Dissertations / Theses on the topic 'Spirometrie'

This work presents spirometric measurements on a group of volunteers. First of all the physiology of respiration is explained. Further the theory necessary for measurement and analysis of respiration parameters is mentioned. A separate chapter contains information about ventilation disorders with focus on obstructive diseases. The measurement methodology is described in the analysis section. The program developed for automatic spirometric signal analysis is described in the next section. Parameters obtained from the program are statistically analysed and compared for physiological and obstructive state. Changes, which the individual parameters represent in relation to the simulated obstruction, are discussed. The appendix section contains a report to be used for laboratory lessons together with the developed program.

This paper summarizes the problems of human thermoregulation and its measurement, with a focus on the method of indirect calorimetry in resting conditions at different ambient temperatures and during physical activity. It also introduces the issue of human thermal comfort and the methodology of its monitoring using thermal manikin. It describes PowerCube Ergo (Ganshorn, Germany) and Cardiovit AT-104 (Schiller, Switzerland), the diagnostic devices used to spiro-ergometry measurements. It introduces the options to export data. The work proposes the protocol for measuring the thermoregulation of the small group of volunteers, which is realized by the practical part. According to the same protocol is monitored thermal comfort of the thermal manikin. In MATLAB is created the application, allowing clear analysis of measurement records. The data are evaluated and discussed.

60 children with bronchial asthma were investigated of the age of 11-15. Children, who were investigated, were divided into 2 groups: the first group consisted of 30 children, who did exercises in the sport hall; the second group consisted of 30 children, who did exercises in the water. Physical therapy for both groups was provided for 30 minutes 6 days a week 1 time per day. Physical therapy included active gymnastic exercises using various physical therapy tools. It was provided two lung ventilation tests with spirometer “Spiromed 250”: the first test was taken before starting to do physical therapy, the second one was taken in the end of physical therapy. We examined the forced expiratory vital capacity (FVC), volume of forced expiration within the first second (FEVı), Gaensler index (FEVı/FVC), peak expiratory flow (PEF), maximum expiratory flow, when 50% of the forced vital capacity has been exhaled (MEF50%). The results of our investigation showed that gymnastic exercises in the water have more positive effect than gymnastic exercises in the sport hall for children with bronchial asthma.

La ventilation est une fonction complexe, avec des variabilités naturelles intra- et inter-individuelles imprévisibles, parfois inhomogènes dans le volume pulmonaire. La spirométrie standard est l'examen de référence pour évaluer la fonction ventilatoire à partir de courbes débit-volume mesurées à la bouche et en respiration forcée. Cette technique simple et fiable est limité par la nécessaire coopération du patient, ainsi que par la nature globale de sa mesure. Étant donné que la respiration est intrinsèquement un phénomène tridimensionnel et que les maladies pulmonaires sont généralement régionales, la ventilation devrait être sondée localement. Malgré les difficultés inhérentes à l'application de l'IRM au poumon, de récent progrès ont permis de révéler le potentiel de l'IRM fonctionnelle pulmonaire à partir d'acquisitions standards facilement transposables en clinique. Depuis une quinzaine d'années des développements évaluent la ventilation à partir de la variation du signal IRM au cours de la respiration. Ces techniques reposent sur une hypothèse forte de linéarité du signal IRM avec la densité de tissus pulmonaire. Une nouvelle méthode évaluant la ventilation localement et dynamiquement à partir des déformations a été développée : la spirométrie 3D par IRM. A partir d'un cycle respiratoire moyen, le Jacobien des déformations et sa dérivée temporelle permettent d'inférer les courbes débit-volume locales. Cette thèse s'attache à valider la spirométrie 3D par IRM, à l'amener à la recherche clinique, et à approfondir la compréhension de la mécanique ventilatoire. Le caractère multidimensionnel de la spirométrie 3D par IRM intègre la complexité de la fonction respiratoire mais la technique encore neuve doit être développée et éprouvée. Les évolutions méthodologiques entreprises durant cette thèse incluent une reconstruction optimisée de la dynamique pulmonaire, une segmentation précise des structures lobaires, la définition de biomarqueurs quantitatifs, ainsi qu'une normalisation des cartes fonctionnelles pour permettre des comparaison intra- et inter-sujets. Une étude prospective sur 25 volontaires (10 femmes, 45 ± 17 ans) respirant librement a été menée, avec des acquisitions répétées en position allongée. La fiabilité de la technique a été approchée selon deux critères : sa répétabilité et son exactitude. Les mesures de volumes courants locaux intégrés sur le volume pulmonaire correspondent à ce qui peut être mesuré par segmentation des volumes pulmonaires. Une excellente répétabilité globale a été trouvée, avec une variabilité résiduelle induite par celle intrinsèque à la respiration.La sensibilité de la spirométrie 3D par IRM a été d'abord étudiée sur 25 volontaires sains en position allongée sur le dos puis sur le ventre. Les cartes fonctionnelles mettent en évidence un gradient de ventilation vers les régions les plus dépendantes à la gravité, démontrant la sensibilité de la technique à la physiologie. Des atlas fonctionnels ont été établis à partir des cartes individuelles normalisées, révélant les motifs nominaux de la ventilation pulmonaire reproductibles sur la cohorte de volontaire. Les distributions spatiales mettent en évidence l'inhomogénéité de la ventilation en respiration libre.Enfin, la sensibilité de la spirométrie 3D aux pathologies obstructives et restrictives est évaluée à travers plusieurs études de cas de maladies neuromusculaires, COVID-19 longue durée, asthme et bronchopneumopathie chronique obstructive (BPCO). Ces recherches soulignent l'importance de caractériser les modes de respiration avec les contributions des muscles respiratoires. La réversibilité de l'asthme à l'administration d'un bronchodilatateur a été trouvé, avec une augmentation marquée des débits après bronchodilatateurs. Une étude longitudinale sur un cas d'asthme sévère a aussi mis en évidence l'efficacité de la biothérapie pour améliorer la fonction ventilatoire, réduisant le volume résiduel ainsi que l'obstruction
Ventilation is a complex function, with unpredictable natural intra- and inter-individual variabilities, sometimes heterogeneous in lung volume. Standard spirometry is the reference exam to assess the ventilatory function from flow-volume loops measured at the mouth during forced expiration. This simple and reliable technique is limited by the necessary cooperation of the patient, as well as by the global nature of its measurement. Since breathing is inherently a three-dimensional phenomenon and lung diseases are generally regional, ventilation should be probed locally.Despite the inherent difficulties in applying MRI to the lung, recent advancements have revealed the potential of functional pulmonary MRI from easily translatable standard acquisitions in clinical settings. Over the past fifteen years, developments have evaluated ventilation based on MRI signal variation during respiration. These techniques rely on a strong assumption of linearity of the MRI signal with lung tissue density. A new method evaluating ventilation locally and dynamically from deformations has been developed: 3D spirometry by MRI. From an average respiratory cycle, the deformation Jacobian and its temporal derivative allow inference of local flow-volume curves. This thesis aims to validate 3D spirometry by MRI, bring it into clinical research, and deepen the understanding of ventilatory mechanics.The multidimensional nature of 3D spirometry by MRI integrates the complexity of respiratory function, but the new technique must still be developed and tested. Methodological developments undertaken during this thesis include optimized reconstruction of pulmonary dynamics, precise segmentation of lobar structures, definition of quantitative biomarkers, as well as normalization of functional maps to enable intra- and inter-subject comparisons. A prospective study on 25 volunteers (10 females, 45 ± 17 years old) breathing freely was conducted, with repeated acquisitions in the supine position. The reliability of the technique was approached by two criteria: its repeatability and accuracy. Measures of local tidal volumes integrated over the lung volume agreed to the measured lung volumes from segmentation. Excellent overall repeatability was found, with residual variability induced by that intrinsic to respiration.The sensitivity of 3D MR spirometry was first studied in 25 healthy volunteers in lying supine and prone positions. Functional maps highlight a gradient of ventilation toward the more gravity-dependent regions, demonstrating the sensitivity of the technique to physiology. Functional atlases were established from normalized individual maps, revealing reproducible nominal patterns of pulmonary ventilation across the volunteer cohort. Spatial distributions highlight the heterogeneity of ventilation during free breathing.Finally, the sensitivity of 3D MR spirometry to obstructive and restrictive pathologies is evaluated through several case studies of neuromuscular diseases, long COVID-19, asthma, and chronic obstructive pulmonary disease (COPD). These studies emphasize the importance of characterizing breathing patterns with contributions from respiratory muscles. Reversibility of asthma with bronchodilator administration was found, with a marked increase in flow rates after bronchodilators. A longitudinal study on a case of severe asthma also demonstrated the effectiveness of biotherapy in improving ventilatory function and reducing residual volume and obstruction

Hälsorisker och lungsjukdomar relaterat till rökning är en sanning som inte kan underskattas. Att den effektivaste åtgärden är att sluta att röka är också ett känt fenomen. Att det krävs en stark inre motivation hos rökaren själv för att lyckas med att sluta att röka är ett annat känt faktum. Vårdpersonalen kan inom sitt hälsofrämjande kompetensområde påverka och förstärka motivationen hos rökare, genom att erbjuda olika rökavvänjningsmetoder. Dessutom finns det möjlighet att genom mätning av lungfunktionen/spirometri diagnostisera eller följa upp en försämrad lungfunktion orsakad av rökning. Det är möjligt att spirometri kan påverka motivationen till rökfrihet, genom att informera rökaren om eventuella eller kommande hälsoskador relaterad till rökning. Denna tanke grundade syftet med denna litteraturstudie. För att belysa spirometrins påverkan på motivation till rökfrihet, studerades nio vetenskapliga artiklar varav åtta stycken var kvantitativa. Samtliga artiklar hade studerat spirometrins påverkan till rökfrihet i olika sammanhang. Resultaten visade att spirometri kan påverka motivationen till rökfrihet till en vis del positivt. Lungfunktions test/spirometri har visat störst påverkan hos rökare med försämrad lungfunktion. Dessutom har resultaten visat att det finns en del rökare med normal lungfunktion också som kan bli positivt påverkad av denna undersökning. Detta blir möjligt då spirometrins resultat tolkas på ett synligt och lättbegripligt sätt av tränad personal. Dessutom kan det vara möjligt att kunskapen om spirometrins tänkbara påverkan på motivationen till rökfrihet, utöka vårdpersonalens hälsofrämjande kompetens.

Tobaksrökning är fortfarande ett problem i Sverige trots dess hälsorisker och höga kostnader både för staten och för rökaren själv. Antalet patienter med KOL ökar kontinuerligt. Primärvården har sjuksköterskeledda KOL-mottagningar där patienter diagnostiseras genom spirometri. I sjuksköterskans kompetensområde ligger att förebygga ohälsa och motivera till livsstilsförändringar. Att kunna få rökaren motiverad till rökstopp innan KOL-utveckling skulle ge stora vinster. Finns viss evidens att spirometri skulle kunna vara en motiverande faktor till rökstopp. Denna uppsats söker svar på hur patienternas rökvanor påverkas av spirometri och om motivationen till rökstopp kan förstärkas. Syftet är att ta reda på betydelsen av spirometri som motivationsfaktor till att sluta röka.Metoden som använts är en litteraturstudie med data från vetenskapliga artiklar varav nio är kvantitativa och en kvalitativ. Resultatet visar att om spirometri-resultatet presenteras på ett sådant sätt att det kopplas ihop med rökning och prognos ger det signifikans för rökfrihet. Studierna visar att nikotinberoendet är svårt att ta sig ur och det kan vara svårt att bryta oberoende av lungsjukdom eller inte. Rökaren skäms över att inte ha eller haft förmåga att kunna sluta. Det är därför oerhört viktigt att vi i vården identifierar rökaren och har möjlighet att stötta till rökstopp.
Program: Fristående kurs

More spirometric analysis needs to be performed in order to discover lung diseases like chronic obstructive pulmonary disease (COPD). A mini spirometer can quickly and easily be used for screening. Today, a plethysmograph is used at the hospital in Helsingborg at the department of clinically physiology. However, they also have a mini spirometer, which is seldom used. By comparing the mini spirometer with the reference (the plethysmograph), results may indicate whether it could be possible to use the mini spirometer for screening or in other situations at the department when immediate and reliable information about lung function is needed. As a total of 45 patients participated in this study. All were examined with the mini spirometre after the conventional spirometry using a reversibility test. Of these there were 41 who were used in the study. After the conventional spirometry, they performed 4 - 7 forced expirations followed by inspirations. Theparameters investigated were FVC (forced vital capacity), FEV1 (forced expiratory vital capacity in 1 second), and FEV1/FVC. For the conventional spirometry slow VC was used, according to clinical routine. With 95 % CI the mean ・} SD was calculated to be for FVC between the 2 methods -0,19 ・} 0,30 litre. For FEV1 the results were 0,04 ・} 0,13 litre and for FEV1/FVC 0,05 ・} 0,05 litre. Paired t-test resulted for FVC in t = 4,1. FEV1 gave t= 1,79 and for FEV1/FVC was t= 6,28. The t-values were compared with t critical= 2,03 which were taken from a table. A lower t- value than t critical suggests that the methods are comparable. When comparing the difference between the both methods, FEV1 agreed well, while FVC and FEV1/FVC was too large.
Fler spirometrier behover genomforas for att upptacka lungsjukdomar som t.ex. kronisk obstruktiv lungsjukdom (KOL). En minispirometer kan snabbt och enkelt screena for detta. Pa Helsingborgs lasarett pa avdelningen for klinisk fysiologi anvands rutinmassigt enbart en plethysmograf-spirometer, trots att det dar aven finns en minispirometer. Genom att undersoka hur noggrann minispirometern ar jamfort med den vanligtvis anvanda spirometern, kan den lilla varianten i vissa fall anvandas vid t.ex. screening eller i samband med andra undersokningar dar information om lungfunktion behovs. Sammanlagt stallde 45 konsekutiva patienter upp pa analys via minispirometri efter genomford konventionell spirometri med reversibilitetstest. Av dessa anvandes 41 stycken i undersokningen. Efter den konventionella spirometrin fick de utfora 4 - 7 forcerade expirationer direkt foljt av inspirationer. De parametrar som anvandes var forcerad expiratorisk volym under den forsta sekunden (FEV1), forcerad vital kapacitet (FVC) och kvoten FEV1/FVC. For den konventionella spirometrin anvandes langsam VC enligt klinisk rutin. Med 95 % KI beraknades medelvardet och SD for skillnaden i FVC mellan de bada metoderna till -0,19 ・} 0,30 liter. For FEV1 var resultatet 0,04 ・} 0,13 liter och kvoten FEV1/FVC gav 0,05 ・} 0,05. Parat t-test gav for FVC t= 4,1. For FEV1 t= 1,79 och for kvoten FEV1/FVC t= 6,28. T- vardena jamfordes med t kritiskt = 2,03 som erholls ur en tabell. Ett lagre t- varde an tkritiskt antyder att metoderna ar tillrackligt lika. FEV1 stamde bra overens mellan de bada metoderna. Det fanns en signifikant skillnad for FVC och forkvoten FEV1/FVC.

Målet med detta examensarbete har varit att utveckla en app med en algoritm för att mäta rotationshastigheten hos en prototyp för en spirometerlösning till en låg kostnad för smart- telefoner. En förstudie har gjorts av smarttelefoners användbarhet för att mäta hälsotillstånd och vilka alternativa lösningar och algoritmer som finns för att mäta rörelsedetektion. I detta arbete har en app med en algoritm utvecklats för att detektera rörelser och mäta rotations- hastigheten hos spirometerprototypens turbin filmad med en smarttelefonkamera. För att metoden ska fungera är det viktigt att rotationshastigheten understiger hälften av kamerans fps (bilder per sekund). Rotationshastigheten hos turbinen måste därför begränsas och det behövs en kamera som klarar minst 120 fps för att fånga rörelserna i prototypens turbin.Arbetet har resulterat i en fungerande algoritm för att bestämma turbinens rotationshastighet. Den utvecklade algoritmen detekterar topparna i en PPG (photoplethysmogram). För att minska beräkningstiden och för att öka noggrannheten analyserar algoritmen färgintensiteten i ett begränsat område, ett s.k. ROI (Region of Interest) i varje bild. Det finns stora möjligheter att använda denna algoritm för att fortsätta utvecklingen av detta alternativa sätt att utföra spirometritester.
The goal with this bachelor thesis was to develop an application with an algorithm to measure the rotation speed of a prototype, as a low-cost solution for measuring spirometry with a smartphone. In a pilot study it was investigated how a smartphone can be used to measure health and what algorithms there are to detect motion in videos. After the pilot study an app with the function to record a video by using the camera of a smartphone and then use an algorithm to detect the rotation speed in the spirometry-prototype’s turbine was developed. To make it work it is important that the rotation speed is low enough so it does not exceed half of the cameras fps. Therefore, to capture the rotation speed of the spirometry-prototype’s turbine the rotation needs to be limited and a smartphone with a camera with at least 120 fps is required.The result of this work is an algorithm that can measure the rotation speed in the spirometry prototype turbine. The algorithm is detecting the peaks in a PPG. To minimize the computation time and to increase the accuracy the algorithm analyses the colour intensity over a ROI in every frame. There is great potential to use this algorithm to further develop this alternative method of measuring spirometry.

Introduktion: Spirometri är en metod som utförs för att utesluta eller bekräfta en lungsjukdom. Dynamisk spirometri innebär mätning av lungvolymsförändringar över tid och omfattar både långsam och forcerad spirometri. Vid långsam spirometri mäts vitalkapacitet (VK). Vid forcerad spirometri mäts forcerad exspiratorisk volym på en sekund (FEV1), forcerad vitalkapacitet (FVK) och FEV%. Spirometri utförs i sittande position men den kan också utföras i stående position. Syftet med studien var att jämföra och se om det föreligger en signifikant skillnad för VK, FVK, FEV1 och FEV% vid dynamisk spirometri mellan sittande och stående position hos studenter utan känd lungsjukdom.  Material och Metod: Studien bestod av 21 frivilliga studenter med åldrarna 21-32 år, där 18 var kvinnor och tre män. Datainsamlingen utfördes vid Örebro universitet och variablerna som mättes vid undersökningen var: VK, FVK, FEV1 och FEV%. Mätningarna upprepades minst tre gånger i både sittande och stående position och de fick inte skilja sig åt mer än 150 ml. Ett parat t- test användes för att se om det förelåg en statistisk signifikant skillnad i mätvärdena mellan sittande och stående position. Resultat: Det parade t-testet visade att det inte föreligger någon statistiskt signifikant skillnad i variablerna VK (p = 0,19), FVK (p = 0,87), FEV1 (p = 0,37) och FEV% (p = 0,26) mellan sittande och stående position. Slutsats: Det föreligger ingen statistiskt signifikant skillnad för dynamisk spirometri mellan sittande och stående position. För att få en uppfattning om hur kroppsposition påverkar spirometri behövs en större population.
Introduction: Spirometry is a method performed to rule out or confirm a lung disease. Dynamic spirometry involves measuring lung volume changes over time. The dynamic spirometry includes slow and forced spirometry. With slow spirometry, vital capacity (VC) is measured. In forced spirometry, forced exspiratory volume of one second (FEV1), forced vital capacity (FVC) and FEV% are measured. Spirometry is performed in a sitting position but can also be performed in a standing position. The aim of the study was to compare whether there is a significant difference for VC, FVC, FEV1 and FEV% in dynamic spirometry between sitting and standing position in students without known lung disease. Method and Materials: The study consisted of 21 volunteer students aged 21-32, of whom 18 were women and three men. The data collection was performed at Örebro University and the variables that were taken into account when performing it were: VC, FVC, FEV1 and FEV%. The maneuvers were repeated at least three times in both sitting and standing positions and they did not differ more than 150ml. A paired t-test was performed to see if there is a statistically significant difference in the measured values between sitting and standing position. Result: The paired t-test showed that there is no statistically significant difference in the variables VC (p = 0.19), FVC (p = 0.87), FEV1 (p = 0.37) and FEV% (p = 0, 26) between sitting and standing position. Conclusion: There is no statistically significant difference for dynamic spirometry between sitting and standing position. To get an idea of how body position affects spirometry, a larger population is needed.

Introduktion: En av de vanligaste undersökningsmetoderna för att bedöma den respiratoriska funktionen är spirometri. Det är en undersökning som mäter lungvolymer och lungvolymsförändringar över tid. En fullständig lungfunktionsundersökning består av statisk och dynamisk spirometri samt mätning av diffusionskapacitet. Studiens syfte var att jämföra två olika utrustningar, en gammal (Jaeger MasterScreen Body och PFT) och en ny utrustning (Vyntus Body och One) om det fanns någon signifikant skillnad på mätresultatet mellan utrustningarna. Metod och material: Studien bestod av 24 testpersoner, 16 kvinnor och 8 män, alla undersökningar utfördes på Fysiologiska kliniken på Västerås sjukhus under februari och april 2020. Variablerna som undersöktes och bearbetades var vitalkapacitet (VK), forcerad vitalkapacitet (FVK), forcerad exspiratorisk volym på en sekund (FEV1), forcerad exspiratorisk volym uttryck i procent med vitalkapacitet (FEV%VK), total lungkapacitet (TLK), residualvolym (RV), mätning av diffusionskapacitet (DLCO) samt alveolär ventilation (VA). Resultat: Resultatet från studien visade att det förelåg en statistisk signifikant skillnad mellan utrustningarna Jaeger och Vyntus. Lungfunktionsutrustningen Vyntus påvisade ett lägre mätresultat på samtliga variabler. Att det förelåg en statistisk signifikant skillnad kan bero på att utrustningarna använder olika mätmetoder, Jaeger har en pneumotach medan Vyntus har en ultraljudssensor. Slutsats: Slutsatsen är att det föreligger systematisk skillnad på den nya utrustningen Vyntus. Vyntus visade lägre värden på samtliga variabler.
Introduction: One of the most common measurements for assessment of pulmonary function is spirometry. It is a method that measures lung volumes and changes in lung volume over time. A complete lung function test consists of static and dynamic spirometry as well as measurement of diffusion capacity. The purpose of the study was to compare two different equipment, an older (Jaeger MasterScreen Body and PFT) and the contemporary (Vyntus Body and One) if there was any significant difference in the measurement result between the two equipment. Method and materials: The study consisted of 24 test subjects, 16 women and 8 men, all examinations were performed at the Physiological Clinic at Västerås Hospital between February and April 2020. The variables investigated and processed were vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume expression as a percentage with vital capacity (FEV%VC), total lung capacity (TLC), residual volume (RV), diffusion capacity measurement (DLCO) and alveolar ventilation (VA). Result: The results of the study showed that there was a statistical significant difference between the two equipments Jaeger and Vyntus. The lung function equipment Vyntus showed a lower measurement result on all variables. This statistical significant difference may be due to the fact that the equipment uses different measurement methods. Jaeger has a pneumotach while Vyntus has an ultrasonic sensor. Conclusion: The conclusion is that there is a systematic difference in the new Vyntus equipment. Vyntus showed lower values for all variables.

Parasites of the genus Spirometra collected in Western Australia, were classified as s. erinacei on the basis of their host range (natural and experimental), developmental rate, morphology and host-parasite relationships. Experimental results, in particular those from an inbred isolate, indicated that earlier workers had underestimated this species phenotypic plasticity. Variation was associated with experimental (infection, collection, processing and examination procedures), environmental (temperature, pH and salinity), host (species, strain, age, size, sex, diet and immune status) and parasitic (age and numbers) factors. The inbred isolate was compared with other Western Australian isolates, Spirometra from other localities in Australia and abroad, and published data on Spirometra and Diphyllobothrium. This showed that several taxonomic criteria are of limited or no value (e.g. the host range of the procercoid, plerocercoid and adult, the prepatent period, and periodicity of egg production), or of use at the specific rather than generic level (e.g. adul t neck length). Infections with Spirometra plerocercoids evoked both humoral and cell mediated immune responses, but the plerocercoids were seldom killed by their host. With time the parasites growth rate, migratory activity, parasite-induced host weight gain, and host mortality these changes are thought to be immunologically mediated. This outcome was not markedly affected by active immunization (with live plerocercoids, plerocercoid tail antigens or secretory antigens), by infections with Taenia taeniaeforrmis or by Bacillus Calmette-Guerin, Corynebacteriwn parvum or Freunds complete adjuvant. A slight immunosuppression (assessed in vivo), was seen in infected mice. This immunosuppression may be caused by plerocercoid secretory products, but whether it contributes to their ability to survive in a wide range of hosts could not be ascertained. The study concluded that perhaps as few as three other forms (S. pretoriensis, Baer, 1924; S. theileri, Baer, 1924 and S. trinitatis, Cameron, 1936) are sufficiently different from the cosmopolitan form(s) of Spirometra to rank as independent species. This study does not support the view, held by some other workers, that Spirometra and Diphyllobothrium should be amalgamated. Thus the genus is clearly in need of taxonomic revision but because of the parasites variability, there is insufficient detailed data on "rare" species for a satisfactory revision at the present time. The similarity between the Australian Spirometra and those in other localities, in particular Japan, and the absence of any records of definitive hosts among animals native to Australia, suggests that this parasite has been introduced to Australia, possibly by mans activities.

This semestral thesis deals with continuous monitoring of pulmonary ventilation during the patients' theraphy and focuses especially on monitoring of their ventilation processes. It is necessarry to detect, monitor and differentiate abdominal and thoracic breathing during the theraphy. This thesis describes the very basic and common method, a spirometry. Next, an overview of more advanced state-of-the-art methods based on both, tactile and proximity principles is given. In addition to that, two recently developed methods by BUT are discussed as well -- a tactile-based measurement similar to blood pressure sensor and a proximity-based measurement method employing TOF cameras. The data acquired by these two methods are proccesed and examined in order to evaluate and justify their performance in a real application.

Background Children with neuromuscular disorders (NMD) have progressive loss of muscle strength and function which can lead to respiratory failure. Postural change in spirometry has been previously used in adult patients to detect diaphragmatic dysfunction, sleep disordered breathing and early respiratory failure. Postural spirometry changes in children with NMD have been advocated in guidelines for the assessment of NMD but not extensively studied. Aim To explore the relationship between postural changes in forced vital capacity [FVC] and polysomnography (PSG) in the assessment of early sleep disordered breathing in children with NMD. Method In this prospective cross sectional study, children with NMD from neurogenetic and respiratory clinics performed spirometry in sitting (si) and supine (su) position. Control group consisting of age and gender matched healthy children also underwent lung function testing. PSG was performed within 6 months of spirometry. Spirometry was acceptable according to ATS standards and PSGs scored according to AASM guidelines. Results Of 40 children with NMD who performed spirometry, 30 were able to perform acceptable supine spirometry. Underlying diagnoses were heterogeneous, with majority having Duchenne Muscular dystrophy (n=17). Mean age was 12.3 years (range 8 to 17yrs,SD ±3) with 21 males and 9 females. Mean FEV1sit and FVCsit were 78% (SD ±22) and 75%(SD±20.4) respectively. SpO2 mean 96% [92 to 98%] and SpO2 nadir was 87% (84 to 96%). Mean% ΔFVC (sit – sup) in these children was 9% (range +6 to -28%,SD±11). When compared with control group, there was a significant difference in supine spirometry between the two groups (p<0.001). PSG data was available on 30 children with NMD. Mean total AHI 6.9/hr (0.3 to 29,±5.9), obstructive AHI 5.2/hr (0.2 to 10), REM AHI 14.3/hr (0.1 to 34.7). On comparing supine spirometry with Total AHI, there was a moderate correlation with with presence of sleep disordered breathing (r=0.62, p=0.001) in those breathing spontaneously. Children established on non-invasive ventilation (NIV) showed a poor correlation with supine spirometry. In order to demonstrate the relationship of supine spirometry with evidence of hypoventilation, correlation was performed between change in postural spirometry and rise in CO2 from non-Rem to REM sleep. The mean (SD) rise was 6mmHg (±1.9) with a range of 4 mmHg to 11 mmHg. Coefficient of correlation was 0.04 (p=0.8) and therefore was not significant. When the NMD group was split between those spontaneously breathing and those established on NIV, there was a poor correlation between supine spirometry and rise in CO2 in both the groups spontaneously breathing (r=0.02,p=0.9) NIV (r=0.13,p=0.74) Conclusion In this cohort study, children with NMD with mild restrictive lung disease have postural changes in spirometry which are significantly greater than healthy controls. The changes in supine spirometry however do not correlate with nocturnal hypoventilation on polysomnography in patients with mild neuromuscular disease

Thesis (M.S.)--Georgia Southern University, 2006.
"A dissertation submitted to the Graduate Faculty of Georgia Southern University in partial fulfillment of the requirements for the degree Master of Science" ETD. Includes bibliographical references (p. 23-27) and appendices.

At least 11 million Americans are diagnosed with chronic obstructive pulmonary disease (COPD), and there is a high likelihood millions more suffer from the disease but are undiagnosed. Spirometry is a medical test to determine how well a patient’s lungs work, and is used to diagnosis COPD. Despite this test’s utility, resident providers may be uneducated about or uncomfortable with administering spirometry. Past research has demonstrated that brief educational interventions can lead to clinically significant improvements in knowledge of spirometry. The purpose of this study is to compare family medicine residents’ responses regarding the use of spirometry in a rural Family Medicine Residency clinic before and after an educational program on the topic. Researchers will administer a survey to resident physicians at the Family Physicians of Bristol clinic about their knowledge regarding spirometry; residents will then be resurveyed after an educational program. It is expected that resident providers will show significant gains in their knowledge of spirometry after the completion of the educational program. Results of this project will be useful in identifying methods to increase medical providers’ awareness and comfort with spirometry, which will hopefully lead to increased accurate diagnosis of airway diseases.

BAKGRUND: Personer med cystisk fibros (CF) har bland annat på grund av tjockt slem i lungorna försämrad lungfunktion och lungkapacitet. Den nedsatta hälsan leder i många fall till en nedsatt livskvalitet.  SYFTE: Syftet med den här litteraturstudien var att ta reda på hur fysisk aktivitet påverkar lungfunktionen och livskvaliteten hos patienter med cystisk fibros. METOD: Sökningar i databaserna Pubmed, Cochrane och Cinahl utfördes för att hitta relevanta artiklar som tog upp sambandet mellan lungfunktion, fysisk aktivitet och livskvalitet. RESULTAT: Med regelbunden träning kan de olika måtten på lungfunktion och kapacitet förbättras. Vissa träningsformer ger bättre resultat på lungkapacitet, och vissa visar större resultat på FEV1. Deltagarna skattade även högre på enkäter om livskvalitet efter avslutat intervention. SLUTSATS: Fysisk aktivitet är positivt för patienter med cystisk fibros och bör rekommenderas för alla. Även om det i sällsynta fall sker en initial försämring kan det vända och bli positivt sedan. Ett roterande schema med olika typer av fysisk aktivitet kan ge patienterna en generell förbättring av sin lungfunktion. En ökad lungfunktion kan även leda till en ökad livskvalitet.
BACKGROUND: People diagnosed with cystic fibrosis (CF) have a lower lung function and capacity partially due to thick mucus. The declining health can also lead to a lower quality of life. AIM: The aim with this review was to find out how physical activity affects the lung function and quality of life in patients with cystic fibrosis. METHODS: Searches in the databases Pubmed, Cochrane and Cinahl were executed to find relevant articles that brought up the connection between lung function, physical activity and quality of life. RESULTS: With regular exercise the different variables measuring lung function and capacity can improve. Some forms of physical activity gave better results on lung capacity, while some showed bigger results on FEV1. The participants scored higher on questionnaires about quality of life after completed intervention. CONCLUSIONS: Physical activity is positive for all patients with cystic fibrosis and should be recommended for everyone. Even when there are rare cases that show an initial decrease in health in the beginning, the positive effects will come later. A rotating schedule of different types of exercise could give the patients an over all improvement of their lung function. An increase in lung function could also lead to an increased quality of life.

IntroduktionSpirometri är en vanlig undersökningsmetod för att bedöma en persons lungfunktion och lungkapacitet, där total lungkapacitet (TLC) är av stort värde. Kroppspletysmografi och kvävgasutsköljning är två metoder som mäter statiska lungvolymer, däribland TLC. Syftet med studien var att jämföra kroppspletysmografi med kvävgasutsköljning och se om det förelåg någon signifikant skillnad på mätresultaten mellan metoderna. Material och metod Studien bestod av 32 försökspersoner, varav 22 kvinnor och 10 män där samtliga undersökningar utfördes på Fysiologkliniken på Västmanlands sjukhus Västerås under februari och mars 2021. Variablerna TLC, funktionell residualkapacitet/intrathorakal gasvolym (FRC/ITGV) och vitalkapacitet (VC) uppmättes och beräknades. Resultatet jämfördes mot Hedenströms referensmaterial. Ett parat t-test med signifikansnivå p<0,05 användes för att se om det förelåg signifikant skillnad.  Resultat och slutsats Vid jämförelse av kroppspletysmografi och kvävgasutsköljning föreligger signifikant skillnad mellan samtliga variabler (p<0,001). Där kvävgasutsköljning uppmäter lägre volymer än kroppspletysmografi.
Introduction Spirometry is a commonly used examination method for validating pulmonary function and lung capacities, where total lung capacity (TLC) is of great value. Body plethysmography and multiple breath nitrogen washout are two methods that measure statical lung volumes, including TLC. The purpose of the study was to compare body plethysmography and multiple breath nitrogen washout to examine if there was a significant difference between the two methods. Material and method The study consisted of 32 test subjects, 22 women and 10 men, all examinations were performed at the Physiological Clinic at Västmansland´s Hospital Västerås between February and Mars 2021. The variables TLC, functional residual capacity/intrathoracic gas volume (FRC/ITGV) and vital capacity (VC) were measured and calculated. The result was compared against Hedenströms reference material. A paired t-test with significance level p<0,05 was used to evaluate if there was a significant difference.  Result and conclusion When comparing body plethysmography and multiple breath nitrogen washout, there is a significant difference between all variables (p<0,001). Where multiple breath nitrogen washout measures lower volumes than body plethysmography.

Forcerad exspiratorisk volym på en sekund (FEV1) och vitalkapacitet (VC) utgör grunden för spirometri som är ett diagnostiskt hjälpmedel vid lungsjukdomar. Spirometri utförs vanligtvis i sittande position, men kan utföras i stående position. Syftet med studien var att jämföra om det finns en signifikant skillnad för FEV1 och VC vid dynamisk spirometri mellan sittande och stående position hos studenter utan känd lungsjukdom. Datainsamlingen utfördes på Klinisk Fysiologi, Länssjukhuset Ryhov i Jönköping av legitimerad biomedicinsk analytiker. 13 frivilliga studenter i åldrarna 22-33 deltog i studien, fyra var män och nio var kvinnor. Genomsnittligt BMI var 21,9 kg/m2 . Manövrarna utfördes minst tre gånger i sittande och sedan stående position. Deltagare med längd över 175 cm fick stå på knä. Medianen för VC i sittande position var 4,5 liter respektive 4,4 liter i stående position. Medianen för FEV1 var 3,6 liter i samtliga kroppspositioner. Wilcoxon-rangsummetest påvisade ingen statistiskt signifikant skillnad för varken VC eller FEV1 mellan sittande och stående position. På grund av litet urval kan ingen generell slutsats dras av denna studie men kan utgöra underlag för fortsatta studier. Ytterligare studier med en större och mer spridd population krävs för att kunna dra generella slutsatser om kroppspositionens påverkan på FEV1 och VC.

This thesis is the first to demonstrate the most appropriate spirometry and FeNO reference values for use amongst Aboriginal and Torres Strait Islander children and young adults. Availability of this data will lead to improved accuracy of spirometry and FeNO interpretation which will aid in more timely diagnosis and management of respiratory conditions for this population. Results from this study also suggest that healthy Australian Indigenous lung function data may not be as low as previously reported in earlier studies.

Astma i hronična opstruktivna bolest pluća (HOBP) su najčešće hronične nezarazne bolesti respiratornog sistema i predstavljaju značajan zdravstveni problem. U dijagnostici i proceni stepena poremećaja disajne funkcije u ovih bolesnika najčešće se koriste spirometrija i telesna pletizmografija. Impulsna oscilometrija predstavlja novu metodu u dijagnostici poremećaja plućne funkcije. Ova metoda je jednostavna za izvođenje i minimalno zavisi od saradnje pacijenta.Osnovni cilj ove doktorske disertacije bio je da se uporede parametri dobijeni impulsnom oscilometrijom, spirometrijom i telesnom pletizmografijom kod pacijenata sa astmom i hroničnom opstruktivnom bolesti pluća, utvrdi senzitivnost navednih metoda u detekciji opstruktivnog poremećaja ventilacije kao i povezanost parametara impulsne oscilometrije, spirometrije i telesne pletizmografije i stepena težine dispnoičnih tegoba kod odraslih pacijenata sa astmom i HOBP. Korelacijom parametara dobijenih impulsnom oscilometrijom i spirometrijom dobijena je umerena negativna korelacija vrednosti R5 sa FEV1 kod pacijenata sa astmom (r= -0.47, r<0.001) i HOBP (r= -0.50, r<0.001), kao i umerena pozitivna korelacija X5 sa FEV1 (r= 0.54, r<0.001, kod pacijenata sa astmom; r= 0.56, r<0.001 kod pacijenata sa HOBP). Registrovana je dobra korelacija Rt sa vrednostima R5 (r=0.63, r<0.001) i H5 (r= -0.55, r<0.001) kod pacijenata sa astmom, kao dobra korelacija Rt sa R5 (r=0.73, r<0.001) i H5 (r= -0.74, r<0.001) kod pacijenata sa HOBP. Kod pacijenata sa astmom nije registrovana razlika između tri metode u detekciji opstruktivnog poremećaja ventilacije kod pacijenata sa simptomima bolesti, dok se upotrebom sve tri metode povećala se senzitivnost. Sve tri metode bile su u slaboj korelaciji sa stepenom dispnoičnih tegoba kod pacijenta sa astmom. Svi HOBP pacijenti imali su spirometrijski registrovanu opstrukciju disajnih puteva. Senzitivnost impusne oscilometrije raste sa stepenom opstrukcije disajnih puteva, te je sposobnost detekcije opstruktivnog poremećaja ventilacije kod pacijenata sa FEV1%<80 % iznosila 55%, 95% CI 43-67 %, a kod pacijenata sa FEV1%<70 % 61%, 95% CI 47-73%. Registrovana je statistički značajna razlika vrednosti oscilometrijskih parametara u odnosu na spirometrijski stadijum HOBP. Kod pacijenata sa HOBP, sve tri metode bile su u umerenoj korelaciji sa stepenom dispnoičnih tegoba. Zaključujemo da postoji umerena korelacija impulsne oscilometrije sa spirometrijom i telesnom pletizmografijom kod pacijenta sa astmom i HOBP. Impulsna oscilometrija bolje korelira sa telesnom pletizmografijom u poređenju sa spirometrijom. Korelacija tri metode raste sa stepenom opstrukcije disajnih puteva. Komplementarna upotreba tri metode daje sveobuhvatniju sliku respiratorne funkcije kod pacijenata sa astmom i HOBP.
Asthma and chronic obstructive pulmonary disease (COPD) are most common chronic noninfectious diseases of the respiratory system, representing a major health issue. Spirometry and body plethysmography are the procedures which are most often performed to diagnose these diseases and evaluate the lung function impairment of the affected patients. Impulse oscillometry is a novel procedure to establish the lung function impairment. It is easy to perform, and minimally depends on a patient's cooperation. The major objective of this Ph. D. thesis is to compare the parameters obtained by impulse oscillometry, spirometry and body plethysmography in patients with asthma and COPD, establish the sensitivity of these procedures in detecting an obstructive ventilation disorder, and correlate the parameters of impulse oscillometry, spirometry and body plethysmpography to the severity of dyspneic symptoms in adult asthma and COPD patients. Correlating the parameters obtained by impulse oscillometry and spirometry, a moderate negative correlation of R5 values to FEV1 in asthma (r= -0.47, р<0.001) and COPD patients (r= -0.50, р<0.001) has been obtained, as well as a moderate positive correlation of X5 to FEV1 (r= 0.54, р<0.001, in asthmatics; r= 0.56, р<0.001 in COPD patients). A good correlation of Rt to R5 (r=0.63, р<0.001) and Х5 values (r= -0.55, р<0.001) has been registered in asthmatics, as well as a good correlation of Rt to R5 (r=0.73, р<0.001) and Х5 (r= -0.74, р<0.001) in COPD patients. In asthma patients, the three analysed procedures exhibited no difference in detecting an obstructive ventilation disorder in the patients with manifested symptoms, while the sensitivity improved when the procedures were complementary performed. Any of the three procedures correlated poorly to the severity of dyspneic symptoms in asthma patients. All COPD patients had a spirometry-registered airway obstruction. The sensitivity of impulse oscillometry increased with the severity of the airway obstruction, so its capacity to detect an obstructive ventilation disorder in the patients with FEV1%<80 % was 55%, 95% CI 43-67 %, and in the patients with FEV1%<70 %, it amounted to 61%, 95% CI 47-73%. A statistically significant difference in the values of all oscillometry parameters was registered depending on the spirometric COPD stage. In COPD patients, all the three procedures were moderately correlated to the severity of dyspenic symptoms. In conclusion, there is a moderate correlation of impulse oscillometry to spirometry and body plethysmography in asthma and COPD patients. Impulse oscillometry correlates better to body plethysmography than to spirometry. The correlation of the three procedures increases with the severity of the airway obstruction. The complementary application of these three procedures provides a more accurate assessment of the respiratory function in asthma and COPD patients.

Medical certification of workers for respirator use is an important activity of occupational medicine health professionals. Spirometry is a diagnostic tool to evaluate respiratory distress/insufficiency that may affect respirator use. In this study, we analyzed the pulmonary function data of 337 workers from different occupations which required medical evaluation to wear a respirator. The American Thoracic Society and National Fire Protection Association criteria were used to evaluate employees. Of 337 workers who were cleared for respiratory use on the basis of medical questionnaires for respirator compliance, 14 (4.15%) failed to pass respirator compliance on the basis of NFPA criteria and 5 (1.48%) failed to pass respirator compliance criteria on the basis of ATS criteria. We compared the use of different Spirometric equations to evaluate these criteria and we found the Crapo equation cleared more workers for respirator use as compared to the Knudson and NHANES III equations. We also measured repeated Forced Expiratory Volume in 1st Second (FEV1) and Forced Vital Capacity (FVC) and compared the results longitudinally over time. Age was the only significant factor affecting the reduction in the lung function in longitudinal analysis. Longitudinal spirometry results suggested that workers were protected while using a respirator in the workplace, but age is the significant factor in reducing their lung function. As some workers were able to qualify for respirator use based on questionnaire alone but failed respirator clearance subsequent to pulmonary function testing, it is recommended that spirometry be used to evaluate clearance for all workers who will use a respirator in the workplace. As well, using different Spirometric equations can affect the outcome on passing or failing clearance for respirator use, and this should be considered in a respiratory medical certification program.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of death worldwide and requires close monitoring and follow up to prevent exacerbations that lead to hospitalizations (CDC, 2015). COPD is often underdiagnosed or misdiagnosed for asthma and also under-treated because providers are not utilizing the recommended diagnostic tool, spirometry, for patients who present with chronic respiratory symptoms (Decramer et al., 2015). The purpose of this study is to assess perceived barriers to spirometry use among primary care providers (PCP) including nurse practitioners (NP) and physician assistants (PA) within Arizona. The aim of this project is to assess for commonalities in barriers and determine practice and educational implications and areas for future research to increase knowledge about the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines so that spirometry is performed more frequently. A survey was administered to PCPs (NPs and PAs) in Arizona through medical professional organizations. Basic demographic data was collected, in addition to questions assessing practice assessment, perceived barriers to spirometry, and utilization of smoking cessation methods and COPD prevention methods. A total of 47 responses were used for the data analysis. Females accounted for 87% (n=41) of the total sample size, and males accounted for 13% (n=6). There were 89% (n=42) NPs and 11% (n=5) PAs. Only 53% (n=25) stated that they have access to a spirometer and 47% (n=22) stated they did not have access to the tool. The most common barriers to spirometry use were concerns about testing quality and accuracy (28%, n=13), cost of the tool (23%, n=11), uncertainty about interpretation (21%, n=10), and unfamiliarity (21%, n=10). Other causes include concerns for reimbursement (11%, n=6), not enough time with patient (11%, n=5), preference to send for pulmonary function tests (11%, n=5), and lastly uncertain about impact of results on clinical practice (6%, n=3). In conclusion, the results call for further practice and educational interventions to mitigate these barriers and provide better support to providers who care for those with chronic respiratory symptoms. Further research into this issue can help lead to interventions and increase knowledge about the GOLD guidelines to improve patient outcomes.

The overall aim of this thesis was to describe subjects with chronic obstructive pulmonary disease (COPD) from different perspectives. Focus was on patients at the time of diagnosis, impact of the disease in comparison to other chronic diseases, factors associated with good health and quality of life (QoL), and diagnostic spirometry in clinical practice. Methods: Qualitative method, grounded theory, was used to analyse patients´ perspectives at the time of diagnosis in a primary care setting (n=10). Public health surveys in the general population were used to compare chronic diseases (n=10,755) and analyse factors associated with health outcomes in COPD (n=1,475). Medical records and spirometry reports, from primary and secondary care, were analysed to assess diagnosis of COPD in clinical practice (n=533). Results: In clinical practice, 70% of patients at the time of diagnosis of COPD lacked spirometry results confirming the diagnosis. Factors related to consequences of smoking, shame and restrictions in physical activity (PA) in particular, were described by patients at the time of diagnosis of COPD. In general subjects with COPD (84%), rheumatoid arthritis (74%) and diabetes mellitus (72%) had an activity level considered too low to maintain good health. In COPD, the most important factor associated with good health and quality of life was a high level of PA. Odds ratios (OR (95%CI)) varied from 1.90 (1.47-2.44) to 7.57 (4.57-12.55) depending on the degree of PA, where subjects with the highest PA level had the best health and QoL. Conclusions: Subjects with COPD need to be diagnosed at an early stage, and health professionals should be aware that feelings of shame could delay patients from seeking care and thus obtaining a diagnosis. The use of spirometry and the diagnostic quality should be emphasised. In patients with COPD greater attention should be directed on increasing the physical activity level, as patients with a low level of physical activity display worse health and quality of life.

Introduktion: Spirometri är en av de vanligaste undersökningsmetoderna som utförs vid bedömning av lungfunktion. Vid en dynamisk spirometri mäts lungvolymsförändringar över tid vid detektion av obstruktiva lungsjukdom. Syftet med denna studie var att validera en konventionell spirometriutrustning, Jaeger MasterScreen PFT(Carefusion, Hoechburg, Tyskland), med en ny handhållen utrustning, COPD-6 mätare (Vitalograph COPD-6 400, Ennis, Irland), för att undersöka om det fanns statistisk signifikanta skillnader på mätresultatet mellan dessa två utrustningar.  Metod och material: 22 lungfriska testpersoner mellan åldrarna 20–33 år varav 17 kvinnor och 5 män deltog i denna studie som utfördes vid Örebro universitet. De spirometrivariabler som undersöktes för Jaegerutrustningen var den forcerade exspiratoriska volymen under första sekunden (FEV1), den forcerade vitalkapaciteten (FVC) samt hur stor andel av hela lungvolymen som en person kan andas ut på första sekunden (FEV1/FVC). Med COPD-6 mätaren mättes FEV1, den forcerade exspiratoriska volymen under sex sekunder (FEV6), samt kvoten av dessa (FEV1/FEV6). För att undersöka om det förelåg en statistisk signifikant skillnad användes ett parat t-test med signifikansnivån α=0,05. Resultat: Resultatet från denna studie visade att det förelåg en statistik signifikant skillnad mellan Jaeger MasterScreen PFT och COPD-6 mätaren med p <0,05 för samtliga undersökta variabler. Bland-Altmananalysen visade en spridning inom konfidensintervallet hos samtliga variabler. Slutsats: I denna studie påvisades en statisk signifikant skillnad mellan utrustningarna där COPD-6 mätare visade lägre mätresultat än Jaegerutrustningen för variablerna FEV1 samt FEV6 alternative FVC. Dock kan inte resultatet från denna studie vara representativt för en större population då endast ett få observationer gjordes.
Introduction: Spirometry is one of the most common examination methods performed when assessing lung function. In dynamic spirometry, changes in lung volume are measured over time for the detection of obstructive pulmonary disease. The purpose of this study was to validate a conventional spirometry equipment, Jaeger MasterScreen PFT(Carefusion, Hoechburg, Germany), with a new handheld equipment, COPD-6 screener (Vitalograph COPD-6 400, Ennis, Irland), to investigate whether there were statistically significant differences in the measurement result between these two equipments. Method and material: 22 lung-healthy test subjects between the ages of 20–33 years of whom 17 women and 5 men, participated in this study, which was conducted at Örebro University. The spirometry variables examined for Jaeger equipment were the forced expiratory volume during the first second (FEV1), the forced vital capacity (FVC) and the percentage of total lung volume that a person can exhale at the first second (FEV1 / FVC). With the COPD-6 screener FEV1, forced expiratory volume for six seconds (FEV6), and the ratio of these (FEV1 / FEV6) were measured. To investigate whether there was a statistically significant difference, a paired t-test with the significance level α = 0.05 was used. Results: The results from this study showed that there was a statistically significant difference between the Jaeger MasterScreen PFT and the COPD-6 screener with p <0.05 for all variables examined. The Bland-Altman analysis showed a spread within the confidence interval for all variables. Conclusion: In this study, a statically significant difference was demonstrated between the equipments where COPD-6 screener showed lower measurement results than the Jaeger equipments for the variables FEV1 and FEV6 alternative FVC. However, the results from this study cannot be representative of a larger population as only a few observations were made.

INTRODUCTION The deployment of new health care models based on the coordination between different levels is a priority at European level to manage the dysfunctions generated by health and social impact of chronic diseases. The transfer of complexity from specialized health care in general hospital-based, to primary care professionals is one of the central elements of change in the health model. This involves the redesign of clinical processes and preparing the workforce for the new environment. The potential of Information and Communications Technology (ICT) as a facilitator element of collaboration between levels of care and greater patient accessibility, have an important role in the deployment and coordination of Integrated Care Services (ICS) that configure the new health model. In this context, the transfer of specialized diagnostic interventions to primary care is a highly relevant area in the change process. The central hypothesis of this thesis is the transfer of functional testing from specialized to primary care within a coordinated care scenario will improve the efficiency of delivery of care and will generate cross-fertilization between levels of care. The general hypothesis is that extensive deployment of different, well-articulated ICS-ICTs covering the entire spectrum of severity of chronic patients generates efficiencies at a system level. This PhD thesis focuses on functional testing and specifically addresses forced spirometry as a use case. This PhD thesis aims to identify the key factors that seem to modulate success of the transfer of forced spirometry (FS) testing to primary care and to other non-specialized professionals and to explore the deployment of services with potential for scalability. The thesis is structured around four specific objectives: OBJECTIVE 1 – TRANSFERABILITY OF FS TO PRIMARY CARE AND PHARMACY OFFICES The first objective is to assess the deployment of the transfer of FS in two scenarios, each with different purposes. The first manuscript analyzes the sustainability of a service to ensure high-quality forced spirometry in primary care. The two other manuscripts under Objective 1 examine the potential of transferability to pharmacy offices, to generate a COPD case-finding program. In the first study "Telemedicine Enhances Quality of Forced Spirometry in Primary Care" efficacy was demonstrated over time (12 m) for quality control of the FS performed by non specialist in five Spanish regions. It was shown that remote collaboration between primary care and specialists has a sustained positive effect on the quality of the FS performed by non-expert personnel. A significant difference between the intervention group (71.5% high quality FS) and the control group (59.5% high quality FS) during the 12 months of the study (p <0.001) was observed. The research generated valuable information to plan properly scalability of the program at regional level, and facilitate the redesign of the role of diagnostic tests in the management of chronic patients in an environment of integrated care. Studies 2 “Early detection of COPD in customers of urban community pharmacies: a pilot-study” and 3 “Spirometry in community-pharmacies: a novel strategy to reduce COPD underdiagnosis”. Results clearly indicate the potential of the community pharmacy as a health partner in close collaboration with primary care. Note that both studies only provide information about feasibility. The efficiency analysis is planned as an activity beyond this thesis, under the EU Project Synergy-COPD and the Master Plan for Respiratory Diseases (PDMAR) of the Department of Health of the Generalitat de Catalunya. OBJECTIVE 2 - ASSESSMENT OF REQUIREMENTS FOR SCALABILITY AT REGIONAL LEVEL Within objective 2, we performed two clusters of studies. The first two (manuscripts 4 and 5) “Survey about the use of Lung Function Testing in Public Hospitals in Catalonia in 2009” and “Estudio de la función pulmonar básica en los centros de atención primaria de Cataluña” analyze the status and needs of FS testing in Catalonia. The second cluster includes two studies (manuscripts 6 and 7) “Design of a basic training program to get quality spirometry” and “HERMES Spirometry: the European Spirometry Driving Licence” with specific proposals for training programs for deployment in Catalonia and at a European level. All these studies were performed directly under the auspices of the Catalan Master Plan of Respiratory Diseases. OBJETIVE 3 - TECHNOLOGICAL CONTRIBUTIONS In this PhD thesis, two areas were identified in which specific technological contributions were needed to ensure the success of the deployment. Firstly, “Technical Requirements of Spirometers in the Strategy for Guaranteeing the Access to Quality Spirometry” the design and production of a FS-CDA for structured data transfer using the protocol HL7 and Clinical Document Architecture (CDA) with the R2 standard supporting interoperability across healthcare tiers (manuscript 8) and, secondly, “Improving quality control of forced spirometry: a new algorithm for automatic evaluation” the development of an automatic tool (algorithm) for remote FS quality control (manuscript 9). The results of the validation with 778 spirometric curves indicated that the sensitivity and specificity of the algorithm was of 96.1 and 94.9%, respectively. The validation of the algorithm provided a second technology element necessary for scalability transfer program of FS to primary care and community pharmacies. The algorithm has been integrated in the ICT management platform for chronic patients. The clinical validation process will be within the EU project Synergy-COPD and scalability in Catalonia plan will materialize in the short term under the PDMAR. CONCLUSIONS 1. The potential for transferability of Forced Spirometry testing to Primary Care was demonstrated by the effectiveness of the web-based collaborative tool that showed sustainable enhancement of high-quality testing performed by non-specialized professionals (manuscript 1). 2. The feasibility of having pharmacy offices play a complementary role to primary care in early diagnosis of chronic respiratory disorders has been proven. Moreover, the potential of pharmacy offices in a future COPD case-finding program has been identified and will be developed beyond this PhD thesis (manuscripts 2 & 3). 3. The lung function testing map in Catalonia was drawn up and requirements for the deployment of high-quality FS within a coordinated care scenario were identified (manuscripts 4 & 5). 4. Conventional and novel coaching strategies to be further developed and integrated into the ICT-supported platform were analyzed (manuscripts 6 & 7) 5. Technological contributions to health system interoperability aimed at facilitating adoption of a high quality FS service supported by ICT were developed and validated, namely: Clinical Document Architecture and an algorithm for automatic assessment of FS quality.
INTRODUCCIÓ El desplegament de nous models de salut basats en la coordinació entre nivells assistencials constitueixen una prioritat a nivell europeu davant la necessitat de gestionar les disfuncions generades per l’elevat impacte sanitari i social de les malalties cròniques. La transferència de la complexitat des de l’atenció sanitària especialitzada, en general de base hospitalària, a professionals d’Atenció Primària constitueix un dels elements centrals del canvi en el model de salut. Això implica el redisseny de processos clínics i la preparació del personal sanitari pel nou entorn. L’ús eficient del potencial que ofereixen les Tecnologies de la Informació i la Comunicació (TIC), com a element facilitador de la col•laboració entre nivells assistencials i d’una major accessi­bilitat del pacient, té un rol important en el desplegament i l’articulació dels Serveis d’Atenció Integrada (SAI) que configuren el nou model de salut. En aquest context, la transferència de les intervencions diagnòstiques especialitzades a l’atenció primària constitueix un àrea molt rellevant en el procés de canvi. L’hipòtesi central de la present tesi doctoral és que la transferència de determinades proves diagnòstiques a l’atenció primària genera eficiències a nivell del sistema de salut. Els diferents estudis realitzats en la tesi es centren en l’espirometria forçada (EF), seleccionada, per les seves característiques, com una prova de concepte. Els objectius generals són explorar aquells fac­tors que s’han identificat com a claus en la modulació del procés de la transferència de l’EF, així com definir estratègies per a la seva escalabilitat regional. La tesi s’estructura en base a 3 objectius específics: OBJECTIU 1 - ANÀLISI DE LA TRANSFERÈNCIA DE LA EF A ATENCIÓ PRIMÀRIA I A OFICINES DE FARMÀCIA. En el primer estudi “Telemedicine enhances Quality of Forced Spirometry in Primary Care” es va demostrar l’eficàcia en el temps (12 m) d’un servei centralitzat pel control de qualitat de l’EF efectuada per professionals no especialitzats de tres regions espanyoles. Es va demostrar que la col•laboració remota entre professionals de primària i especialistes de funció pulmonar tenen un efecte positiu sostingut sobre la qualitat de l’EF realitzada per personal no expert. Es va observar una diferència significativa entre el grup d’intervenció (71.5% EF d’alta qualitat) i el grup control (59.5% EF d’alta qualitat) durant els 12 mesos de l’estudi (p<0.001). La investigació va generar informació valuosa per planejar de forma adient l’escalabilitat del programa a nivell regional. Els resultats d’aquest estudi, junt amb altres apartats de la tesi i d’altres investigacions en curs, facilitaran el redisseny del rol de les proves diagnòstiques en la gestió dels pacients crònics en un entorn d’atenció integrada. Els estudis 2 (Early detection of COPD in customers of urban community pharmacies: a pilot­study) i 3 (Spirometry in community-pharmacies: a novel strategy to reduce COPD underdiag­nosis) de la tesi responen de forma afirmativa a la següent pregunta: Poden les oficines de farmàcia tenir un rol rellevant en un programa de detecció de casos de MPOC? Els resultats són clarament indicatius del potencial de les oficines de farmàcia com a agent sanitari en estreta col•laboració amb Atenció Primària. Cal senyalar que amdos estudis sola­ment aporten informació sobre factibilitat. L’anàlisi d’eficiència es planeja com a una activitat més enllà d’aquesta tesi doctoral, en el marc del projecte EU Synergy-COPD i del Pla Director de Malalties de l’Aparell Respiratori (PDMAR) del Departament de Salut de la Generalitat de Catalunya. OBJECTIU 2 – AVALUACIÓ DE REQUERIMENTS PER A L’ESCALABILITAT REGIONAL A NIVELL DE CATALUNYA En els estudis 4 (Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009) y 5 (Estudio de la función pulmonar básica en los centros de atención pri­maria de Cataluña. Atención Primaria) s’analitzà la situació i necessitats futures de les proves de funció pulmonar a Catalunya a nivell hospitalari i extra-hospitalari en el marc del PDMAR. Els resultats obtinguts confirmen la necessitat de desplegar l’EF a l’Atenció Primària i d’incrementar l’homogeneïtat territorial en el que respecta a l’accés a les proves de funció pul­monar per a pacients i professionals. Es confirma la necessitat del programa de transferència de l’EF plantejat en la tesi doctoral. En un segon grup d’estudis en el Objectiu 2 de la tesi, efectuats en el marc del PDMAR, s‘analitzaren les necessitats i estratègies pel que fa a l’entrenament dels professionals no es­pecialitzats tant en l’àmbit català, estudi 6 (Disseny d’un programa de formació basic para aconseguir espirometries de qualitat), com a nivell europeu, estudi 7 (HERMES Spirometry: the European Spirometry Driving Licence). OBJECTIU 3 – CONTRIBUCIONS TECNOLÒGIQUES A L’ESCALABILITAT L’estudi 8 (Requerimientos técnicos de los espirómetros en la estrategia para garantizar el acceso a una espirometría de calidad) va aportar un element essencial per assegurar l’interoperabilitat de les dades de l’EF al assegurar l’estandardització de la transferència d’informació utilitzant el protocol HL7 v3 i CDA (Clinical Document Architecture) amb estàndard R2. Efectuat amb el suport de l’Oficina d’Estàndards i Interoperabilitat del Departament de Salut de la Generalitat de Catalunya dins el Pla de Digitalizació de la Imatge Mèdica. L’estàndard de transferència de l’EF ha estat ja adoptat per alguns fabricants d’equips de medició i és un requeriment per als concursos públics a nivell regional. A més, a l’estudi 9 (Clinical Decision Support System to Enhance Quality Control of Forced Spi­rometry) es va generar i validar un algoritme per el control automàtic de la qualitat de l’EF. Els resultats de la validació amb 778 corbes espiromètriques varen indicar que la sensibilitat i especificitat de l’algoritme era del 96.1 i 94.9%, respectivament. La validació de l’algoritme aportà un segon element tecnològic necessari per a l’escalabilitat del programa de transfer­ència de l’EF a Atenció Primària i a les oficines de farmàcia. L’algoritme ha estat integrat a la plataforma TIC de gestió de malalts crònics. La validació del procés clínic s’efectuarà dins del projecte EU Synergy-COPD i el pla d’escalabilitat a Catalunya es materialitzarà a curt termini en el marc del PDMAR. CONCLUSIONS 1. Es demostra el potencial de transferibilitat de l’EF a Atenció Primària amb el suport d’una aplicació web de treball col•laboratiu que va facilitar un augment significatiu i sostenible de la qualitat de les proves efectuades per personal no especialitzat (manuscrit 1). 2. Es verificà la factibilitat del rol de les oficines de farmàcia per a la detecció de casos de MPOC en un programa coordinat amb Atenció Primària. Les oficines de Farmàcia podrien tenir un rol complementari a l’Atenció Primària en el diagnòstic de MPOC oculta. El desenvolupament i validació del programa es completarà una vegada finalitzada la present tesi doctoral (manuscrits 2 i 3). 3. L’elaboració del mapa de proves de funció pulmonar a Catalunya va permetre la identifi­cació dels requeriments per a l’escalabilitat regional del programa de transferència de l’EF en el marc d’un model de atenció integrada (manuscrits 4 i 5). 4. Es va verificar el rol essencial de les estratègies d’entrenament dels professionals no espe­cialitzats com a component essencial d’un programa de transferència d’EF de qualitat a l’ Atenció Primària (manuscrits 6 i 7). 5. Es van efectuar dos contribucions tecnològiques rellevants per assegurar la interoperabilitat de l’EF a nivell del sistema de salut: l’elaboració del CDA (manuscrit 8) i el desenvolupament i validació d’un algoritme per l’avaluació automàtica de la qualitat de l’EF (manuscrit 9).
INTRODUCCIÓN El despliegue de nuevos modelos de salud basados en la coordinación entre niveles asisten­ciales constituye una prioridad a nivel Europeo ante la necesidad de gestionar las disfunciones generadas por elevado impacto sanitario y social de las enfermedades crónicas. La transferencia de complejidad desde la atención sanitaria especializada, en general de base hospitalaria, a profesionales de Atención Primaria, constituye uno de los elementos centrales del cambio en el modelo de salud. Ello implica el rediseño de procesos clínicos y la preparación del personal sanitario para el nuevo entorno. El uso eficiente del potencial que ofrecen las Tecnologías de la Información y la Comunicación (TIC), como elemento facilitador de la colaboración entre niveles asistenciales y de una mayor accesibilidad del paciente, tiene un papel importante en el despliegue y articulación de los Servicios de Atención Integrada (SAI) que configuran el nuevo modelo de salud. En este con­texto, la transferencia de las intervenciones diagnósticas especializadas a la atención primaria constituye un área muy relevante en el proceso de cambio. La hipótesis central de la presente tesis doctoral es que la transferencia de determinadas pruebas diagnósticas a la atención primaria genera eficiencias a nivel del sistema de salud. Los dife­rentes estudios realizados en la tesis se centran en la espirometría forzada (EF), seleccionada, por sus características, como una prueba de concepto. Los objetivos generales son explorar aquellos factores que se han identificado como claves en la modulación del proceso de la transferencia de la EF, así como definir estrategias para su escalabilidad regional. La tesis se estructura en base a 3 objetivos específicos: OBJETIVO 1 - ANÁLISIS DE LA TRANSFERENCIA DE LA EF A ATENCIÓN PRIMARIA Y A OFICINAS DE FARMACIA. En el primer estudio “Telemedicine enhances Quality of Forced Spirometry in Primary Care” se demostró la eficacia en el tiempo (12 m) de un servicio centralizado para control de calidad de la EF efectuada por profesionales no especializados de tres regiones españolas. Se demostró que la colaboración remota entre profesionales de primaria y especialistas de función pulmonar tiene un efecto positivo sostenido sobre la calidad de la EF realizada por personal no experto. Se observó una diferencia significativa entre el grupo intervención (71.5% EF de alta calidad) y el grupo control (59.5% EF de alta calidad) durante los 12 meses del estudio (p<0.001). La investigación generó información valiosa para planear de forma adecuada la escalabilidad del programa a nivel regional. Los resultados de este estudio, junto con otros apartados de la tesis y otras investigaciones en curso, facilitarán el rediseño del papel de las pruebas diagnósticas en la gestión de los pacientes crónicos en un entorno de atención integrada. Los estudios 2 (Early detection of COPD in customers of urban community pharmacies: a pilot­study) y 3 (Spirometry in community-pharmacies: a novel strategy to reduce COPD underdiag­nosis) de la tesis responden de forma afirmativa a la siguiente pregunta: Pueden las oficinas de farmacia tener un papel relevante en un programa de detección de casos de EPOC? Los resultados son claramente indicativos del potencial de las oficinas de farmacia como agente sanitario en estrecha colaboración con Atención Primaria. Cabe señalar que ambos estudios solo aportan información sobre factibilidad. El análisis de eficiencia se planea como una actividad más allá de esta tesis doctoral, en el marco del proyecto EU Synergy-COPD y del Plan Director de Enfermedades de Aparato Respiratorio (PDMAR) del Departamento de Salud de la Generalitat de Catalunya. OBJETIVO 2 – EVALUACIÓN DE REQUERIMIENTOS PARA LA ESCALABILIDAD REGIONAL A NIVEL DE CATALUNYA En los estudios 4 (Encuesta de utilización de la función pulmonar en los hospitales públicos de Cataluña en 2009) y 5 (Estudio de la función pulmonar básica en los centros de atención primaria de Cataluña. Atención Primaria) se analizó la situación y necesidades futuras de las pruebas de función pulmonar en Catalunya a nivel hospitalario y extra-hospitalario en el marco del PDMAR. Los resultados obtenidos confirman la necesidad de desplegar la EF en Atención Primaria y de incrementar la homogeneidad territorial en lo que respecta al acceso a las pruebas de función pulmonar para pacientes y profesionales. Se confirma la necesidad del programa de transferencia de la EF planteado en la tesis doctoral. En un segundo grupo de estudios en el Objetivo 2 de la tesis, efectuados en el marco del PDMAR, se analizaron las necesidades y estrategias en lo que respecta al entrenamiento de profesionales no especializados tanto en el ámbito catalán, estudio 6 (Diseño de un programa de formación básico para conseguir espirometrías de calidad), como a nivel Europeo, estudio 7 (HERMES Spirometry: the European Spirometry Driving Licence). OBJETIVO 3 – CONTRIBUCIONES TECNOLÓGICAS A LA ESCALABILIDAD El estudio 8 (Requerimientos técnicos de los espirómetros en la estrategia para garantizar el ac­ceso a una espirometría de calidad) aportó un elemento esencial para asegurar la interopera­bilidad de los datos de EF al asegurar la estandarización de la transferencia de información uti­lizando el protocolo HL7 v3 y CDA (Clinical Document Architecture) con estándar R2. Efectuado con el soporte de la Oficina de Estándares e Interoperabilidad del Departament de Salut de la Generalitat de Catalunya dentro del Plan de Digitalización de la Imagen Médica. El estándar de transferencia de la EF ha sido ya adoptado por algunos fabricantes de equipos de medición y es un requerimiento para los concursos públicos a nivel regional. Además, en el estudio 9 (Clinical Decision Support System to Enhance Quality Control of Forced Spirometry) se generó y validó un algoritmo para el control automático de la calidad de la EF. Los resultados de la validación con 778 curvas espirométricas indicaron que la sensibilidad y especificidad del algoritmo era del 96.1 y 94.9%, respectivamente. La validación del algoritmo aportó un segundo elemento tecnológico necesario para la escalabilidad del programa de transferencia de la EF a Atención Primaria y a oficinas de farmacia. El algoritmo ha sido inte­grado a la plataforma TIC de gestión de pacientes crónicos. La validación del proceso clínico se efectuará dentro del proyecto EU Synergy-COPD y el plan de escalabilidad en Catalunya se materializará a corto plazo en el marco del PDMAR. CONCLUSIONES 1. Se demostró el potencial de transferibilidad de la EF a Atención Primaria con el soporte de una aplicación web de trabajo colaborativo que facilitó un aumento significativo y sostenible de la calidad de las pruebas efectuadas por personal no especializado (manuscrito 1). 2. Se verificó la factibilidad del rol de las oficinas de farmacia para la detección de casos de EPOC en un programa coordinado con Atención Primaria. Las oficinas de Farmacia podrían tener un rol complementario a la Atención Primaria en el diagnóstico de EPOC oculta. El desarrollo y validación del programa se completará una vez finalizada la presente tesis doc­toral (manuscritos 2 y 3). 3. La elaboración del mapa de pruebas de función pulmonar en Catalunya permitió la identi­ficación de los requerimientos para la escalabilidad regional del programa de transferencia de la EF en el marco de un modelo de atención integrada (manuscritos 4 y 5). 4. Se verificó el papel esencial de las estrategias de entrenamiento de profesionales no espe­cializados como componente esencial de un programa de transferencia de EF de calidad a Atención Primaria (manuscritos 6 y 7). 5. Se efectuaron dos contribuciones tecnológicas relevantes para asegurar la interoperabi­lidad de la EF a nivel del sistema de salud: la elaboración del CDA (manuscrito 8) y el desarrollo y validación de un algoritmo para la evaluación automática de la calidad de la EF (manuscrito 9).

Early detection of chronic obstructive pulmonary disease (COPD) is crucial since the protective effect from smoking cessation diminishes when the disease becomes severe. Little is known about early changes before the onset of airflow limitation. In addition, the natural history of COPD has not been extensively investigated in longitudinal studies. In this work, I firstly compared quantitative CT densitometry between low- and regular-dose CT images, and between different CT scanners. I found a significant overestimation of “emphysema” using densitometry measurements from low-dose CT images, while measurements were comparable between the two scanners. Secondly, I validated a CT measurement of %overinflation using both a dynamic cutoff (maximal lung inflation) and CT cluster analysis, by comparing them to the histological gold standard for emphysema, the lung surface area to volume ratio. In addition, CT cluster analysis supplemented CT lung density in quantifying pulmonary emphysema. Thirdly, I tested the contributions of parenchymal overinflation and airways’ remodeling to airflow limitation in a cross-sectional study design. In COPD subjects, the “airway-dominant” phenotype had less severe airflow limitation but smaller airway lumen area compared to the “emphysema-dominant” phenotype. Smokers who had normal spirometry showed less parenchymal overinflation but there was considerable overlap with those who had established COPD. The fourth original investigation is a longitudinal study of spirometry and CT analyses in heavy smokers without COPD. I found that baseline parenchymal overinflation was significantly associated with the subsequent rate of decline in lung function. This novel finding suggests that CT analysis could serve as a useful biomarker to identify those “susceptible” smokers who will develop COPD. Lastly, I showed that progressive airflow limitation was associated with worsening airway abnormalities only in smokers without COPD at baseline, whereas it was only associated with progression in parenchymal destruction in smokers with pre-existing COPD. In addition, smokers who had, or did not have, established COPD at baseline showed a comparable rate of progression of airflow limitation and parenchymal overinflation. In summary, these cross sectional and longitudinal studies of a unique cohort of smokers, using validated CT measurement tools, provide important insights regarding the onset and natural history of COPD.

Pulmonary function testing is an important part when it comes to evaluating patients with or at risk for lung diseases. Measurement of the diffusing capacity with carbon monoxide (DLCO) of the lung is a very important parameter and reflects how well the gas exchange work. Traditionally the DLCO have been measured by the single breath (SB) method which requires a forcefully inhalation and a 10 second breath-hold. Not all patients are able to perform the method due to illness or related problems therefore it would be favourable if the ward could change to an easier method called intrabreath (IB). The IB method is not depending on a breath-holding manoeuvre, which should make it easier to perform. Eleven volunteers participated in the study. They all performed both DLCO techniques, starting with the SB followed by IB. The DLCO, when determined with the IB technique, had an excellent correlation to the SB technique. However, the IB systematically showed a lower value for DLCO, and can therefore not use the same references as SB. Before the ward can change from the SB- to the IB- method there are needs for further studies. New studies should include more volunteers so more trustworthy reference values can be made, they should also include sick patients as a check-up for the new reference values. For the moment the ward have to stay with the SB method.

Background: Lung function assessments have become the cornerstone of understanding the ever-increasing burden of non-communicable respiratory conditions worldwide. The introduction of pulmonary function testing (PFT) has made maximal expiratory flow/volume (MEFV) measurements the basis of lung function assessments and spirometry the most widely used diagnostic tool for lung function testing. The effectiveness of spirometry to distinguish between normal and abnormal lung function has been realised in adults; however, there is an observed history of misinterpretation in children. The quality of measurements remains a major concern in children and good quality measurements are critical in the diagnosis of any health condition as well as understanding the burden of abnormal lung function in children in low and middleincome countries (LMICs). Objective: This study describes the quality and variation of spirometry reads for evaluating lung function in children in a Malawian population. Methods: This study was conducted according to a protocol developed and granted ethical approval by the Faculty of Health Sciences Human Research Ethics Committee, University of Cape Town (HREC REF 669/2018). The protocol describes the parent study data collection, project analysis plans and ethical and other considerations. Current literature on lung function using spirometry was systematically reviewed and synthesised. The literature review included primary studies and review articles that included spirometry measurement in children from settings in Africa and other low- and middle- income countries. The descriptive study involves secondary analysis of data contributed by the Children Lung Health study, a cross-sectional survey conducted in Malawi. Spirometry measurements from 802 healthy children aged 6-8 years, inexperienced in performing MEFV manoeuvres, are evaluated. Data in the primary study were collected by means of a structured questionnaire which included items on socio-demographic characteristics and spirometry was performed according to the American Thoracic Society and European Respiratory Society (ATS/ERS) guidelines using an Easy on-PC spirometer in the participant‘s home. The ATS/ERS standards for adults and the modified recommendations for children were applied to evaluate quality. Descriptive statistics were used to describe the quality of spirometry indices and univariable logistic regression to identify and describe variables that are predictors of quality. Results: The findings of the study were that many children (34%) failed to reach the complete ATS/ERS quality standards. The end-of-test criteria (forced expiratory time) was the most difficult to meet for children and if this is not met (i.e. exhalation is not complete), the forced vital capacity (FVC) will be underestimated leading to it being misinterpreted. More than 30% of the children failed to meet the repeatability criteria when the relative differences for FVC and forced expiratory volume in the first second (FEV1) was used, yet they are the most appropriate in paediatric practice as compared to absolute differences. Young children were more likely to produce poor quality spirometry as compared to older children. Conclusion: Young children may perform acceptable spirometry according to the modified ATS/ERS recommendations; however, the quality remains suboptimal. Further modification of the already lowered quality standards, seems to be the viable option, but the implications of this clinically has not been evaluated. Other alternatives need to be explored for this group.

Inhalation of organic dust, including endotoxin, has been associated with inflammatory response of the pulmonary system. Limited studies have evaluated the work shift effects of endotoxin on respiratory outcomes for workers in the dairy industry, such as spirometry changes. Measurement techniques for exhaled nitric oxide (eNO) have been standardized by the American Thoracic Society (ATS) and used as a biomarker to identify diseases marked with lung inflammation. Dairy parlor workers are known to work long hours in one location with little job variability. The objectives of this study were to quantify exposure concentrations of inhalable dust and endotoxin among dairy parlor workers, evaluate acute cross-shift changes in respiratory status using spirometry, and assess the effectiveness of exhaled nitric oxide for detecting cross-shift bronchial inflammation changes. The cross-sectional study recruited 62 dairy parlor workers from 10 large herd dairy farms across Iowa, Minnesota, Wisconsin, and South Dakota. Data collected before and after the work shifts included spirometry tests, eNO measurements, and pulmonary symptom questionnaires. Personal breathing zone exposure to inhalable dust was assessed during the shift using Button Aerosol Samplers. Gravimetric analysis was used to determine airborne concentrations of inhalable dust and endotoxin concentration was determined using the recombinant factor C assay. Inhalable dust concentrations ranged from 0.09 - 4.95 mg/m3 with a geometric mean of 0.58 mg/m3. Inhalable endotoxin concentrations ranged from 4-1968 EU/m3 with a geometric mean of 117 EU/m3. The study participants pre-shift forced expiratory volume in the first second (FEV1) as a percentage of predicted was an average of 93.4%. Study group cross-shift FEV1 decreased by -1.16%. Six participants with moderate post-shift concentrations of eNO had an average FEV1 cross-shift change of -3.19%. Dairy parlor workers are exposed to concentrations of organic dusts that may adversely impact health. Future studies should test interventions in milking parlors to reduce dust exposure among dairy workers.

An investigation into anthropocentric, socio-economic, racial and environmental factors influencing lung function. In modern clinical practice the data derived from pulmonary function tests are an integral part of the evaluation of pulmonary disease states. Such data may shed light on the nature of the disease state, the extent (severity) of the disease and the degree of functional impairment that is present. It is generally recognized that there is a lack of consistent data regarding "normal" values in pulmonary function. Despite great progress in standardizing instrumentation, methodology and calculation of the lung function test, the interpretation of the test is complicated by the lack of standardized prediction values. The identification of race as a confounding variable is particularly important in an evaluation of appropriateness of currently used pulmonary function reference values. It has been pointed out that reference values for blacks, in particular, have deficiencies and that this issue demands urgent investigation. The study of differences in lung function in different race groups is complex. Race, itself, is a controversial concept and its close relationship to social stratification needs to be explored before differences may be attributed to race itself.

Bakgrund Det är känt att öppen hjärtkirurgi har en negativ påverkan på lungfunktion mätt med spirometer. Studier som undersökt samma påverkan mätt med Forcerad Oscillerande Teknik (FOT) är till vår vetskap obefintlig. Eftersom FOT är en mera skonsam mätmetod än spirometri kan det vara viktigt att ta reda på om det är möjligt att mäta postoperativ lungfunktion med FOT hos patienter som genomgått öppen hjärtkirurgi. Syfte Studiens syfte var att undersöka hur luftvägsresistans och -reaktans (eftergivlighet) mätt med FOT samt vital kapacitet (VC), Forcerad Vitalkapacitet (FVC) och Forcerad Expiratorisk volym (FEV1) mätt med spirometer påverkas hos patienter som genomgått öppen hjärtkirurgi. Korrelation mellan R5, X5, R5-19 samt AX, uppmätt med FOT och VC, FVC och FEV1, uppmätt med spirometri, och operationstid, anestesitid eller tid i ECC kommer att undersökas. Metod De preoperativa mätningar utfördes med FOT-intrumentet tremFlo®️ C-100, och spirometer, SpiroTube Mobile Edition dagen innan kirurgi. Testerna upprepades tre dagar efter kirurgi. Analys av preoperativa data, postoperativa data och förändring däremellan analyserades på 18 patienter. Resultat En försämrad lungfunktion postoperativt uppmättes med båda metoderna. VC, FVC, FEV1 var nästan halverade (53-56%) i jämförelse med preoperativa värden. Vidare fann vi ökad resistans, både i hela lungan och i perifera luftvägar (R5: +0,98 ± 0,88 cm H2O.s/L, R5-19: +0,64 ± 0,58 H2O.s/L) samt en minskad reaktans (eftergivlighet) (X5: -1,10 ± 1,24). Slutsats Öppen hjärtkirurgi har en negativ effekt på lungfunktion mätt med både FOT och spirometri. Det fanns inga samband mellan sövningstid och försämrad lungfuntkion. Fler studier krävs för att utvärdera om man kan ersätta spirometrin med den mera skonsamma mätmetoden FOT hos patienter som har begränsad förmåga att utföra forcerade andetag.

Purpose: Lung function is typically characterized by spirometer measurements, which do not offer spatially specific information. Imaging during exhalation provides spatial information but is challenging due to large movement over a short time. The purpose of this work is to provide a solution to lung imaging during forced expiration using accelerated magnetic resonance imaging. The method uses radial golden angle stack-of-stars gradient echo acquisition and compressed sensing reconstruction. Methods: A technique for dynamic three-dimensional imaging of the lungs from highly undersampled data is developed and tested on six subjects. This method takes advantage of image sparsity, both spatially and temporally, including the use of reference frames called bookends. Sparsity, with respect to total variation, and residual from the bookends, enables reconstruction from an extremely limited amount of data. Results: Dynamic three-dimensional images can be captured at sub-150 ms temporal resolution, using only three (or less) acquired radial lines per slice per timepoint. The images have a spatial resolution of 4.6 x 4.6 x 10 mm. Lung volume calculations based on image segmentation are compared to those from simultaneously acquired spirometer measurements. Conclusion: Dynamic lung imaging during forced expiration is made possible by compressed sensing accelerated dynamic three-dimensional radial magnetic resonance imaging. (C) 2015 Wiley Periodicals, Inc.