COPD is a common inflammatory disease of the airways, alveoli and microvasculature that is under-diagnosed in smokers at risk for the disease. The majority of COPD patients have mild airway obstruction. Symptomatic smokers with mild COPD are at higher risk for earlier mortality and poorer perceived quality of life than non-smokers. Moreover, dyspnoea and activity restriction are common among smokers with minor spirometric abnormalities. Tobacco-related inflammatory injury of the lungs manifests as heterogeneous physiological impairment with highly variable clinical expression. Thus, simple spirometry provides only a crude assessment of disease pathophysiology, especially in the early stages of the disease.

Background: Respiratory illnesses caused by occupational exposure have the most negative effects on the workers’,health status in workplaces. In occupations with a high likelihood of labor-induced pulmonary diseases, a periodic spirometry test is usually used to monitor occupational lung function and prevent occupational respiratory diseases. Monitoring workers exposed to occupational pulmonary diseases is widely done using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) for early diagnosis of obstructive pulmonary and lung diseases. We assessed the usefulness of longitudinal data of periodic spirometry tests in a sulfate production industry. Materials and Methods: In this longitudinal study, 212 individuals working in a sulfate production industry near Tehran were examined. Demographic data and information, such as FEV1, FVC, FEV1%, FVC%, and FEV1 / FVC ratio were obtained from 2009 to 2013. Data were analyzed using the SPSS software version 21. The one-way analysis of variance (ANOVA) and repeated measures ANOVA for data analysis. Results: The results showed that the variation of the spirometry parameters over 5 years was significant. The factors studied not only decreased in some years but also increased in comparison with the previous year. Also, the average FEV1 and FVC and also FEV1 / FVC significantly was different at different time points [F(2. 864, 590. 029)= 27. 269, P <. 0001], [F(2. 910, 599. 546)= 38. 239, P <. 0001], and [F(3. 257, 671. 019)= 13. 351, P <. 0001]. Conclusion: The best spirometry tests, not only acceptable tests, are important in longitudinal spirometry evaluations. There is no systematic supervision on spirometry tests in Iran and the results of this study reflect a serious need for such supervision.

Background: Asthma could be diagnosed by its characteristic presentation. Spirometry can help the diagnosis by revealing post-bronchodilator response. Classically, salbutamol (albuterol) is used for evaluating post-bronchodilator response. This drug causes paradoxical bronchospasm in less than 10% of asthmatic patients. This study aimed to evaluate the frequency of paradoxical bronchospasm with salbutamol during spirometry and compare it with other drugs that did not reveal paradoxical bronchospasm such as levalbuterol and ipratropium.Materials and Methods: One hundred-Ninety two asthmatic subjects were entered in this clinical trial. All patients showed clinical manifestations of asthma and revealed obstructive pattern during spirometry. They were randomly assigned into three groups of drugs included: salbutamol, levalbuterol and ipratropium. Two puffs of these drugs were administered via a spacer and patients waited for fifteen minutes for the maximal effect to take place. Then spirometry was obtained again and postbronchodilator FEV1 and its alterations were compared among the three groups.Results: The mean±SD age of patients was 49.40±17.4 years; the mean age, demographic data, clinical findings and spirometry results showed no significant difference among groups. FEV1 percent of predicted was 58.6±19.5 which proved that most subjects were suffering from severe asthma. Improvement of FEV1 by salbutamol (22.2±3%) and levalbuterol (16±18%) was significantly more compared with ipratropium (9.4±11%) (t=2.5, P=0.01 and t=2.2, P=0.01, respectively). Paradoxical bronchospasm (more than 12% decrease in FEV1) was seen in two (3%), one (1.5%) and four (6%) subjects of salbutamol, ipratropium and levalbuterol groups, respectively. Regarding clinical improvement, levalbuterol resulted in the higher frequency of clinical improvement compared to salbutamol and ipratropium.Conclusion: With the dosage recommended for reversibility testing during spirometry, salbutamol showed comparable bronchodilator response and paradoxical bronchospasm frequency compared to levalbuterol and ipratropium.

Spirometry is a tool for screening and early diagnosis of harms caused by occupational respiratory exposures. Since spirometry results largely depend on the spirometry method, their credibility and acceptability may vary. Accordingly, this cross-sectional study was conducted to assess the quality of spirometry procedures and reports in the periodic examinations of workers in an industry. The study assessed a total number of 506 recorded spirometry test results related to the periodic examinations of 190 workers in an industry between 2005 and 2015. Each test was assessed in terms of ATS (American Thoracic Society) standards and the quality of reporting, and the obtained results were compared with the spirometry tests conducted by the research team. The most common error in performing these tests was the failure to allow for the 6-second exhalation (in 70% of the cases). After removing the effect of increasing age, it was found that the reported FVC (Forced Vital Capacity) and FEV1 (Forced Expiratory Volume in one second ) in these tests were different from those in the standard spirometry tests performed by the research team by 5% in more than half of the cases and by more than 10% in a quarter of the cases. The results revealed the poor quality of the spirometry tests in the periodic examinations of the workers. Therefore, it is recommended to train the spirometry operators and monitor more vigorously the quality of spirometry tests in the occupational examinations.

Background Cough variant asthma (CVA) is a chronic or recurrent cough without wheezing accompanied by bronchial hyper-responsiveness and eosinophilic inflammation of the airways. This study aimed to evaluate the validity of spirometry in the diagnosis of CVA, as well as determining the specificity and sensitivity of spirometry parameters in CVA. Materials and Methods This descriptive observational study was conducted from March 2015 to February 2016. The subjects were 73 patients 5 to 15 years of age who referred to the pulmonology clinics of Tabriz Pediatric Center, Tabriz city, Iran. The patients were divided into two groups of classic asthma (n=37), and CVA (n=36). Basic spirometry parameters such as FEV1/FVC and FEF25-75% were measured and the spirometry findings of each individual were measured based on European Respiratory Society (ERS) criteria. After intervention (β 2 (beta2) adrenergic receptor agonists as bronchodilator test), in two groups, spirometry was again performed. The FEV1/FVC and FEF 25-75% parameters were examined for intervention. Data analysis was performed using SPSS (version 16. 0). Results Cut-off points for the diagnosis of CVA and classic asthma were obtained using FEV1/FVC and FEF 25-75% spirometry. The cut-off point for FEV1/FVC for the diagnosis of CVA was calculated to be 80%. When the FEV1/FVC ratio was higher than 80%, diagnosis of CVA was possible with a specificity of 94. 59%, and sensitivity of 66. 67%. These findings suggest a specificity and sensitivity of 94. 59%, and 66. 67%, respectively, for the diagnosis of classic asthma (with an FEV1/FVC ratio of below 80%). Analysis showed a positive predictive value of 100% for CVA at FEF 25-75% with a negative predictive value of 55. 4%. Conclusion Spirometry can be a sensitive method for the diagnosis of CVA at a FEF 25-75% below 65%; however, it lacks the specificity for accurate diagnosis of CVA.

Background: Systemic lupus erythematosus (SLE) can affect all organ systems including the respiratory tract and skeletal muscles. Some of the respiratory findings can be attributed to respiratory muscle involvement. The purpose of this study was to clarify the characteristics of pulmonary function tests (PFT), especially maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in females with systemic lupus erythematosus (SLE).Materials and Methods: During a 12-mounth period, forced vital capacity (FVC), FEV1, FEF25-75, MIP, and MEP were measured prospectively in 76 consecutive female patients, suffering active SLE. The measured values were compared to an age-matched group of healthy women.Result: FVC was lower in the patients than in controls (2.81 versus 3.64) P=0.000. Maximal inspiratory pressure (Plmax) was lower in the female patients than in 78 controls (3.42 versus 7.36) P=0.000. Maximal expiratory pressure (PEmax) was lower in the female patients than in controls (4.14 versus 9.68 kPa) P=0.000, There were no correlations between Plmax or PEmax and parameters of disease activity. Mouth occlusion pressure within the first 0.1 s of inspiration was higher in SLE patients than in controls (2.43 versus 1.38); however, the difference was not statistically significant (P=0.16).Conclusion: This study provides evidence of inspiratory and expiratory muscle weakness in SLE and may cause FVC reduction as well. The pathophysiologic mechanisms and the prognostic significance should be further investigated.