Background and objectiveQuadriceps muscle dysfunction is an important contributor to exercise limitation in chronic obstructive pulmonary disease, but little is known about skeletal muscle function and its impact on exercise capacity in patients with fibrotic idiopathic interstitial pneumonia (IIP). The aim of the study was to compare quadriceps strength and endurance in patients with fibrotic IIP and healthy controls, and relate it to exercise capacity.MethodsQuadriceps strength and endurance, as well as respiratory muscle strength, and 6-min walk distance were compared among 25 patients with fibrotic IIP, forced vital capacity mean (standard deviation) 78.7 (14.0) %predicted, carbon monoxide transfer factor 40.3 (10.9) %predicted and 33 age-matched healthy controls using non-volitional measures. Quadriceps strength was assessed using magnetic femoral nerve stimulation (quadriceps twitch force), and endurance using the decay in force in response to repetitive magnetic stimulation of the quadriceps over 5min.ResultsBoth groups had comparable anthropometrics, gender proportion and respiratory muscle strength. Patients were significantly weaker than controls; quadriceps twitch force 10.1 (3.0)kg versus 8.0 (2.4)kg (P=0.013). Quadriceps force in response to repetitive magnetic stimulation declined significantly more rapidly in patients during the endurance protocol (P<0.001). In controls, there was a significant relationship between 6-min walk distance and quadriceps twitch force (r 0.40, P=0.038), and quadriceps endurance (r 0.59, P=0.016). In patients, only PaO2 and inspiratory muscle strength were retained as independent correlates of 6-min walk distance (r(2)=0.3 P=0.022).ConclusionsQuadriceps strength and endurance are reduced in patients with fibrotic IIP compared with healthy controls, but are less tightly correlated with exercise performance.This study demonstrates that quadriceps strength and endurance are significantly reduced in patients with fibrotic idiopathic interstitial pneumonia compared with healthy controls.

It is not known whether vitamin D levels make a significant contribution to muscle dysfunction in chronic obstructive pulmonary disease (COPD). In 104 COPD patients (mean±sd forced expiratory volume in 1 s 44±22 % predicted) and 100 age- and sex-matched controls, serum 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)(2)D) and parathyroid hormone (PTH) levels were measured and related to quadriceps strength and endurance. In a subset of 26 patients and 13 controls, quadriceps biopsy was performed and mRNA expression of myogenic regulatory factors (mrf) and fibre-specific myosin heavy chains (MHC) was determined. COPD patients were weaker and less physically active than controls. 25(OH)D levels were similar in both groups (48.5±25.5 nmol·L(-1) COPD versus 55.4±28.3 nmol·L(-1) control, p=0.07) but PTH levels were significantly higher in patients (5.2±2.3 pmol·mL(-1) versus 4.4±2.0 pmol·L(-1), p=0.01). 1,25(OH)D was significantly correlated with strength in controls, but not in COPD patients and not with quadriceps endurance assessed using repetitive magnetic stimulation in COPD (n=35) or control (n=35) subjects. In controls, but not COPD patients, muscle biopsy analysis showed a negative relationship between 25(OH)D and MHCIIa expression (r(2)=0.5, p=0.01) and a positive relationship between mrf4 and MHCIIa expression (r(2)=0.5, p=0.009), and myogenic regulatory factor myf5 and MHCI expression (r(2)=0.72, p=0.004). In contrast with healthy controls, muscle strength is not associated with vitamin D levels in COPD, which may represent vitamin D resistance.

Purpose of the study: Older patients with head and neck cancer may be denied the potentially beneficial addition of chemotherapy to primary radiotherapy in the management of head and neck cancer, because of fears that older patients will develop relatively more treatment related morbidity and not tolerate treatment, when compared to younger patients. This could lead to breaks in, or discontinuation of radiotherapy giving poorer outcomes for survival and local control in older patients.

Introduction: Little is known about the quadriceps function and its role in exercise capacity in Fibrotic Idiopathic Interstitial Pneumonia, FIIP. Methods: To compare quadriceps function in patients with FIIP and healthy controls and relate it to exercise capacity, 25 patients with FIIP, FVC 78.7% predicted, TLco 40.3% predicted and 25 age-matched healthy controls were studied. Measurements included FFM, respiratory muscle strength, voluntary quadriceps strength (QMVC), twitch quadriceps force (TwQ), an endurance protocol of 5 minutes of repetitive magnetic stimulation of the quadriceps and the 6MWT. Results: Both groups had comparable anthropometrics and respiratory muscle strength. Quadriceps force declined more rapidly in patients in the endurance protocol. TwQ was lower in patients. In controls there was a significant relationship between quadriceps endurance and 6MWD (r2 0.40, p=0.016). In patients, stepwise regression analysis left only PaO2 as a significant correlate of 6MWD (r2 0.30, p =0.022) Conclusions: Patients with FIIP have significantly impaired quadriceps strength and endurance. In contrast to controls, quadriceps function is not correlated with 6MWD.

Chronic Obstructive Pulmonary Disease ( COPD) is a debilitating disease affecting an estimated 3 million people in the United Kingdom. It is characterised by progressive and irreversible airway obstruction and lung parenchymal damage, and by multisystem involvement including skeletal muscle impairment, systemic inflammation, and an increased prevalence of osteoporosis, cardiovascular disease and lung cancer.Patients with COPD have reduced dietary intake of vitamin D, spend a reduced amount of time outdoors and have been shown to have lower levels of 25-hydroxyvitamin D (25[OH] D) than age-matched subjects without COPD. The active metabolite of vitamin D, 1,25-dihydoxyvitamin D (1,25[OH] 2D), is a pleiotropic hormone with effects on lung development and function, the immune system and musculoskeletal function; vitamin D deficiency also associates with increased prevalence of cardiovascular disease and cancer. This article focuses on the evidence that vitamin D deficiency is highly prevalent in patients with COPD and reviews associations between vitamin D status and lung function, muscle function and risk of osteoporosis, cardiovascular disease and cancer. The potential pathological mechanisms which may be involved are also discussed.

RATIONALE:Exhaled breath condensate (EBC) is increasingly studied as a noninvasive research method of sampling the lungs, measuring several biomarkers. The exact site of origin of substances measured in EBC is unknown, as is the clinical applicability of the technique. Special techniques might be needed to measure EBC biomarkers.OBJECTIVES:To assess biomarker concentrations in clinical disease and investigate the site of origin of EBC, we compared EBC and bronchoalveolar lavage (BAL) biomarkers in 49 patients undergoing bronchoscopy for clinical indications.MEASUREMENTS:We measured exhaled nitric oxide, 8-isoprostane, hydrogen peroxide, total nitrogen oxides, pH, total protein, and phospholipid (n = 33) and keratin (n = 15) to assess alveolar and mucinous compartments, respectively. EBC was collected over 10 min using a refrigerated condenser according to European Respiratory Society/American Thoracic Society recommendations, and BAL performed immediately thereafter.RESULTS:8-Isoprostane, nitrogen oxides, and pH were significantly higher in EBC than in BAL (3.845 vs. 0.027 ng/ml, 28.4 vs. 3.8 microM, and 7.35 vs. 6.4, respectively; p < 0.001). Hydrogen peroxide showed no difference between EBC and BAL (17.5 vs. 20.6 microM, p = not significant), whereas protein was significantly higher in BAL (33.8 vs. 183.2 microg/ml, p < 0.001). Total phospholipid was also higher in EBC, but keratin showed no difference. No significant correlation was found between EBC and BAL for any of the biomarkers evaluated either before or after correction for dilution.CONCLUSIONS:In clinical disease, markers of inflammation and oxidative stress are easily measurable in EBC using standard laboratory techniques and EBC is readily obtained. However, EBC and BAL markers do not correlate.

Background: Lupin is a legume. Its seed can be ground into flour and incorporated into food as a protein source. Cases of rhinitis, urticaria, and anaphylaxis from ingestion of lupin have been reported as well as asthma.Objective: To present a cross-sectional study of workers in a food processing company who were exposed to lupin and developed occupational allergy secondary to inhaling lupin products.Methods: Subjects were interviewed using a standardized questionnaire, including demographics and current and past symptoms. They underwent skin prick tests (SPTs) to common aeroallergens and lupin products, spirometry, and off-line exhaled nitric oxide measurement. Symptomatic subjects, sensitized to lupin on SPT, underwent methacholine bronchial provocation challenge. Those with bronchial hyperresponsiveness had specific bronchial provocation challenge to lupin.Results: A total of 53154 subjects completed testing (98%). Overall, 21% (11153) had positive SPT results to lupin. The lupin-sensitive group had a trend toward atopy (P = .06). Seven of 11 (64%) subjects in this group were symptomatic; all had rhinitis, and 2 had wheeze. Two subjects had positive methacholine challenges, and 1 had a positive specific bronchial provocation challenge to lupin with both an early-phase and a late-phase response.Conclusion: Allergy to inhaled lupin occurs in the workplace. A high sensitization rate on SPT was found, which correlated with symptoms. The clinical significance of cross-reactivity between legumes on SPT is unclear.Clinical implications: Sensitization to the legume, lupin, can occur from exposure at work and carries a high prevalence of clinical symptoms, which in some cases leads to occupational rhinitis and asthma.