, Wells AU, Lam B. Year in review 2009: Interstitial lung diseases, acute injury, sleep, physiology, imaging and bronchoscopic intervention. Respirology 2010; 15:172-81. [PMID: 20199638 DOI: 10.1111/j.1440-1843.2009.01696.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Peter R Eastwood
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, Western Australia 6009, Australia.
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