BACKGROUND: Recently, cardiopulmonary exercise testing (CPX) has become a popular diagnostic method for differentiating the main cause of exertional dyspnea or exercise limitation. We evaluated the difference in the CPX results according to interpretative algorithms and the methods of exercise in Korea. METHOD: Sixty-six patients with chronic lung disease and 48 adults with dyspneic symptoms, but with no abnormalities in a spirometry performed symptom limited CPX, were included in this study. The results were interpreted using both Wasserman's(WA) and Eschenbacher's algorithm (EA), and a comparison between both algorithms was made. Thirty-three healthy medical students performed the CPX with a cycle ergometer and treadmill. The results were interpreted with EA and the concurrenec in interpretations was evaluated according to the methods of exercise. RESULTS: 1. In patients with chronic lung disease, the overall concordance rate between the two algorithms was 63.6%. The concordance rates were 69.8% in patients with obstructive, 25.0% in those with restrictive, and 66.7% in those with mixed pulmonary insufficiency. In patients with dyspneic symptoms but normal findings in resting spirometry, the concordance rate was 60.4%. 2. In healthy medical students, in results interpreted with EA, the concordance rate between the cycle ergometer and treadmill exercise was 25.0%. CONCLUSION: Both interpretative algorithms and methods of exercise may affect the CPX results. In using CPX as a diagnostic test for the causes of dyspnea in the Korean population, the interpretative algorithms and method of exercise need to be standardized, and a predictive VO2max equation needs to be established.
Adult ; Diagnostic Tests, Routine ; Dyspnea ; Exercise Test* ; Humans ; Korea ; Lung Diseases ; Methods* ; Spirometry ; Students, Medical

OBJECTIVETo study the accuracy of position estimation of right-sided double-lumen endobronchial tubes (DLTs) without carinal hook in elderly patients according to the changes of inspiratory peak airway pressure (Ppeak), lung compliance (Cdyn), pressure-volume loop (P-V loop), and flow-volume loop (F-V loop).

METHODSNinety-six elderly patients undergoing thoracic surgery were intubated with right-sided Mallinckrodt DLTs, the depth of which was determined based on the regressive equation. After 15 min of two lung ventilation (TLV), the Ppeak showed a more than 50% increase from the baseline in 22 patients when switching to one lung ventilation (OLV) with Cdyn less than 50% of the baseline and Ppeak in excess of 22 cmH(2)O. In these 22 cases, the position of the DLT was determined by fiberoptic bronchoscope (FOB) and adjusted to the precise position at 15 min of OLV.

RESULTSDLTs were inserted into the right middle bronchi in 19 cases and the right lower lobe bronchi in 3 cases. At 124-/+39 s after OLV, the SpO(2) began to decrease, and the Ppeak of OLV increased by 91.0% and Cdyn decreased by 62.7%. The slope of P-V curve was reduced and the P-V loop extended, with reduced increment of the expiratory limb and the area of the F-V loop, so that the tips of the DLT were withdrawn by 0.5 to 1.9 cm. The Ppeak of OLV increased only by 43.4% when DLT was in correct position, and was Cdyn decreased by 33.6% ( P<0.01).

CONCLUSIONWhen changes of Ppeak and Cdyn in excess of above guidelines occurs after switching from TLV to OLV in the elderly patients, FOB should be applied to determine the tip position of DLT before SpO(2) reduction takes place.

Aged ; Bronchoscopy ; methods ; Female ; Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; adverse effects ; methods ; Male ; Respiratory Mechanics ; Spirometry ; Thoracic Surgical Procedures

OBJECTIVETo evaluate the diagnostic value of spirometrically controlled quantitative CT in silica-exposed workers.

METHODSWhole lung spiral scans at 50% vital capacity (VC) and image with high resolution CT(HRCT) at 10% VC and 90% VC level and 5 cm above/below carina were performed in 62 silica-exposed workers and 54 healthy adults. Automatic evaluation software, Pulmo, was used to evaluate the quantitative parameters and compared with clinical pulmonary function tests.

RESULTS9 workers with emphysema were detected by CT scans from 62 silica-exposed workers. The quantitative parameters of 10% VC and 90% VC were significantly different between the silica-exposed workers and the controls (P < 0.05). With the increasing of length of exposure to silica dust, the difference showed a ladder-like rising.

CONCLUSIONSpirometrically controlled quantitative CT is a sensitive, accurate and objective method. It is superior to conventional CT and pulmonary function tests for the early detection in silica-exposed workers, espicially for detecting early stage of small airway disease.

Humans ; Occupational Exposure ; Respiratory Function Tests ; Sensitivity and Specificity ; Silicon Dioxide ; adverse effects ; Spirometry ; Tomography, X-Ray Computed ; methods ; Vital Capacity

OBJECTIVETo investigate the clinical applications of portable spirometry in asthma.

METHODSTwenty patients with asthma were recruited from Peking Union Medical College Hospital. Flow-volume loop, simultaneous asthma symptoms, and mood were monitored three times a day for consecutive 14 days.

RESULTSIn patients with a normal daytime spirometry, marked decline of forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were observed at night and/or in the early morning. A within subject correlation analysis between FEV1, PEF, and asthma symptoms showed that the correlation between symptoms and airway obstruction was found only in seven out of twenty patients (35%). Four patients (20%) reported many symptoms with nearly normal portable spirometry. Accordingly, their symptoms were not correlated with FEV1 and PEF. This group of patients was defined as over-perceivers. On the contrary, another two patients (10%) did not report any symptoms while obvious airways obstruction was recorded by a portable spirometry. These patients were defined as under-perceivers.

CONCLUSIONSDynamic monitoring of flow-volume loop with a portable spirometry is more accurate than routine lung function test in assessment of asthma severity. In addition, combined with simultaneous monitoring of symptoms, it would be of particularly helpful in identifying two specific types of asthma patients, e.g. over-perceivers and under-perceivers.

Adolescent ; Adult ; Asthma ; physiopathology ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Peak Expiratory Flow Rate ; Spirometry ; instrumentation ; methods

Background: Neural respiratory drive (NRD) using diaphragm electromyography through an invasive transesophageal multi-electrode catheter can be used as a feasible clinical physiological parameter in patients with chronic obstructive pulmonary disease (COPD) to provide useful information on the treatment response. However, it remains unknown whether the surface diaphragm electromyogram (EMGdi) could be used to identify the deterioration of clinical symptoms and to predict the necessity of hospitalization in acute exacerbation of COPD (AECOPD) patients. Methods: COPD patients visiting the outpatient department due to acute exacerbation were enrolled in this study. All patients who were subjected to EMGdi and classical parameters such as spirometry parameters, arterial blood gas analysis, COPD assessment test (CAT) score, and the modified early warning score (MEWS) in outpatient department, would be treated effectively in the outpatient or inpatient settings according to the Global Initiative for Chronic Obstructive Lung Disease guideline. When the acute exacerbation of the patients was managed, all the examination above would be repeated. Results: We compared the relationships of admission-to-discharge changes (Δ) in the normalized value of the EMGdi, including the change of the percentage of maximal EMGdi (ΔEMGdi%max) and the change of the ratio of minute ventilation to the percentage of maximal EMGdi (ΔVE/EMGdi%max) with the changes of classical parameters. There was a significant positive association between ΔEMGdi%max and ΔCAT, ΔPaCO, and ΔpH. The change (Δ) of EMGdi%max was negatively correlated with ΔPaO/FiOin the course of the treatment of AECOPD. Compared with the classical parameters including forced expiratory volume in 1 s, MEWS, PaO/FiO, the EMGdi%max (odds ratio 1.143, 95% confidence interval 1.004-1.300) has a higher sensitivity when detecting the early exacerbation and enables to predict the admission of hospital in the whole cohort. Conclusions The changes of surface EMGdi parameters had a direct correlation with classical measures in the whole cohort of AECOPD. The measurement of NRD by surface EMGdi represents a practical physiological biomarker, which may be helpful in detecting patients who should be hospitalized timely.
Diaphragm ; physiopathology ; Electromyography ; methods ; Forced Expiratory Volume ; physiology ; Hospitalization ; Humans ; Pulmonary Disease, Chronic Obstructive ; metabolism ; physiopathology ; Spirometry ; Vital Capacity ; physiology

BACKGROUND: Lung age, calculated from sex, forced expiratory volume in one second (FEV1), and height, was developed to illustrate premature changes to the lungs and could be used to motivate smoking cessation. However, this method has not been tested in association with smoking in Korea. The purpose of this study was to investigate the association of lung age with smoking and other factors in Korean males. METHODS: We reviewed the records of 1,100 healthy men who visited a health promotion center at Ewha Womans University Medical Center from January 2008 to June 2009. Lung age was calculated from FEV1 and normal predictive values of spirometry according to age in the Korean population. The difference between lung age and chronological age was evaluated in relation to smoking status, weight, body mass index, waist, muscle mass, fat mass, and exercise. RESULTS: The age difference was significantly higher in current smokers than in non-smokers (12.47 +/- 19.90 vs. 7.30 +/- 19.52, P < 0.001). Additionally, the age difference was positively correlated with life time pack-year (beta = 0.223; P < 0.001) and fat mass (beta = 0.462; P < 0.001). Lung age increased 1 year for 4.48 pack-year increase or for 2.16% increase in fat mass. CONCLUSION: We found a significant relationship between lung age and both smoking status and fat mass in healthy Korean males. Lung age may be a useful tool for motivating cessation of cigarette smoking and management of risk factors related to obesity.
Academic Medical Centers ; Body Weight ; Female ; Forced Expiratory Volume ; Health Promotion ; Humans ; Korea ; Lung* ; Male ; Methods ; Muscles ; Obesity ; Risk Factors ; Smoke* ; Smoking Cessation ; Smoking* ; Spirometry

PURPOSE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD) uses the post-bronchodilator spirometry for diagnosis and severity staging. We evaluated differences in the severity classification of COPD, based on pre- and post-bronchodilator spirometry. MATERIALS AND METHODS: From 2000 to 2004, 207 COPD patients who underwent spirometry before and after inhalation of 400 microg of fenoterol were analyzed. A responder to the bronchodilator test (BDT) was defined by the American Thoracic Society (ATS) as an increase in forced expiratory volume in one second (FEV1) or forced vital capacity > or = 12% and > or = 200 mL, and by the European Respiratory Society (ERS) as an increase in FEV1 > or = 10% of the predicted value. COPD severity was classified according to the 2008 GOLD guidelines. RESULTS: For the entire study population, the FEV1 increased by 11.8 +/- 12.5% of baseline after BDT and 41.1% and 27.1% of subjects were classified as responders using the ATS and ERS criteria, respectively. Based on pre-BDT spirometry, 55, 85, 58, and 9 patients were classified as Stage I-IV COPD, respectively. Sixty-seven (32.4%) patients changed severity staging after BDT, including 20.0%, 28.2%, 44.8%, and 66.7% of pre-BDT patients Stages I through IV, respectively. More ATS or ERS BDT-responders had a change in severity staging than non-responders (52.9% vs. 18.9% and 62.5% vs. 21.2%, both p < 0.001). CONCLUSION: Our data suggest that the severity staging of COPD using pre-BDT spirometry might lead to significant differences as compared to staging, based on post-BDT spirometry, as recommended by the current GOLD guidelines.
Bronchodilator Agents/*diagnostic use ; Fenoterol/diagnostic use ; Forced Expiratory Volume/drug effects ; Humans ; Practice Guidelines as Topic ; Prognosis ; Pulmonary Disease, Chronic Obstructive/*diagnosis ; Spirometry/methods

BACKGROUNDIt remains controversial what better defines abnormal lung function at the extremes of age. This study aimed to establish new spirometric reference equations for residents in Jinan and compare the most accepted two spirometric definitions of chronic obstructive pulmonary disease (COPD)-a fixed post-bronchodilator ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC) below 70% vs. FEV1/FVC < lower limit of normal (LLN)-in an elderly population (age ≥60 years).

METHODSAmong 10 002 cases, only never-smokers who had no respiratory symptoms or diagnoses of cardiopulmonary diseases and whose lung function measurements strictly followed the American Thoracic Society guidelines, were included in the statistical analysis. For each gender, prediction equations of FEV1, FVC, FEV1/FVC and corresponding LLN values were developed using multiple regression models.

RESULTSIn this cross-sectional study, spirometric reference values were statistically derived from a sample of 1328 healthy never-smokers (672 males, 656 females), age 56-84 years. As expected, age and height were the main predictors for all lung function parameters. Using the two spirometric definitions, the number of pulmonary function test results interpreted as obstructed varied markedly in the elderly population for both genders (males: χ(2) = 19.59, P < 0.01; females: χ(2) = 5.67, P = 0.017).

CONCLUSIONSThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion probably leads to overdiagnosis in asymptomatic elderly never-smokers. Our study suggests that the predicted LLN values will reduce the misclassification risk instead. However, cohort studies are urgently needed for clinical validation.

Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Forced Expiratory Volume ; physiology ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Respiratory Function Tests ; Spirometry ; methods

BACKGROUND: Forced oscillation technique (FOT) is a method to characterize the mechanical properties of the respiratory system over a wide range of frequencies. Its' most important advantage is to require minimal cooperation from the subject. This study was performed to evaluate the usefulness of the FOT applications in patients with bronchial asthma by estimating the associations between asthma severity and FOT parameters, and the relationships between FOT and spirometry parameters. METHODS: 216 patients with asthma were enrolled in this study. Patients were classified into 3 different groups according to their symptoms and pulmonary functions. Respiratory impedance, resistance (at 5 Hz, 20 Hz, 35 Hz) and resonant frequency were measured by FOT. FEV1, FVC and MMEF were measured with conventional spirometry. RESULTS: There were significant differences of resonant frequency, resistance at 5 Hz and 20 Hz, resistance difference at 5 Hz and 20 Hz according to asthma severity (p<0.05, respectively). Resonant frequency, resistance at 5 Hz, and impedance were significantly correlated with FEV1 (r = -0.55, -0.48, -0.49, p<0.05, respectively), and with MMEF in patients with normal pulmonary function (r = -0.37, -0.35, -0.34, p<0.05, respectively). Resistance at 5 Hz had similar reproducibility compared to FEV1 (resistance at 5 Hz, r = 0.78 vs FEV1, r = 0.79). CONCLUSION: FOT is a useful and alternative method to evaluate the clinical status of bronchial asthma. Further studies will be needed to clarify its value for a wide range of clinical applications.
Adult ; Aged ; Analysis of Variance ; Asthma/*diagnosis ; Comparative Study ; Female ; Forced Expiratory Volume ; Human ; Korea ; Male ; Middle Age ; Oscillometry ; Probability ; Sensitivity and Specificity ; Severity of Illness Index ; Spirometry/methods

PURPOSE: The aim of this study was to investigate the effect of incentive spirometer exercise (ISE) on pulmonary function and maximal phonation time (MPT) in children with spastic cerebral palsy (CP). MATERIALS AND METHODS: Fifty children with CP were randomly assigned to two groups: the experimental group and the control group. Both groups underwent comprehensive rehabilitation therapy. The experimental group underwent additional ISE. The forced vital capacity (FVC), forced expiratory volume at one second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and MPT were assessed as outcome measures before and after 4 weeks of training. RESULTS: There were significant improvements in FVC, FEV1, PEF, and MPT in the experimental group, but not in the control group. In addition, the improvements in FVC, FEV1, and MPT were significantly greater in the experimental group than in the control group. CONCLUSION: The results of this randomized controlled study support the use of ISE for enhancing pulmonary function and breath control for speech production in children with CP.
Adolescent ; Body Fluids ; Breathing Exercises/*methods ; Cerebral Palsy/complications/*physiopathology ; Child ; *Exercise ; Female ; Forced Expiratory Volume ; Humans ; Lung ; Male ; Motivation ; *Spirometry ; Treatment Outcome