Prevalence of abnormal findings when adopting new national and international Global Lung Function Initiative reference values for spirometry in the Finnish general population

Peer reviewe

Allergic rhinoconjunctivitis doubles the risk for incident asthma – Results from a population study in Helsinki, Finland

SummaryObjectiveTo examine the incidence of allergic rhinoconjunctivitis and asthma, and to assess allergic rhinoconjunctivitis as a risk factor for incident asthma, we performed a 11-year follow-up postal survey.MethodsThe original study population was a random population sample of 8000 inhabitants of Helsinki aged 20–69 years in 1996. Participants in the first postal questionnaire survey, 6062 subjects, were invited to this follow-up study, and provided 4302 (78%) answers out of 5484 traced subjects in 2007.ResultsCumulative incidence of asthma from 1996 to 2007 was 4.0% corresponding to an annual incidence rate of 3.7/1000/year. After exclusion of those with asthma medication or physician-diagnosed chronic bronchitis or COPD at baseline in 1996, the cumulative incidence decreased to 3.5% (incidence rate 3.2/1000/year), and further to 2.7% (2.5/1000/year) when also those reporting recurrent wheeze or shortness of breath during the last year in 1996 were omitted from the population at risk. Remission of asthma occurred in 43 subjects and was 16.9% over 11 years. Cumulative 11-year incidence of allergic rhinoconjunctivitis was 16.9% corresponding to 16.8/1000/year, and cumulative remission was 18.1%. Incidence of allergic rhinoconjunctivitis was significantly lower among those who had lived in the countryside or on a farm during the first 5 years of life, but this was not true for asthma. In multivariate analysis, farm living during the first 5 years of life was protective for the development of allergic rhinoconjunctivitis, OR 0.75 (95%CI 0.57–0.99). Allergic rhinoconjunctivitis was a significant independent risk factor for incident asthma, OR 2.15 (95%CI 1.54–3.02). In the cohort, the prevalence of rhinoconjunctivitis increased from 38.0% in 1996 to 40.9% in 2007, physician-diagnosed asthma from 6.8% to 9.4%, while current smoking decreased from 31.3% to 23.3%.ConclusionIncidence of allergic rhinoconjunctivitis was higher than in earlier studies, while asthma incidence remained on similar level, both being significantly higher in women. Allergic rhinoconjunctivitis doubled the risk for incident asthma

Spirometrian suorittaminen ja tulkinta : uudet suomalaiset ja monikansalliset viitearvot käyttöön - Suomen Kliinisen Fysiologian yhdistyksen ja Suomen Keuhkolääkäriyhdistyksen suositus 2015

•Hil­jattain on jul­kaistu uu­det suoma­laiset ai­kuisten spi­ro­metrian vii­tearvot, joi­den mit­taukset kat­tavat myös vanhus­väestön 84 vuo­den ikään as­ti. •Uu­sien ar­vojen tulkin­nassa otetaan käyt­töön mi­tatun ar­von poik­keaman mää­rä viitear­vo­po­pu­laation ­kes­kiar­vosta z-yksik­köinä (sama kuin SD). Muu­toksen vaikeu­saste ar­vioidaan z-ar­von mu­kaan. •Nor­maalin va­riaation ala­raja on klii­ni­sissä tutki­muk­sissa kai­kille spi­ro­met­ria­muut­tu­jille sa­ma (z-ar­vona –1,65). Ter­veistä 95 % asettuu tä­män ra­jan ylä­puo­lelle. •Syn­ty­pe­rältään ulko­maa­laisten las­ten ja ai­kuisten tutki­muk­sissa suosi­tellaan käytet­tä­väksi uu­sia kansain­vä­lisiä GLI2012-vii­tear­voja. •Suo­ma­laisten las­ten tutki­muk­sissa suosi­tellaan käytet­tä­väksi edelleen van­hoja suoma­laisia viitear­voja, mut­ta nii­den klii­ni­sessä sovel­ta­mi­sessa suosi­tellaan nyt z-ar­vojen käyt­töä. •Ai­kuisten van­hat suoma­laiset vii­tearvot ei­vät ole perus­tuneet todel­lisiin mittaus­tu­loksiin yli 64-vuo­tiailla. Van­hojen ar­vojen käyt­tö on aiheut­tanut toden­nä­köi­sesti hengi­tys­tieobst­ruktion yli­diag­nos­tiikkaa vanhem­missa ikä­ryh­missä.Peer reviewe

Association of breathing sound spectra with glottal dimensions in exercise-induced vocal cord dysfunction

The objective of this study was to evaluate associations between the breathing sound spectra and glottal dimensions in exercise-induced vocal cord dysfunction (EIVCD) during a bicycle ergometry test. Nineteen subjects (mean age 21.8 years and range 13-39 years) with suspected EIVCD were studied. Vocal folds were continuously imaged with videolaryngoscopy and breathing sounds were recorded during the bicycle exercise test. Twelve subjects showed paradoxical movement of the vocal folds during inspiration by the end of the exercise. In seven subjects, no abnormal reactions in vocal folds were found; they served as control subjects. The glottal quotient (interarytenoid distance divided by the anteroposterior glottal distance) was calculated. From the same time period, the tracheal-vocal tract resonance peaks of the breathing sound spectra were analyzed, and stridor sounds were detected and measured. Subjects with EIVCD showed significantly higher resonance peaks during the inspiratory phase compared to the expiratory phase (p <0.014). The glottal quotient decreased significantly in the EIVCD group (p <0.001), but not in the control group. 8 out of 12 EIVCD patients (67%) showed stridor sounds, while none of the controls did. There was a significant inverse correlation between the frequencies of the breathing sound resonance peaks and the glottal quotient. The findings indicate that the typical EIVCD reaction of a paradoxical approximation of the vocal folds during inspiration, measured here as a decrease in the glottal quotient, is significantly associated with an increase in inspiratory resonance peaks. The findings are applicable in the documentation of EIVCD findings using videolaryngoscopy, in addition to giving clinicians tools for EIVCD recognition. However, the study is limited by the small number of subjects.Peer reviewe

Hengitystyö lihavuudessa mitattuna kehopletysmografilla, vertailu emfysemaattiseen COPD:hen ja keuhkofibroosiin.

Objectives. Body plethysmography is a lung function testing method usually applied for determination of thoracic gas volume and airways resistance, but option to measure work of breathing is available in most models. Although the method has been known over fifty years, assessment of work of breathing with it has not yet systematically studied in obesity. The aim of the study was to evaluate the relevance of work of breathing measured by body plethysmography in obese subjects and to compare the results with those of healthy controls and patients with pulmonary diseases of different pulmonary mechanics. Methods. Altogether sixty-two adults were studied prospectively: healthy non-smoking obese subjects (BMI >30, N=15), patients with interstitial lung disease (ILD) (N=15), emphysematic COPD (emphysema) (N=16) and healthy non-smoking controls (controls) (N=16). Inspiratory, expiratory and total work of breathing (WOBin, WOBex and WOB) and specific work of breathing (sWOBin, sWOBex and sWOB) were measured. Results. In obese subjects, WOB, WOBin (p<0.001) and WOBex (p=0.002) were elevated in comparison to controls. Also in ILD, WOB was significantly higher than in controls (p< 0.006). sWOBin, sWOBex and SWOB were significantly higher in emphysema than in the controls (p< 0.001). Conclusions. In obesity and ILD WOB whereas in emphysematic COPD sWOB differed significantly from controls, which is caused by differences in lung mechanics and lung volumes. The results concerning COPD correspond earlier study, but the present results suggest that body plethysmography is suitable for the assessment of work of breathing also in obesity.Peer reviewe

Smartphone-Based Self-Testing of COVID-19 Using Breathing Sounds

Telemedicine could be a key to control the world-wide disruptive and spreading novel coronavirus disease (COVID-19) pandemic. The COVID-19 virus directly targets the lungs, leading to pneumonia-like symptoms and shortness of breath with life-threatening consequences. Despite the fact that self-quarantine and social distancing are indispensable during the pandemic, the procedure for testing COVID-19 contraction is conventionally available through nasal swabs, saliva test kits, and blood work at healthcare settings. Therefore, devising personalized self-testing kits for COVID-19 virus and other similar viruses is heavily admired. Many e-health initiatives have been made possible by the advent of smartphones with embedded software, hardware, high-performance computing, and connectivity capabilities. A careful review of breathing sounds and their implications in identifying breathing complications suggests that the breathing sounds of COVID-19 contracted users may reveal certain acoustic signal patterns, which is worth investigating. To this end, acquiring respiratory data solely from breathing sounds fed to the smartphone's microphone strikes as a very appealing resolution. The acquired breathing sounds can be analyzed using advanced signal processing and analysis in tandem with new deep/machine learning and pattern recognition techniques to separate the breathing phases, estimate the lung volume, oxygenation, and to further classify the breathing data input into healthy or unhealthy cases. The ideas presented have the potential to be deployed as self-test breathing monitoring apps for the ongoing global COVID-19 pandemic, where users can check their breathing sound pattern frequently through the app.http://doi.org.libproxy.bridgeport.edu/10.1089/tmj.2020.011

Quantitative Imaging of Regional Aerosol Deposition, Lung Ventilation and Morphology by Synchrotron Radiation CT

To understand the determinants of inhaled aerosol particle distribution and targeting in the lung, knowledge of regional deposition, lung morphology and regional ventilation, is crucial. No single imaging modality allows the acquisition of all such data together. Here we assessed the feasibility of dual-energy synchrotron radiation imaging to this end in anesthetized rabbits; both in normal lung (n = 6) and following methacholine (MCH)-induced bronchoconstriction (n = 6), a model of asthma. We used K-edge subtraction CT (KES) imaging to quantitatively map the regional deposition of iodine-containing aerosol particles. Morphological and regional ventilation images were obtained, followed by quantitative regional iodine deposition maps, after 5 and 10 minutes of aerosol administration. Iodine deposition was markedly inhomogeneous both in normal lung and after induced bronchoconstrition. Deposition was significantly reduced in the MCH group at both time points, with a strong dependency on inspiratory flow in both conditions (R-2 = 0.71; p <0.0001). We demonstrate for the first time, the feasibility of KES CT for quantitative imaging of lung deposition of aerosol particles, regional ventilation and morphology. Since these are among the main factors determining lung aerosol deposition, we expect this imaging approach to bring new contributions to the understanding of lung aerosol delivery, targeting, and ultimately biological efficacy.Peer reviewe

Computerized respiratory sound analysis in people with dementia: a first-step towards diagnosis and monitoring of respiratory conditions

Computerized respiratory sound analysis has been shown to be an objective and reliable way to assess respiratory diseases. However, its application in non-collaborative populations, such as people with dementia, is still unknown. Therefore this study aimed to characterize normal and adventitious respiratory sounds (NRS; ARS) in older people with and without dementia. A cross-sectional study including two groups of 30 subjects with dementia and 30 subjects without dementia was performed. Digital auscultation was used to record NRS and ARS per breathing-phase (inspiration/expiration) at trachea and thorax. Frequency at percentiles 25, 50 and 75, frequency at maximum-intensity, maximum-intensity (I max) and mean-intensity (I mean) characterized NRS. Crackle number, frequency, initial-deflection-width, 2cycle-duration, and largest-deflection-width and wheeze number, frequency and occupation-rate characterized ARS. Groups were similar in socio-demographics, except for anthropometrics. No significant differences were found between groups in NRS frequency or ARS at trachea or thorax. Significant lower I max (inspiration: 36.88(29.42;39.92) versus 39.84(36.50;44.17) p  =  0.007; expiration: 34.51(32.06;38.87) versus 42.33(36.92;44.98) p  <  0.001) and I mean (inspiration: 15.23(12.08;18.60) versus 18.93(15.64;21.82) p  =  0.003 and expiration: 14.57(12.08;18.30) versus 18.87(15.64;21.44) p  =  0.001) at trachea and higher I mean (inspiration: 17.29(16.04;19.31) versus 16.45(15.05; 18.79) p  =  0.005 and expiration: 16.71(15.31;18.56) versus 16.38(14.40;17.85) p  =  0.011) at thorax were found in subjects with dementia when compared with subjects without dementia. To conclude, people with and without dementia had similar NRS and ARS characteristics, except for NRS intensity. Computerized respiratory sound analysis was feasible in a non-collaborative population. Further research is needed to enhance the use of respiratory acoustics in non-collaborative populations, with strong potential to be applied in different settings for diagnosis and monitoring purposes