Household Air Pollution Risk on Respiratory Health among Women: A Case Study of Indian District after Clean Fuel Programme

Objectives: Some of the highest exposures to air pollutants in developing countries occur inside homes where biomass fuels are used for daily cooking. Inhalation of these pollutants may cause deleterious effects on health. Study Design: A total of 450 non-smoking, non-pregnant women aged 15 years and above exposed to domestic smoke from cooking fuels from an early age, working in poorly ventilated kitchen were selected and on investigation presented various health problems. Method: Symptoms were enquired by means of using standard questionnaire adopted from that of the American Thoracic Society (ATS, 1995). Lung function was assessed by the measurement of Forced Vital Capacity (FVC), (FEV1), i.e. volume of air (in liter) that is forcefully exhaled in one second. Using ratio of FEV1 to FVC (FEVI/FVC), expressed as percentage. Results: FVC less than 80% of the predicted was considered as abnormal pulmonary function. Symptoms like chest pain, breathlessness, eye irritation, and blackout were found to be significantly higher in biomass users (P <0.05). Moreover, an increasing trend in the prevalence of symptoms/morbid conditions was observed with increase in exposure. Conclusion Thus women exposed to biomass fuels smoke suffer more from health problems and are at greater risk of respiratory illnesses when compared with other fuel users.

More complaints than findings - Long-term pulmonary function in children and adolescents after COVID-19

Background: The frequency of persistent symptoms after coronavirus disease 2019 (COVID-19) in adults varies from 4.5% to 87%. Pulmonary function can also show long-term impairment in adults: 10% of hospitalised adults had reduced spirometry values, and 24% had decreased diffusion capacity. To date, only preliminary evidence is available on persistent respiratory sequelae in children and adolescents, therefore our objective was to examine the long-term effects of COVID-19 on pulmonary function in this age group. Methods: Multiple-breath washout, body plethysmography, and diffusion capacity testing were performed after an average of 2.6 months (range 0.4-6.0) following COVID-19 in 73 children and adolescents (age 5-18 years) with different disease severity. Cases were compared to 45 controls with and without infection within six months prior to assessment after exclusion of severe acute respiratory coronavirus-2 infection (SARS-CoV-2). Results: Of the 19 patients (27.1%) who complained about persistent or newly emerged symptoms since COVID-19, 8 (11.4%) reported respiratory symptoms. Comparing patients with COVID-19 to controls, no significant differences were detected in frequency of abnormal pulmonary function (COVID-19: 12, 16.4%; controls: 12, 27.7%; OR 0.54, 95% CI 0.22-1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity (p=0.045) in patients with severe infection regardless of SARS-CoV-2 infection. Discussion: Pulmonary function is rarely impaired in children and adolescents after COVID-19, except of those with severe infection. The discrepancy between persistent respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.

Functional and structural evaluation in the lungs of children with repaired congenital diaphragmatic hernia

Background To evaluate the long-term functional and structural pulmonary development in children with repaired congenital diaphragmatic hernia (CDH) and to identify the associated perinatal-neonatal risk factors. Methods Children with repaired CDH through corrective surgery who were born at gestational age ≥ 35 weeks were included in this analysis. Those who were followed for at least 5 years were subjected to spirometry and chest computed tomography for evaluation of their functional and structural growth. Main bronchus diameters and lung volumes (total, left/right) were measured. According to total lung volume (TLV) relative to body surface area, children were grouped into TLV ≥ 50 group and TLV < 50 group and the associations with perinatal-neonatal factors were analyzed. Results Of the 28 children (mean age, 6.2 ± 0.2 years) with left-sided CDH, 7 (25%) had abnormal pulmonary function, of whom 6 (87%) showed restrictive patterns. All pulmonary functions except FEF25–75% were worse than those in matched healthy control group. Worse pulmonary function was significantly associated with small head and abdominal circumferences at birth. The mean TLV was 1339.1 ± 363.9 mL and LLV/TLV was 47.9 ± 2.5 mL. Children with abnormal pulmonary function were more likely to have smaller lung volumes. In multivariate analysis, abdominal circumference at birth was significantly associated with abnormal lung volume. Conclusions A quarter of children with repaired CDH showed abnormal pulmonary function. Small abdominal circumference at birth was associated with abnormal pulmonary function and lower TLV.

Impacts of air pollution on respiratory symptoms and pulmonary functions among public drivers in Chiang Mai

Objectives To explore differences in pulmonary functions, respiratory symptoms and related factors among public commercial drivers between periods of high and low air pollution. Methods This cross-sectional analytical study comparing the same individuals during periods of high and low air pollution was conducted using spirometry and a self-administered questionnaire which included respiratory symptoms, personal factors, work-related factors and personal personal health data. Air pollution data were collected from reports of the Pollution Control Department. The statistic tests used were the Wilcoxon signed-rank test and McNemar’s test. Results Among the 49 subjects included in both periods (with one outlier removed), differences were found in forced expiratory volume (FEV1) and forced vital capacity (FVC) between periods of high and low air pollution (p = 0.030 and 0.042, respectively). Closing windows, wearing more respiratory protection, having no extra work and reducing exposure to second-hand smoke showed differences in FEV1 between the high and low air pollution periods (p = 0.013, 0.003, 0.049, and 0.034, respectively). Among the 22 subjects who had abnormal pulmonary function during the high air pollution period, the respiratory function of 10 individuals improved during the period of low air pollution. Respiratory symptoms which differed between the periods of high and low air pollution were night coughing and morning phlegm (p = 0.034 and 0.021, respectively). These results might have been affected by the COVID-19 situation which resulted in reduced working hours and hence less exposure time. Conclusions Air pollution is associated with lung function and respiratory symptoms. Abnormal pulmonary function which occurs during periods of high air pollution can improve as the level of air pollution declines. Policies and education campaigns, e.g., closing windows while driving, wearing respiratory protection and avoiding second-hand smoke, can help reduce the impact of air pollution. Chiang Mai Medical Journal 2021;60(1):27-40. doi 10.12982/CMUMEDJ.2021.03

Three-month pulmonary function and radiological outcomes in COVID-19 survivors: a longitudinal patient cohort study

Background This study aimed to investigate pulmonary function and radiological outcomes in a group of coronavirus disease 2019 (COVID-19) survivors. Methods 172 COVID-19 survivors in a follow-up clinic in a referral hospital underwent high resolution computed tomography (CT) of the thorax and pulmonary function tests at three month after hospital discharge. Results The median duration from hospital discharge to radiological and pulmonary function test was 90 (interquartile range=88-95) days. The abnormal pulmonary function was found in 11 (6.40%) patients, and abnormal small airway function (FEF25-75%) in 12 (6.98%). Six (3.49%) patients had obstructive ventilation impairment and six (3.49%) had restrictive ventilatory impairment. No significant differences in lung function parameters were observed between the non-severe and severe groups. Of 142 COVID-19 patients performed CT scan, 122 (85.91%) showed residual CT abnormalities and 52 (36.62%) showed chronic and fibrotic changes. The ground-glass opacities absorption in the lungs of severe cases was less satisfactory than that of non-severe patients. The severe paients had higher CT scores than non-severe cases (2.00 versus 0.00, P &lt; 0.001) Conclusion Of the COVID-19 survivors, 6.40% still present pulmonary function abnormality three month after discharge, which did not vary by disease severity during hospitalization. 85.91% patients had abnormalities on chest CT, with fibrous stripes and ground glass opacity as the most common pattern.

Spirometry in adult hypothyroid patients: a comparative study

ObjectivesHypothyroidism adversely affects pulmonary function, which may improve by thyroxine therapy. Limited studies about the effect of hypothyroidism on spirometric parameters in adult patients were conducted in Basra, south of Iraq. Moreover, the effect of thyroxine therapy on spirometric parameters was not covered by these studies. In this study, pulmonary function in adult’s hypothyroid patients was evaluated by spirometry to detect any impairment, type of impairment, and to evaluate the effect of thyroxine therapy.MethodsA comparative study was conducted in Al-Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) in Al-Faiha teaching hospital, Basrah, Iraq. Subjects are divided into four groups: uncontrolled hypothyroid group (n=72), controlled hypothyroid group (n=60), newly diagnosed hypothyroid group (n=52), and control group (n=110). Spirometry was done to all subjects in sitting position, it’s repeated at least three times and the best result was recorded.ResultsA significantly (p<0.05) less spirometric parameters and more abnormal pulmonary function test (PFT) were noticed in hypothyroid groups, the reduction were more pronounced in the uncontrolled hypothyroid group. The abnormality in PFT was mostly of restrictive type. A significantly (p<0.05) negative correlation has been found between thyroid-stimulating hormone (TSH) and spirometric parameters, while the correlation of fT4 is significantly (p<0.05) positive with FVC% and FEV%.ConclusionIn hypothyroidism, high TSH and low fT4 are recognized causes of a reduction in spirometric parameters. Therefore, spirometry can be used to detect pulmonary function changes in hypothyroidism.

Abstract WP249: Association of Reduced FEV1 and Stroke Risk

Background: The systemic inflammation and oxidative stress of obstructive lung disease could promote cerebrovascular dysfunction and platelet hyperactivity, thereby increasing stroke risk 1-2 . There have been studies in the literature supporting an increased risk for stroke (ischemic and hemorrhagic) in patients with obstructive lung disease 3-4 . We aim to assess whether this association is confirmed using data collected from the Cardiovascular Health Study (CHS). Methods: This is a secondary analysis of CHS. The primary outcome is ischemic stroke and the secondary outcome is hemorrhagic stroke. The primary predictor is abnormal pulmonary function at the baseline visit, defined as FEV1<80% of predicted. We fit Cox proportional hazards models and adjusted for baseline covariates that were associated with the outcomes, which for ischemic stroke included age, race, smoking, cholesterol, diabetes, hypertension, atrial fibrillation, and history of TIA or myocardial infarction; and for hemorrhagic stroke included age, cholesterol, diabetes, and hypertension. Results: We included 5,438 patients, of whom 880 (16.2%) had ischemic stroke and 142 (2.6%) had hemorrhagic stroke. Mean (SD) days of follow-up was 4,458 (2,499). There were 331/5,438 (6.1%) of patients with abnormal pulmonary function at baseline, who had a higher risk of ischemic stroke (HR 1.36, 95% CI 1.05-1.76, p=0.019) (Figure 1). This remained significant in the adjusted multivariate model (HR 1.43, 95% CI 1.08-1.90, p=0.013). Abnormal pulmonary function was not associated with hemorrhagic stroke risk in either the unadjusted (p=0.635) or adjusted models (p=0.659). Conclusion: Patient’s with a reduced FEV1<80% were found to have an increased risk for ischemic stroke. However, this was not associated with an increased risk for hemorrhagic stroke, suggesting a less robust link between obstructive lung disease and hemorrhagic stroke risk.