2. spirometri

3. Spirometry Don’t blow it! Lange Chest 2009:136:608 Technique for performing forced exhalation maneuver. The subject starts with tidal breathing and, when ready, inhales maximally and rapidly. Forced exhalation begins with a “blast” and continues until plateau is seen on the volume-time curve or the patient is unable to continue.

4. Spirometry Don’t blow it! Lange Chest 2009:136:608 Acceptable and unacceptable flow-volume loops normal cough in first second premature ending submaximal effort hesitation at start

5. Spirometry Don’t blow it! Lange Chest 2009:136:608

6. Spirometry Don’t blow it! Lange Chest 2009:136:608 Back-extrapolation. To determine a new time-zero, back-extrapolation is performed using the steepest part of the slope on the volume-time curve, the PEF. This will minimize inaccuracies in FEV 1 due to hesitation at the start of exhalation.

7. Spirometry Don’t blow it! Lange Chest 2009:136:608 Back-extrapolation. To determine a new time-zero, back-extrapolation is performed using the steepest part of the slope on the volume-time curve, the PEF. This will minimize inaccuracies in FEV 1 due to hesitation at the start of exhalation. Extrapolated Volume ( EV ) must be < 5% of FVC or 0.15 L, whichever is greater

8. Spirometry Don’t blow it! Lange Chest 2009:136:608

13. Normative study: healthy sRaw data against height for five centers. Normative data from the multicenter study (five centers) and the previous study by Klug and Bisgaard. Accuracy of Whole-Body Plethysmography Requires Biological Calibration Poorisrisak Chest 2009;135:1476

14. Normative study: healthy sRaw data against height for five centers. Normative data from the multicenter study (five centers) and the previous study by Klug and Bisgaard. Accuracy of Whole-Body Plethysmography Requires Biological Calibration Poorisrisak Chest 2009;135:1476 Normative data (105 preschool children) were generated and were without significant difference between centers and independent of height, weight, age, and gender.

15. valori normali

16. Rationale : Advances in spirometry measurement techniques have made it possible to obtain measurements in children as young as 3 years of age; however, in practice, application remains limited by the lack of appropriate reference data for young children, which are often based on limited population-specific samples. Objectives : We aimed to build on previous models by collating existing reference data in young children (aged 3–7 yr), to produce updated prediction equations that span the preschool years and that are also linked to established reference equations for older children and adults. Spirometry Centile Charts for Young Caucasian Children Stanojevic AJRCCM 2009:180:547

18. Risk associated with poor lung function

19. Background: Little is known about the perception of airflow obstruction in patients hospitalized for acute asthma. Objectives: To evaluate patient perception of airflow obstruction at hospital discharge and at a 2-week follow-up visit and to determine whether symptom control and/or severity of airflow obstruction identified patients at risk for acute asthma after discharge. Perception of airflow obstruction in patients hospitalized for acute asthma Davis Ann Allergy Asthma Immunol 2009;102:455

22. Perception of airflow obstruction in patients hospitalized for acute asthma Davis Ann Allergy Asthma Immunol 2009;102:455 AT DISCHARGE AT DISCHARGE AT FOLLOW-UP AT FOLLOW-UP (A) Mean Asthma Control Questionnaire symptom score and (B) mean FEV 1 % pred in participants with and without subsequent acute asthma.

23. Perception of airflow obstruction in patients hospitalized for acute asthma Davis Ann Allergy Asthma Immunol 2009;102:455 AT DISCHARGE AT DISCHARGE AT FOLLOW-UP AT FOLLOW-UP Only a spirometry performed 2 weeks after discharge identified subjects at risk of subsequent asthma. (A) Mean Asthma Control Questionnaire symptom score and (B) mean FEV 1 % pred in participants with and without subsequent acute asthma.

28. Piccole vie aree

29. lung function non-collaborante

30. The potential use of spirometry during methacholine challenge test in young children with respiratory Vilozni, Ped Pul 2009;44:720 Background :The concentration of methacholine that causes a fall of 20% from baseline forced expiratory volume in the first second (PC20-FEV 1 ) in the methacholine challenge test (MCT) is not usually considered a diagnostic tool in preschool children since PC20-FEV 1 may not be achievable <6 years of age.

33. Risposta ai broncodilatatori

37. Riduzione di funzionalità nel tempo

39. Association of FVC and Total Mortality in US Adults With Metabolic Syndrome and Diabetes Mu Lee Chest 2009;136:171

40. Association of FVC and Total Mortality in US Adults With Metabolic Syndrome and Diabetes Mu Lee Chest 2009;136:171 In persons with MetS, a reduced FVC is associated with further increases in mortality, suggesting that the evaluation of lung function may be useful for risk stratification in those with MetS.

42. Polygraph tracings of four sample subjects in the four group A New Breath-Holding Test May Noninvasively Reveal Early Lung Abnormalities Caused by Smoking and/or Obesity Inoue Chest 2009;136:545

43. physiology

51. Exercise Testing All subjects performed treadmill graded exercise stress testing. Subjects were asked to walk or run on a treadmill with initial speed of 1.9 kphr. The treadmill speed was increased gradually over the first 7 min of the test to a maximum of 7 kphr and then the grade on the treadmil was increased by 2.5% each minute to a maximum of 20%. Subjects were encouraged to exercise until exhaustion. Subjects breathed through a mouthpiece from which inspired and expired gas concentrations were continuously analyzed and tidal volumes were measured using a computerized breath-by-breath exercise system (Medgraphics, CardioO2, St. Paul, MN). Minute ventilation (V0E), oxygen consumption (V0O2), carbon dioxide excretion (V0CO2 ), RER (V0CO2=V0O2), and ventilatory equivalents for oxygen (V0E=V0O2 ) and carbon dioxide (V0E=V0CO2 ) were calculated on a breath-by-breath basis. Does the 6-min walk test correlate with the exercise stress test in children? Lesser , Ped Pul 2010;45:135

52. Exercise Testing Heart rate was continuously monitored by electrocardiogram and oxygen saturation was determined by pulse oximeter (Capnocheck plus with oximetry, BCI international, Smiths Medical, Kent, UK). Effort was considered to be maximal if the highest observed heart rate was >170 bpm and the peak RER was 1.0. The V0O2 max was recorded as the highest achieved V0O2 during exercise, and the HR at V0O2 max and O2 pulse (V0O2 max/HR at V0O2 max) were also recorded. Anaerobic threshold (AT) was determined at the point at which V0CO2 increased non linearlycompared to V0O2, calculated by the exercisesystem (Medgraphics, CardioO2) and checked manually. Does the 6-min walk test correlate with the exercise stress test in children? Lesser , Ped Pul 2010;45:135

53. Six-Minute Walk Test The 6-min walk test was conducted as per American Thoracic Society standards.1 Subjects were informed that the object of the test was to walk as far as possible for 6 min, and that they were permitted to slow down or rest when necessary. They were then asked to walk back and forth in the hallway for 6 min and standardized instructions were given before, during, and at the completion of the test.1 The investigator remained at one end of the hallway and did not walk with the subjects. The distance walked was recorded in meters (6MWD). To calculate the work of walking (6MWORK), 6MWD was converted to kilometers and multiplied by the weight in kilograms. Does the 6-min walk test correlate with the exercise stress test in children? Lesser , Ped Pul 2010;45:135