Effects of weight change and weight cycling on lung function in overweight and obese adults

Abstract: Rationale: Epidemiological studies have reported on the detrimental effects on lung function after natural, and thus limited, weight gain in unselected populations. Studies on bariatric surgery, on the contrary, have indicated large improvements in lung function after substantial weight loss. Objectives: To study the associations between profound weight loss or gain and pulmonary function within the same population. A second objective was to investigate the effect of weight cycling on pulmonary function. Methods: From our lung function database, we selected the records of subjects in follow-up for continuous positive airway pressure therapy for sleep apnea with a weight change of \u2a7e20 kg within 5\u2009years. Lung function (N\u2009=\u2009255) at baseline was normal except for a tendency toward mild restriction in morbid obesity. Within this sample, 73 subjects were identified with significant \u201cweight cycling\u201d, defined as a \u2a7e10-kg opposite change in body weight before or after the \u2a7e20-kg weight change. Results: Weight change affected pulmonary function more in men than in women (P\u2009<\u20090.001). In men, forced vital capacity (FVC) increased an average of 1.4% predicted per unit of body mass index after weight loss and the reverse after weight gain, whereas women exhibited a smaller change of 0.9% predicted per unit of body mass index. Weight loss slightly increased the ratio of forced expiratory volume in 1\u2009second to FVC and decreased the specific airway resistance, whereas the opposite occurred with weight gain. Greater effects of weight change on lung function were observed in leaner subjects (P\u2009=\u20090.02) and in older subjects (P\u2009<\u20090.002). Changes in total lung capacity followed the changes in FVC, with no change in residual volume, and the greatest change was observed in functional residual capacity. In subjects with weight cycling, the improvement in lung function due to weight loss was reversed by subsequent weight gain and vice versa. Conclusions: This study provides evidence that the detrimental effect of obesity on lung function is a passive and reversible process

Evaluation of the Global Lung Function Initiative reference equations in Belgian adults

BACKGROUND: Over the past decade, the Global Lung Function Initiative (GLI) Network has published all-age reference equations on spirometry, diffusing capacity of the lung for carbon monoxide (D(LCO)) and lung volumes. METHODS: We evaluated the appropriateness of these equations in an adult Caucasian population. Retrospective lung function data on subjects who performed tests prior to a diagnostic sleep investigation were analysed. From the medical records, lung healthy, lifetime nonsmoking, nonobese subjects were selected, resulting in a population of 1311 subjects (68% male; age range 18–88 years). RESULTS: Multiple linear regression analysis revealed that lung function z-scores did not differ between subjects with and without sleep apnoea but did depend on height and age. The average forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) z-score was 0 but exhibited an inverse association with height in both sexes (p<0.01). Values of FEV(1) and FVC in both sexes were larger than predicted (mean±sd z-score +0.30±0.96 or 104±13% pred; p<0.01). Overall, static lung volumes and D(LCO) were adequately predicted. However, D(LCO) z-scores were inversely associated with height in males and age in females (p<0.01). For all lung function indices, the observed scatter was reduced compared with the prediction. Therefore, for all indices <5% of the data were below the GLI-proposed lower limit of normal (LLN) threshold. CONCLUSION: GLI reference equations provide an adequate fit in Belgian adults. However, the GLI-proposed LLN is too low for our Antwerp population, resulting in underdiagnosis of disease. Furthermore, airway obstruction and diffusion disorders might be misclassified due to height and age associations

Evaluation of the global lung function initiative reference equations in Belgian adults

Background Over the past decade, the Global Lung Function Initiative (GLI) Network has published all-age reference equations on spirometry, diffusing capacity of the lung for carbon monoxide (DLCO) and lung volumes. Methods We evaluated the appropriateness of these equations in an adult Caucasian population. Retrospective lung function data on subjects who performed tests prior to a diagnostic sleep investigation were analysed. From the medical records, lung healthy, lifetime nonsmoking, nonobese subjects were selected, resulting in a population of 1311 subjects (68% male; age range 18-88 years). Results Multiple linear regression analysis revealed that lung function z-scores did not differ between subjects with and without sleep apnoea but did depend on height and age. The average forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) z-score was 0 but exhibited an inverse association with height in both sexes (p<0.01). Values of FEV1 and FVC in both sexes were larger than predicted (mean +/- SD z-score +0.30 +/- 0.96 or 104 +/- 13% pred; p<0.01). Overall, static lung volumes and DLCO were adequately predicted. However, DLCO z-scores were inversely associated with height in males and age in females (p<0.01). For all lung function indices, the observed scatter was reduced compared with the prediction. Therefore, for all indices <5% of the data were below the GLI-proposed lower limit of normal (LLN) threshold. Conclusion GLI reference equations provide an adequate fit in Belgian adults. However, the GLI-proposed LLN is too low for our Antwerp population, resulting in underdiagnosis of disease. Furthermore, airway obstruction and diffusion disorders might be misclassified due to height and age associations

Evaluation of the learning effect on the six-minute walk distance in adults with long COVID

Abstract: There was no learning effect found on six-minute walk distance (6MWD) in patients with long COVID, performing a six-minute walk test twice. However, considerable variation in the difference between the two 6MWDs was observed: only 51% showed an increas

Randomised, controlled, open-label pragmatic trial evaluating changes in functional exercise capacity after primary care PUlmonary REhabilitation in patients with long COVID: protocol of the PuRe-COVID trial in Belgium

Introduction Long COVID is a prevalent condition with many multisystemic symptoms, such as fatigue, dyspnoea, muscle weakness, anxiety, depression and sleep difficulties, impacting daily life and (social and physical) functioning. Pulmonary rehabilitation (PR) may improve physical status and symptoms of patients with long COVID, yet the evidence is limited. Therefore, this trial aims to study the effect of primary care PR on exercise capacity, symptoms, physical activity and sleep in patients with long COVID.Methods and analysis PuRe-COVID is a prospective, pragmatic, open-label, randomised controlled trial. A sample of 134 adult patients with long COVID will be randomised to a 12 week PR programme in primary care, supervised by a physiotherapist or to a control group, following no PR. A 3 month and 6 month follow-up period is foreseen. The primary endpoint will be the change in exercise capacity measured by 6-minute walk distance (6MWD) at 12 weeks, hypothesising a more significant improvement in the PR group. Other parameters, such as pulmonary function tests (including maximal inspiratory pressure/maximal expiratory pressure), patient-reported outcomes (COPD Assessment Test, modified Medical Research Council Dyspnoea Scale, Checklist Individual Strength, post-COVID-19 Functional Status, Nijmegen questionnaire, Hospital Anxiety and Depression Scale, Work Productivity and Activity Impairment Questionnaire and EuroQol-5D-5L), physical activity measured by an activity tracker, hand grip strength and sleep efficiency, are secondary and exploratory outcomes.The recruitment started on 19 April 2022, and 52 patients were included as of 14 December 2022.Ethics and dissemination Ethical approval was obtained in Belgium from the relevant institutional review boards on 21 February 2022 (Antwerp University Hospital, approval number 2022-3067) and on 1 April 2022 (Ziekenhuis Oost-Limburg in Genk, approval number Z-2022-01). Findings from this randomised controlled trial will be disseminated in peer-reviewed publications and presentations at international scientific meetings.Trial registration number NCT05244044

Early Career Members at the ERS International Congress 2017 : highlights from the Assemblies.

The 2017 ERS International Congress was, as always, well organised, providing participants with a good mixture of translational and clinical science. Early career members were very well represented in thematic poster, poster discussion and oral presentation sessions and were also actively involved in chairing sessions. The efforts of the Early Career Members Committee (ECMC) to increase the number of early career members included in the competence list (the list of early career members with an interest in being more actively involved in the society) paid off immensely, because the number of early career members registered improved hugely across all assemblies after the Congress. Several newly registered early career members have collated some highlights of the Congress for their assemblies, which should be of interest to all members. As assemblies 12 and 13 are new, there is no report from assembly 12 as there is not yet, at the time of writing, an early career member representative for this newly created assembly