IEEE J Biomed Health Inform

Measurement of partial expiratory flow-volume curves has become an important technique in diagnosing lung disease, particularly in children and in the elderly. The objective of this study was to investigate the feasibility of predicting abnormal spirometry using the partial flow-volume curve generated during a voluntary cough. Here, abnormal spirometry is defined as less than the lower limit of normal (LLN) predicted by standard reference equations [1]. Cough airflow signals of 107 subjects (56 male, 51 female) were previously collected [2] from patients performing spirometry in a pulmonary function clinic. A variety of features were extracted from the airflow signal. A support vector machine (SVM) classifier was developed to predict abnormal spirometry. Airflow signal features and SVM parameters were selected using a genetic algorithm. The ability of the classifier to distinguish between normal and abnormal spirometry based on cough flow was evaluated by comparing the classifiers decisions with the LLN for the given subject's spirometry, including forced expiratory volume in one second (FEV1), forced vital capacity (FV C), and their ratio (FEV1=FV C%). Findings indicated that it was possible to classify patients whose spirometry results were less than the LLN with an overall accuracy of 76% for FEV1, 65% for FV C, and 76% for the ratio FEV1=FV C%. Accuracies were determined by repeated double cross-validation [3]. This study demonstrates the potential of using airflow measured during voluntary coughing to identify test subjects with abnormal spirometry.CC999999/ImCDC/Intramural CDC HHS/United States2016-09-13T00:00:00Z25781965PMC4860154vault:1708

Prediction of post-tuberculosis lung damage using CT lung imaging measures among adults in Malawi

The burden of tuberculosis (TB) is high globally and in sub-Saharan Africa (SSA). Although TB treatment regimens are now widely available, and with high success rates in most parts of the world, TB can lead to long-term health consequences. Evidence has shown that completion of TB treatment can mark the beginning of chronic lung damage and other sequelae. There is a need for early identification of individuals at risk of post-tuberculosis lung damage (PTLD) to necessitate its appropriate management. This study evaluated the significance of radiological features from computed tomography (CT) scan in describing PTLD patterns at treatment completion and predicting PTLD outcomes at 12 months post treatment, as a possible tool to detect risk of PTLD at an early stage. This thesis comprises three parts. Part A is the study protocol, which outlines the purpose, methods and ethical considerations of the proposed study. Part B is the literature review, which summarizes the existing literature on PTLD, the risk factors for PTLD, and the relationship between imaging data and PTLD. The objective of the literature review was to identify gaps in literature which would provide context for further research. Part C is the journal-ready manuscript, which provides the results of the conducted study and a discussion on the implication of these results. The results of the study showed that CT imaging features were important in determining concurrent abnormal spirometry at baseline in post-TB individuals. These features were not useful in predicting spirometry outcomes at 12 months after treatment completion. However, there is need for further validation of these results in other settings and the consideration of other lung damage outcomes

Effect on smoking quit rate of telling patients their lung age: the Step2quit randomised controlled trial

Objective To evaluate the impact of telling patients their estimated spirometric lung age as an incentive to quit smoking.Design Randomised controlled trial.Setting Five general practices in Hertfordshire, England.Participants 561 current smokers aged over 35.Intervention All participants were offered spirometric assessment of lung function. Participants in intervention group received their results in terms of "lung age" (the age of the average healthy individual who would perform similar to them on spirometry). Those in the control group received a raw figure for forced expiratory volume at one second (FEV1). Both groups were advised to quit and offered referral to local NHS smoking cessation services.Main outcome measures The primary outcome measure was verified cessation of smoking by salivary cotinine testing 12 months after recruitment. Secondary outcomes were reported changes in daily consumption of cigarettes and identification of new diagnoses of chronic obstructive lung disease.Results Follow-up was 89%. Independently verified quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4% (difference 7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%; number needed to treat 14). People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group. Cost per successful quitter was estimated at 280 pound ((euro) 365, $556). A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group; a total of 16% (89/561) of participants.Conclusion Telling smokers their lung age significantly improves the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.Trial registration National Research Register N0096173751

European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years.

Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.A Task Force (TF) supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.The TF then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The TF formulated recommendations using the GRADE Evidence to Decision framework.Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future

Respiratory symptoms and chronic obstructive pulmonary disease : prevalence and risk factors in a predominantly low-income urban area of Cape Town, South Africa

Includes bibliographical references.The continuing worldwide increase in the incidence of chronic obstructive pulmonary disease (COPD) has led to international initiatives to improve surveillance and identify preventable risk factors for this and related chronic lung diseases. The studies reported here aimed to examine the prevalence and risk factors for respiratory symptoms and COPD; to introduce and test surveillance methodologies; and to inform treatment and control measures for this disease. The Lung Health Survey 2002 sampled 3512 individuals aged ≥ 15 years from an urban population of 36,334 in the predominantly low-income area of Ravensmead and Uitsig, Cape Town, South Africa. Information on respiratory symptoms, risk factors and healthcare utilisation was collected using a respiratory questionnaire which included questions that had been validated elsewhere. In 2005, a subsample of 960 persons aged ≥ 40 years participated in the Burden of Obstructive Lung Disease (BOLD) study comprised of a questionnaire and pre and postbronchodilator spirometry, in order to assess the prevalence of COPD. A high prevalence of respiratory symptoms of 38.3% was reported. Tobacco smoking showed a consistent positive association with chronic bronchitis, wheeze, dyspnoea and cough. Strong associations with cannabis smoking, pulmonary tuberculosis, occupational exposures and low socioeconomic status were found. The association of cannabis smoking with respiratory symptoms suggest that it may be a risk factor for COPD. The BOLD study revealed an exceptionally high prevalence of COPD in both men and women aged 40 years and older (29% and 20%, respectively) reflecting the very high prevalence of smoking in both sexes in the test area. The majority of those affected had moderate to severe disease, that is, symptoms with spirometric impairment (GOLD Stage II and higher). Even non-smoking women had a comparatively high prevalence of CO PO (12.6%), attributable to other risk factors such as tuberculosis and occupational exposures. Previous pulmonary tuberculosis was shown to be a strong predictor of COPD, which warrants further study. Review of healthcare utilisation confirmed significant under-recognition and under-treatment within local health services. These results confirm the need to prioritise preventative and treatment strategies for obstructive lung disease in South Africa

Design and Development of Low cost spirometer with pc Interface

The primary test of lung function is called Spirometry. Spirometry parameters are derived from pressure and/or flow measurements. The spirometer records exhaled air volume, and produces graphic and numeric information in the form of spirometric parameters and tracings that can depict and describe the mechanical properties of the lung. Some possible measurements are like Pressure and gas flows behave during one respiratory cycle in volume controlled. Patient Spirometry measures airway pressures, flow, volumes, compliance, and airway resistance breath-by-breath at the patient’s airway. The flow of gas is measured, and the inspiratory and expiratory concentrations of oxygen and carbon dioxide analyzed. All parameters are measured through a single, lightweight flow sensor and gas sampler, placed at the patient’s airway. The “close to the patient” measurement is a sensitive and continuous reflector of patient’s ventilator status, obtained independently of the ventilator used. The breath-by-breath measurement of pulmonary gas exchange is technically very demanding and requires sophisticated compensation and data processing algorithms to achieve the accuracy required in the clinical use. Measurement of respiratory gas flow continuously is associated with several problems, such as the effects of humidity, alternating gas composition, secretions, and the dynamic response of the flow sensors. Medical technologies have enabled accurate measurement of respiratory gas exchange in a wide variety of clinical conditions. The clinical applications range from assessment of energy requirements to comprehensive analysis of ventilation and oxygen transport in patients with complex cardio respiratory problems. Obstructive disorders, which are much more common than restrictive abnormalities include asthma and COPD. Asthmatic bronchitis, chronic bronchitis, and emphysema are included in COPD. These diseases can be identified by a low FEV / FVC ratio or an FEV that is lower than predicted. Spirometric data have been presented as exhaled volume over time. These volume-time curves are easy to visualize and allow physicians to identify FEV, FVC, and expiratory time at a glance. The flow transducer permits physicians to visualize peak flow and timed peak flow. Which is a check of patients’ efforts FEV, FVC, and FEV, FVC ratio are expressed in terms of lower limit of normal. Here the FEV1/FVC ratio is about the same as (i.e., 57% vs. 59%), but the absolute FEV, is only 66% of predicted. Spirometric measurements can be as fundamental to medicine as are pulse, blood pressure. Temperature, height and weight measurements and therefore could be considered in the physical examination as important vital signs

Assessment and control of respirable crystalline silica in quarries and dimension stone mines

The health risk of breathing very fine particles of respirable crystalline silica (RCS) dust, resulting in poor lung health is not well defined in Australia, even though many hundreds of thousands of workers are exposed to uncontrolled dusty activities daily. It is now clear from international studies that lung health of workers continues to be affected at relatively low exposures to RCS, even at occupational exposure limits (OEL) including the current Safe Work Australia Exposure Standard (SWA-ES). This has prompted the United States to reduce their permissible exposure limit (PEL) to one half of the Australian SWA-ES, to 0.05 mg/m3, and challenges the adequacy of the current Australian SWA-ES, which is 0.1 mg/m3. In terms of numbers of workers affected, the mining industry employs approximately 267,000 workers, which is 2.3 percent of the total workforce, and accounts for about 10.2 % of Australia’s Gross Domestic Product (GDP). Approximately 55,000 workers are employed in Queensland mining, many of whom work in quarries and dimension stone mines where exposure to RCS is known to be elevated. A recent assessment estimated that about 440,000 deaths from cancer attributable to RCS exposure will occur throughout Europe from 2010 to 2069. Unless exposure to RCS is well controlled, many hundreds of thousands of lives will also be cut short from silicosis and chronic obstructive pulmonary disease (COPD). As the weight of evidence grows in Australia, the disease risks attributable to RCS will increasingly become more obvious. This study evaluated the health risk from exposure to RCS for 47 quarry and dimension stone mine workers throughout Queensland, Australia. Personal exposures to RCS were measured across a range of exposures, and lung function testing was carried out in parallel. Findings revealed that about one in four workers were exposed to RCS above the SWA-ES, and more than one in ten were being exposed at a concentration of more than twice this limit. A major finding for those workers exposed to RCS at the SWA-ES was loss of lung function greater than 20%. The increased loss of lung function was positively correlated with jobs associated with increased RCS exposure. When similar exposure groups were combined into three RCS exposure ranges categorised as high (≥ 0.09 - ≤ 0.20 mg/m3), medium (≥ 0.04 - ≤ 0.08 mg/m3) and low (< 0.04 mg/m3), analysis of variance (ANOVA) confirmed that the loss of lung function below the lower limit of normal (LLN) at the current SWA-ES, is significant (p < 0.05). Abnormal lung function patterns were also more pronounced for smokers who were exposed to RCS ≥ 0.04 mg/m3 and not as obvious for smokers exposed to RCS < 0.04 mg/m3. This demonstrated that both smoking and RCS had a combined impact resulting in poor lung health. In this study, vehicles fitted with standard heating, ventilation and air-conditioning systems (HVAC) were tested for ingress of respirable dust into the operator’s cabin, and compared with more recent technology. Evaluation of the effectiveness of newer technology, a RESPA® pre-cleaner, filter and pressurization (PFP) unit, demonstrated up to a four-fold reduction in RCS entering the cabin, when compared with standard air-conditioning systems. Electron microscopy (EM) was used to describe the physical characteristics of respirable silica and dust particles collected on respirable sample filters previously analysed for silica by infrared spectroscopy. Data revealed that silica particles were generally less than 5 μm in physical diameter and many particles were elongated. These smaller particles are known to be most hazardous to lung health. Findings also demonstrated that larger length elongated particles were collected by the cyclone sampler, which influenced the particle size distribution curve. There was a good fit between the physical cumulative silica particle size distribution, representing particle counts for selected workplace samples, when plotted against the theoretical AS2985-2009 (density dependent) Equivalent Aerodynamic Diameter (EAD) sampling efficiency curve. This means that density is not the only factor for particle capture in the cyclone sampler. These silica particles do not behave as perfect spheres, which is the premise underpinning the International Organization for Standardization (ISO) 7708-1995, sampling efficiency curve and AS2985-2009, adopted by the Australian Standard for sampling respirable dust. The science for these standards is based on information that is at least twenty years old, and results from the current study confirmed that particle shape must be considered in the sampling efficiency curve and lung health risk assessment. An unexpected finding from analysis of RCS dust by EM was the identification of fibrous mineral particles in several samples, with both morphology and elemental composition similar to erionite. Erionite is known to cause mesothelioma, which is typically associated with asbestos when inhaled at high enough concentrations. Further investigation and characterization of respirable dusts at mining sites where erionite is a potential contaminant is recommended. Confirmation of the presence and extent of erionite, and further characterization of exposure will assist in determining the extent of health risk to quarry and dimension stone mine workers in Queensland and elsewhere. Overall, the findings from this study challenge the adequacy of RCS health risk assessment standards in Australia. In addition, typical operator cabin air-conditioning technology will not reduce exposure to RCS where silica is present in dusty workplaces. The study also demonstrates the importance of health surveillance, to identify gaps, raise awareness about primary prevention, and drive timely intervention

Study of Pulmonary Function Tests in Cardiac patients

INTRODUCTION: Coronary artery heart disease and rheumatic heart disease are among the most common causes of morbidity and mortality in India. These two diseases are the most common causes of cardiac failure. Patients with these diseases should have regular follow-up with doctors. Impaired pulmonary function is common in cardiac patients. Respiratory muscle wasting has been well documented in Rheumatic Heart Disease patients. But Pulmonary Function Test is the least common test that is undergone by the patients. This current study is aimed to assess the Pulmonary Function of cardiac patients with coronary artery heart disease and rheumatic heart disease who have recovered from cardiac failure. AIMS AND OBJECTIVES: 1. To study the Pulmonary Function Test patterns in patients with coronary artery heart disease and Rheumatic Heart Disease who have revived from Cardiac Failure. 2. To diagnose any underlying undiagnosed respiratory problem coexisting with cardiac failure. MATERIALS AND METHODS: This study is a observational study conducted in Department of Medicine, Tirunelveli Medical College Hospital. Seventy five patients admitted in TVMCH from MAY 2014 to MAY 2015 will participate in the study. The volunteer patients who met the inclusion criteria, signed a consent form after they got a clear explanation of the spirometry evaluation procedures. Inclusion Criteria: 1. Adult patients with Rheumatic Heart Disease (Male and Female). 2. Coronary artery heart disease patients less than 60 years of age (Male and Female). Exclusion Criteria: 1. Pediatric patients less than 12 years of age and Adult patients more than 60 years of age. 2. Rheumatic Heart disease patients with known respiratory disease (COPD, Bronchial Asthma, Pulmonary Tuberculosis) 3. CAHD patients with known respiratory disease (COPD, Bronchial Asthma, Pulmonary Tuberculosis) Morbid and sick patients. 4. Severe Left Ventricular Dysfunction patients as per ECHO report. Data Collection: 1. Detailed medical history and physical examination is done. 2. Basic Laboratory investigations such as complete blood count, RFT and Urine analysis done. 3. ECG, 4. X-Ray Chest PA view, 5. Echocardiogram, 6. Spirometry test. SPIROMETER: The spirometry is performed using a device called a spirometer, which comes in several different varieties. Most spirometers display the following graphs, called spirograms: 1. A volume-time curve, showing volume (liters) along the Y-axis and time (seconds) along the X-axis 2. A flow-volume loop, which graphically depicts the rate of airflow on the Y-axis and the total volume inspired or expired on the X-axis PROCEDURE: The basic forced volume vital capacity (FVC) test varies slighty depending on the equipment used. Generally, the patient is asked to take the deepest breath they can, and then exhale into the sensors hard as possible, for as long as possible, preferably at least 6 seconds. It is sometimes directly followed by a rapid inhalation (inspiration), in particular when assessing possible upper airway obstruction. Sometimes, the test will be preceded by a period of quiet breathing in and out from the sensor (tidal volume) or the rapid breath in (forced inspiratory part) will come before the forced exhalation. During the test, soft nose clips may be used to prevent air escaping through the nose. Filter mouthpieces may be used to prevent the spread of microorganisms. DISCUSSION: This study “study of pulmonary function tests in cardiac patients” is an observational study done on 75 patients revived from cardiac failure. The parameters studied were forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and ratio of FEV1/FEV. Among the studied patients, 52% had normal pattern of pulmonary function test, 32% had restrictive pattern and 16% had obstructive pattern. Both males and females had similar type of distribution of pulmonary function test pattern. Compared to cardiac failure patients with coronary artery disease, patients with rheumatic heart disease had lower proportion of patients with normal pulmonary function test pattern. The prevalence of restrictive pattern of pulmonary function test was more in those with rheumatic heart disease than those with coronary artery heart disease. The prevalence of obstructive pattern was more in patients with left ventricular ejection fraction of less than 50% CONCLUSION: The presence of impaired pulmonary function tests in cardiac failure patients has been already demonstrated in various studies. This study concludes that more than half of the cardiac failure patients had normal pulmonary function pattern. In those who had abnormal pulmonary function pattern, incidence of restrictive pattern was more than that of obstrictive pattern. The prevalence of restrictive pattern of pulmonary function test was more in patients with rheumatic heart disease than coronary artery disease patients. As LV ejection fraction of patients with cardiac failure decreased there is a higher incidence of obstructive pattern of pulmonary function test