BACKGROUND & AIMS: :The purpose of this study was to assess the contribution of SCUBA to the pulmonary effects of diving to 4.5 meters depth in healthy subjects using a randomized crossover control condition. Ten healthy divers performed two 60-minute 'dives' using SCUBA in a swimming pool. The non-immersed 1 ATA SCUBA control exposure took place at ambient pressure in the laboratory. Thirty minutes prior to, and 30 and 90 minutes post-exposure, FVC (forced vital capacity), FEV1.0 (forced expired volume), peak expiratory flow rate (PEFR), diffusing capacity (DL(co)), heart rate (HR) and temperature were measured. No significant differences were noted in HR, temperature or spirometry between the two conditions. A significant reduction in diffusing capacity occurred at 30 and 90 minutes after the pool dive (9.3% and 15.1%, respectively, p < 0.05). There was no concordant change in DL(co) following the non-immersed 1 ATA SCUBA control. Thus, a pool dive to 4.5 meters for 60 minutes causes a decrease in DL(co), without a change in spirometry, while breathing from SCUBA equipment without immersion causes no significant change in lung function.

背景与目标： : 这项研究的目的是使用随机交叉对照条件评估SCUBA对健康受试者潜水对4.5米深度的肺部影响的贡献。十名健康的潜水员在游泳池中使用水肺进行了两个60分钟的 “潜水”。非浸没的1 ATA水肺对照暴露是在实验室环境压力下进行的。暴露前30分钟，暴露后30分钟和90分钟，FVC (强制肺活量)，FEV1.0 (强制呼气容积)，呼气峰流速 (PEFR)，扩散能力 (DL(co))，心率 (HR) 和温度被测量。两种条件之间的HR，温度或肺活量没有显着差异。泳池潜水后30分钟和90分钟，扩散能力显着降低 (分别为9.3% 和15.1%，p <0.05)。非浸入1 ATA水肺控制后，DL(co) 没有一致的变化。因此，池潜水至4.5米60分钟引起DL(co) 的降低，而肺活量测定法没有变化，而从没有浸没的水肺设备呼吸不会引起肺功能的显著变化。

BACKGROUND & AIMS: :Alteration in lung function at high altitude influences exercise capacity, worsens hypoxia, and may predispose to high-altitude illness. The effect of high altitude on lung function and mechanisms responsible for these alterations remain unclear. Seven adult male mountaineers were followed prospectively during a climbing expedition to Mount Everest, Nepal. Measurements of spirometry and respiratory muscle function were performed for the duration of the expedition, during changes in altitude between 3450 and 7200 meters (m). Measurements included the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), maximal voluntary ventilation (MVV) in 12 seconds, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and respiratory muscle endurance (Tlim). At an altitude of 3450 m, the FVC initially increased (9%) over 24 h, followed by a significant decline; the FEV(1), MVV, MIP, and MEP showed similar progressive decline. At 5350 m, FVC increased by 21% over the first 48 h, then decreased. The FVC, FEV(1), MVV, MIP, and MEP initially increased and then gradually diminished over time. Respiratory muscle endurance (Tlim) decreased over the first three days at 3450 m but then remained unchanged. MVV decreased at lower altitude followed by a slight increase and then a significant decline. Compared with baseline, we observed a fluctuating course for spirometric measurements, respiratory muscle strength, and endurance at high altitude. Initial transient increases in parameters occurred on ascent to each new altitude followed by a gradual decline during prolonged stay.

背景与目标： : 高原肺功能的改变会影响运动能力，加剧缺氧，并可能导致高原疾病。高海拔对肺功能的影响以及导致这些改变的机制尚不清楚。在尼泊尔珠穆朗玛峰的一次攀登探险中，有七名成年男性登山者被追踪。在3450至7200米 (m) 的高度变化期间，在考察期间进行了肺活量测定和呼吸肌功能的测量。测量包括强制肺活量 (FVC)，1秒强制呼气量 (FEV(1))，12秒最大自愿通气 (MVV)，最大吸气压力 (MIP)，最大呼气压力 (MEP) 和呼吸肌耐力 (Tlim)。在海拔3450 m处，FVC最初在24小时内增加 (9%)，随后显着下降; FEV(1)，MVV，MIP和MEP显示出类似的进行性下降。在5350 m处，FVC在最初的48小时内增加了21%，然后降低。FVC、FEV(1) 、MVV、MIP和MEP最初增加，然后随着时间的推移逐渐减少。在3450 m的前三天，呼吸肌耐力 (Tlim) 降低，但随后保持不变。MVV在较低的高度下降，随后略有增加，然后显着下降。与基线相比，我们观察到高空肺活量测量，呼吸肌力量和耐力的波动过程。参数的初始瞬态增加发生在上升到每个新高度时，随后在长时间停留期间逐渐下降。

BACKGROUND & AIMS: Although home nebulizers are widely used to deliver bronchodilator medication to patients with asthma and chronic obstructive pulmonary disease (COPD), the long-term benefits and hazards are unknown. The present authors have previously reported a prospective 12-month study of home nebulizer use involving 49 patients (15 asthma, mean forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) 1.3/2.1 1; 34 COPD, mean FEV1/FVC 0.7/1.8 1). Thirty-two of these patients were treated with long-term domiciliary nebulized bronchodilator treatment, the other 17 patients chose metered dose inhaler (MDI) therapy. The present paper reports the progress of these patients over 5 yr. Five-year survival was similar in both groups (nebulizer users 56%, MDI users 53%). Most deaths were due to respiratory failure (14 deaths) or lung cancer (four deaths). Survival was determined mainly by FEV1 (R = 0.54, P = 0.0001) and age (R = -0.47, P = 0.0007). Laboratory lung function tests (16 nebulizer users) showed that FEV1 and FVC were still higher than pre-nebulizer baseline measurements after 36 months of nebulizer use, but PEFR had fallen by 7%. Twenty-one of 23 surviving nebulizer users completed a questionnaire after 36 months of treatment. All used their nebulizer at least once per day and 20 of 21 patients reported that they still obtained full benefit from each nebulized treatment. The morning peak flow response to nebulized treatment was the same at baseline and at 36 months (48 1 min-1). All patients remained breathless (mean subjective score 4.8 on seven-point scale) but the subjective response to nebulized treatment was unchanged at 36 months. Tachyphylaxis did not develop among 13 patients who underwent repeated reversibility studies using 200 micrograms of salbutamol at 6, 12 and 36 months. It is concluded that home nebulizer therapy is safe and effective for a small number of carefully selected patients with severe asthma or COPD, who have been evaluated by a rigorous home nebulizer assessment protocol prior to commencing home nebulizer therapy.

背景与目标： 尽管家用雾化器广泛用于向哮喘和慢性阻塞性肺疾病 (COPD) 患者提供支气管扩张剂药物，但其长期益处和危害尚不清楚。本作者先前报道了一项涉及49例患者的家庭雾化器使用的前瞻性12个月研究 (15例哮喘，1 s/强制肺活量 (FEV1/FVC) 1.3/2.1 1; 34例COPD，平均FEV1/FVC 0.7/1.8 1)。其中32例患者接受了长期家庭雾化支气管扩张剂治疗，其他17例患者选择了定量吸入器 (MDI) 治疗。本文报告了这些患者超过5年的进展。两组的五年生存率相似 (雾化器用户56%，MDI用户53%)。大多数死亡是由于呼吸衰竭 (14例死亡) 或肺癌 (4例死亡)。生存率主要由FEV1 (R = 0.54，P = 0.0001) 和年龄 (R = -0.47，P = 0.0007) 决定。实验室肺功能测试 (16位雾化器使用者) 显示，在使用雾化器36个月后，FEV1和FVC仍高于雾化器前的基线测量值，但PEFR下降了7%。在治疗36个月后，23名幸存的雾化器使用者中有21名完成了问卷调查。所有人每天至少使用一次雾化器，21名患者中有20名报告说，他们仍然从每次雾化治疗中获得了全部收益。在基线和36个月 (48 1 min-1) 时，对雾化治疗的晨峰流量反应相同。所有患者均保持呼吸困难 (平均主观评分以7分制4.8)，但对雾化治疗的主观反应在36个月时没有变化。在6、12和36个月时，使用200微克沙丁胺醇进行了反复可逆性研究的13例患者中没有出现速激肽。结论家庭雾化器治疗对于少数精心挑选的重度哮喘或COPD患者是安全有效的，这些患者在开始家庭雾化器治疗之前已经通过严格的家庭雾化器评估方案进行了评估。

BACKGROUND & AIMS: :We assessed whether spirometric measurements are associated with the development of accelerated FEV(1) decline and lung cancer among active and previous smokers with a wide range of lung function. Bivariate and multivariate analyses that adjusted for age, intervention arm, smoking status at enrollment and smoking history, years exposed to asbestos, and evidence of asbestosis were used to assess whether baseline FEV(1) and FEV(1)/FVC ratio were associated with accelerated FEV(1) decline and incident lung cancer. The 3,041 participants enrolled from 1985 to 1994 were followed through April 30, 2005. Baseline FEV(1)/FVC ratio<0.7 was significantly associated with an increased risk for rapid lung function decline (OR=1.73; 95% CI 1.31-2.28; p<0.001). Baseline FEV(1)/FVC ratio<0.7 was also significantly associated with an increased risk of developing lung cancer, even when baseline FEV(1) was >80%. Lung cancer risk among participants with baseline airflow obstruction and FEV(1)<60% was 4-fold higher than participants without baseline airflow obstruction and FEV(1)>80% (p<0.001), even among former smokers. These data indicate an FEV(1)/FVC<0.7 among smokers is significantly associated with faster airflow loss, and an increased risk for developing lung cancer, even among those individuals with a normal FEV(1).

背景与目标： : 我们评估了在具有广泛肺功能的活跃和先前吸烟者中，肺活量测量是否与FEV(1) 加速下降和肺癌的发展有关。双变量和多变量分析，调整年龄，干预组，入组时的吸烟状况和吸烟史，接触石棉的年份，使用石棉沉滞症的证据来评估基线FEV(1) 和FEV(1)/FVC比率是否与FEV(1) 加速下降和肺癌事件相关。1985年1994年的3,041名参与者通过2005年4月30日进行随访。基线FEV(1)/FVC比值 <0.7与肺功能快速下降的风险增加显着相关 (OR = 1.73; 95% CI 1.31-2.28; p<0.001)。基线FEV(1)/FVC比值 <0.7也与患肺癌的风险增加显著相关，即使基线FEV(1)> 80%。基线气流阻塞且FEV(1)<60% 的参与者的肺癌风险比无基线气流阻塞且FEV(1)>80% 的参与者高4倍 (p<0.001)，即使在以前的吸烟者中也是如此。这些数据表明吸烟者中的FEV(1)/FVC<0.7与更快的气流损失以及患肺癌的风险增加显著相关，即使在FEV(1) 正常的个体中也是如此。

BACKGROUND & AIMS: :Chronic obstructive pulmonary disease (COPD) is common and often undiagnosed in its early stages, especially in smokers, who are also most at risk. Patients can develop severe or very severe disease before they consult a physician. It is therefore important to identify patients at-risk of COPD and check their lung function regularly since early stage disease is often asymptomatic or mistaken for asthma. Primary care physicians are often the first health care providers to encounter patients with COPD in the early stages, and their role in early detection and treatment process is pivotal. Spirometry is a cheap, simple and reliable method for the early detection and monitoring of COPD patients, and for establishing a differential diagnosis. Spirometry gives immediate results and communicating the results to smokers has been shown to motivate them to quit. Early diagnosis and appropriate therapy can positively influence disease course, slowing progression, relieving symptoms and reducing the incidence of acute 'flares', or exacerbations.

背景与目标： : 慢性阻塞性肺疾病 (COPD) 很常见，并且在早期阶段通常无法诊断，尤其是吸烟者，他们的风险也最大。在咨询医生之前，患者可能会患上严重或非常严重的疾病。因此，重要的是要确定有COPD风险的患者并定期检查其肺功能，因为早期疾病通常是无症状的或被误认为哮喘。初级保健医生通常是第一个在早期阶段遇到COPD患者的医疗保健提供者，他们在早期发现和治疗过程中的作用至关重要。肺活量测定法是一种廉价、简单、可靠的方法，可用于COPD患者的早期检测和监测，并建立鉴别诊断疾病。肺活量测定法可立即得出结果，并将结果传达给吸烟者已被证明可以激发他们戒烟。早期诊断和适当的治疗可以积极影响病程，减缓进展，缓解症状并减少急性 “急症” 或加重的发生率。

BACKGROUND & AIMS: BACKGROUND:Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates. OBJECTIVES:To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function. METHOD:Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years. RESULTS:The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups. CONCLUSION:Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Frequent monitoring of forced vital capacity at home may be of added value in patients with SSc-associated interstitial lung disease (SSc-ILD) to monitor disease progression and guide treatment decisions. The aim of this study was to evaluate the feasibility and optimal frequency of online home spirometry using a home monitoring application in patients with SSc-ILD. METHODS:This was a prospective, observational study in patients with SSc-ILD. Patients evaluated for 3 months the online home monitoring application ILD-online integrated with a Bluetooth-connected spirometer. Patients performed daily home spirometry for 6 weeks and weekly home spirometry for 6 weeks. In addition, patients completed an evaluation questionnaire after 3 months and online patient-reported outcomes at baseline and 3 months. RESULTS:Ten consecutive patients participated. Mean adherence to home spirometry was 98.8% (s.d. 1.5). Home and hospital spirometry were highly correlated. The mean coefficient of variation was lower for weekly [2.45% (s.d. 1.19)] than daily [3.86% (s.d. 1.45)] forced vital capacity measurements (P = 0.005). All patients considered the home monitoring application and spirometer easy to use and no patients considered home spirometry burdensome. All patients would recommend home monitoring to other patients with SSc. CONCLUSIONS:Home spirometry using an online home monitoring application is feasible in patients with SSc-ILD, with high adherence and patient satisfaction. Larger long-term studies are needed to assess whether home spirometry can detect the progression of ILD in patients with SSc.

背景与目标：

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :The aim of the present study was to provide new spirometry reference equations in a sample of the Brazilian population for the following parameters: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, peak of expiratory flow (PEF), forced expiratory flow at 50% (FEF50%), 75% average vital capacity (FEF25-75%), and average forced expiratory flow time (FEFT). This was a prospective study using results from chest radiographs, electrocardiograms, and questionnaires to investigate the participants' respiratory symptoms, sedentarism, and comorbidities (Charlson comorbidity index). From December 2010 to July 2014, individuals were randomly selected from various locations in the state of Rio de Janeiro. All individuals were examined by a single technician in the morning at the laboratory, and performed the spirometry with the same spirometer. Spirometry values were tabulated for the creation of three equation models: linear regression, logarithmic regression, and logarithms through a method that incorporates the lambda, median, and coefficient of variation (LMS method). Initially, 7003 individuals from both genders were contacted, and 454 were recruited. The data from the new equations were compared with one Brazilian and eight international equations, resulting in a high correlation (r>0.9). The values derived from the LMS method and linear regression were very similar (P>0.5), and both could be used to acquire the reference values for Brazilian spirometry. Data derived from the equations of this study were different from the current Brazilian equation, which could be justified by the different method used.

背景与目标： : 本研究的目的是为以下参数在巴西人群样本中提供新的肺活量参考方程: 强制肺活量 (FVC)，1秒强制呼气量 (FEV1)，FEV1/FVC比，呼气流量峰值 (PEF)，50% 时的强制呼气流量 (FEF50 %)，75% 平均肺活量 (FEF25-75 %) 和平均强制呼气流量时间 (FEFT)。这是一项前瞻性研究，使用胸部x光片，心电图和问卷调查的结果来调查参与者的呼吸道症状，镇静和合并症 (Charlson合并症指数)。从2010年12月到2014年7月，从里约热内卢州的各个地方随机选择个人。早晨，所有个人都由一名技术人员在实验室进行了检查，并使用相同的肺活量计进行了肺活量测定。通过结合 λ，中位数和变异系数 (LMS方法) 的方法，列出了用于创建三个方程模型的肺活量测定值: 线性回归，对数回归和对数。最初，接触了来自两种性别的7003个人，并招募了454个人。将来自新方程的数据与一个巴西方程和八个国际方程进行比较，导致高度相关性 (r>0.9)。从LMS方法和线性回归得出的值非常相似 (P>0.5)，并且两者都可以用于获得巴西肺活量测定法的参考值。从这项研究的方程式得出的数据与当前的巴西方程式不同，这可以通过使用的不同方法来证明。

BACKGROUND & AIMS: BACKGROUND:Restriction is a typical functional abnormality in interstitial lung disease (ILD) patients, but is not always present, especially in the early stage of the disease. The greater reduction of vital capacity (VC; %pred.) than total lung capacity (TLC; %pred.) is regarded as a typical pattern of lung function disturbances in ILD patients. STUDY OBJECTIVES:To explore the diagnostic value of spirometry in a detection restrictive pattern the relative volume loss assessed by TLC and VC in large series of patients with a diagnosis of ILD referred for lung function tests was evaluated. METHODS:Retrospective, cross-sectional analysis of pulmonary function data was done. The sampleconsisted of 1,173 patients with the diagnosis of different interstitial lung diseases investigated during a period of 5 years. Only patients without airway obstruction (normal FEV1%VC) were included. In all cases spirometry and whole body plethysmography were performed by experienced staff using MasterLab - 'Jaeger' equipment according to ERS standards. Reference values according to ERS guidelines were applied. RESULTS:The mean value of TLC expressed as %pred. was significantly (p < 0.001) lower than VC in all patients (93.7 +/- 18.6 vs. 98.0 +/- 21.4%pred.). The frequency of abnormal (lowered) TLC results was also higher than lowered VC (22.8 vs. 17.8%). Sensitivity of VC reached 69.3% and the positive predictive value was 88.5% in detecting volume restriction as compared to TLC measurement. CONCLUSION:The relative loss of TLC was greater than VC in our large group of patients. Measurement of TLC should be part of functional assessment of ILD patients, irrespective of whether they present or do not present a restrictive pattern in spirometry.

背景与目标：

BACKGROUND & AIMS: :Inflammatory processes affecting nasal and bronchial mucosa are similar in nature. The purpose of this study was to examine whether children with perennial allergic rhinitis, without underlying asthma, have impaired pulmonary function. We also investigated whether nasal corticosteroids and loratidine would improve the pulmonary function tests of those children with impaired lung function. Fifty subjects with moderate/severe persistent allergic rhinitis due to exclusively dust mite sensitization and no past medical history suggestive of asthma were assessed. The control group consisted of 26 matched healthy subjects. Subjects with airway obstruction, as detected by forced expiratory volume/1 s (FEV1) or forced expiratory flow from 25/% to 75% (FEF(25-75)) values <80% of those predicted, were treated with loratidine, once a day for 10 days, and daily nasal budesonide for 3 months. We found that 11 of 50 patients (22%) with perennial allergic rhinitis had impaired pulmonary function (FEF(25-75) values <80%), compared to 1/26 (3.8%) of the control group (p < or = 0.05). Reversibility was observed in 9/11 (81.8%), mean 24.7% +/- 10.3%. Within 3 months of treatment, 7/10 had FEF(25-75) > 80% of their predicted values as well as significant improvements in their FEV1 (p = 0.04), and FEV1/FVC (p = 0.04). We conclude that a substantial proportion of children with perennial allergic rhinitis have diminished FEF (25-75) values and reversible airway obstruction. Nasal corticosteroids improve the pulmonary function tests of these children with impaired lung function.

背景与目标： : 影响鼻和支气管粘膜的炎症过程在性质上是相似的。这项研究的目的是检查患有常年性变应性鼻炎且没有潜在哮喘的儿童是否肺功能受损。我们还研究了鼻皮质类固醇和氯替丁是否会改善那些肺功能受损的儿童的肺功能测试。评估了50名因仅尘螨致敏而患有中度/重度持续性过敏性鼻炎的受试者，并且没有既往病史提示哮喘。对照组由26名匹配的健康受试者组成。通过强制呼气量/1 s (FEV1) 或强制呼气流量从25/% 至75% (FEF(25-75)) 值 <预测值的80% 检测到的气道阻塞的受试者，接受loratidine治疗，每天一次，持续10天，和每日经鼻布地奈德治疗3个月。我们发现，与对照组的1/26 (3.8%) 相比，50例常年性变应性鼻炎患者中有11例 (22%) 肺功能受损 (FEF(25-75) 值 <80%) (p <或 = 0.05)。在9/11 (81.8%) 中观察到可逆性，平均24.7% +/- 10.3%。在治疗的3个月内，7/10的FEF(25-75)> 其预测值的80%，以及其FEV1 (p = 0.04) 和FEV1/FVC (p = 0.04) 的显著改善。我们得出的结论是，患有常年性变应性鼻炎的儿童中有很大一部分的FEF (25-75) 值降低和可逆性气道阻塞。鼻皮质类固醇可改善这些肺功能受损儿童的肺功能测试。

BACKGROUND & AIMS: INTRODUCTION:The vagus nerve plays a special role in the control of respiratory system activity which represents the parasympathetic part of the autonomic nervous system. A small bronchial innervation by the sympathetic system also is observed, and there is a significant expression of adrenergic receptors, in particular β⊂2 receptors, in the airways. The development of genetics and molecular biology allows for a detailed study which can clarify the essential elements in the pathogenesis of many types of lung disease, as well as the physiological phenomena - bronchial smooth muscle tone and their contractile mechanism. MATERIAL AND METHODS:The study involved 148 healthy male volunteers aged 20-26. In all subjects, gene polymorphism at nucleotide position 46 and 79 of β⊂2-adrenergic receptor (β⊂2-ADR) was assessed. According to the gene polymorphism data, we divided the whole examined population of males into 6 groups for further studies. Moreover, in all the subjects, we performed spirometry testing to verify their pulmonary functions. RESULTS:The basic values of spirometry tests in all subjects were in the range of normal values. The frequency of different genotypes in the gene polymorphism of the β⊂2-adrenergic receptor at nucleotide positions 46 and 79 were typical for the Caucasian population. Analysis of the output values of spirometry, conducted in the particular groups based on their genotype, showed significant inter-group differences in the selected spirometry tests. CONCLUSIONS:Our results may be useful in explaining the differences in the measured values of spirometric indices in healthy subjects in relation to the polymorphism of β⊂2-ADR, and may also contribute to the verification of standards for spirometric indices for this selected group of young males in the Polish population.

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BACKGROUND & AIMS: BACKGROUND AND OBJECTIVE:Although guidelines for asthma emphasize the importance of spirometry for continuity and evaluation of care, it is underused in general practice. The objective of this study was to investigate the effect of spirometry and medical review on asthma control in general practice over 12 months. METHODS:Patients were recruited through 31 practices, which were randomly allocated to one of three groups: Group A had 3-monthly spirometry with medical review, Group B spirometry only before and after the trial, and Group C usual care. Asthma control data were analysed by intention to treat using non-parametric tests and logistic regression models fitted to allow for confounders, repeated measures and clustering by practice. RESULTS:The trial was completed by 195 patients (Group A 69, Group B 78, Group C 48). Asthma control improved in all groups during the 12 months trial, most impressively in Group A (odds ratio per 3 months = 1.27, 95% confidence interval: 1.08-1.49, P = 0.004), but the difference between the groups' respective 3-monthly changes was not significant. At 6 months, asthma control in Group A had increased more from baseline than in Groups B + C (P = 0.006). CONCLUSIONS:Regular spirometry with medical review was associated with improved asthma control in general practice patients, while there was less improvement in either the spirometry only or usual care group. The mechanisms of this improvement may include appropriate adjustment of medication and improved compliance.

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BACKGROUND & AIMS: :The reliability of spirometry is dependent on strict quality control. We examined whether quality control criteria recommended for adults could be applied to children aged 2-5 years. Forty-two children with cystic fibrosis and 37 healthy children attempted spirometry during their first visit to our laboratory. Whereas 59 children (75%) were able to produce a technically satisfactory forced expiration lasting 0.5 second, only 46 (58%) could produce an expiration lasting 1 second, with the youngest children having the most difficulty. Start of test criteria for adults were inappropriate for this age group, with only 16 of 59 children producing a volume of back extrapolation as a proportion of forced vital capacity of less than 5%, whereas all but 4 could produce a volume of back extrapolation of 80 ml or less. More than 90% of children were able to produce a second forced vital capacity and a second forced expired volume in 0.75 second within 10% of their highest. Errors in the spirometry software resulted in inaccurate reporting of expiratory duration and inappropriate timed expired volumes in some children. We describe recommendations for modified start of test and repeatability criteria for this age group, and for improvements in software to facilitate better quality control.

背景与目标： : 肺活量测定的可靠性取决于严格的质量控制。我们检查了是否可以将成人推荐的质量控制标准应用于2-5岁的儿童。42名患有囊性纤维化的儿童和37名健康儿童在首次访问我们的实验室时尝试进行肺活量测定。尽管59名儿童 (75% 名) 能够产生技术上令人满意的持续0.5秒的强制呼气，但只有46名儿童 (58% 名) 能够产生持续1秒的呼气，其中最小的儿童最困难。成人的开始测试标准不适合该年龄组，59名儿童中只有16名产生的背部外推量与强迫肺活量的比例小于5%，而4名儿童以外的所有儿童都可以产生80毫升或更少的背部外推量。超过90% 的儿童能够在0.75秒内产生第二次强制肺活量和第二次强制过期量，在其最高10% 范围内。肺活量测定软件中的错误导致某些儿童的呼气持续时间报告不准确，并且定时过期量不适当。我们描述了针对该年龄段的修改测试开始和可重复性标准的建议，以及对软件进行改进以促进更好的质量控制的建议。

BACKGROUND & AIMS: BACKGROUND:Significant morbidity and mortality in patients with sickle cell disease are accounted for by lung complications. To facilitate good respiratory care for children with sickle cell anaemia the generation of local predicted values is highly important. OBJECTIVE:To determine the reference equations for spirometry indices estimation in children with sickle cell anaemia, which can be readily used as proxy when there is no easy accessibility to spirometer. METHODS:A cross-sectional study with linear regression models developed to estimate reference values for spirometric indices in Nigerian children with sickle cell anaemia aged 5-12 years. RESULTS:Age as independent variables for estimation of forced expiratory volume in 1 s (FEV1) was associated with lowest coefficient of determination (R2) and highest standard error. The coefficient of determination (R2) and standard error was highest and lowest, respectively, when arm span was used to determine peak expiratory flow rate (PEFR). Prediction models for PEFR and FEV1 gave the closest mean estimates that were 0.18 and 0.16 lower and higher than the actual mean PEFR and FEV1, respectively, but the differences was significant only in FEV1. On the contrary the prediction models for forced vital capacity (FVC) gave mean estimates that was 1.02 higher than the actual mean FVC, however, the finding was not significant. CONCLUSION:Preferred proxy for spirometry indices in children with sickle cell anaemia may be arm span.

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