Introduction: Measuring respiratory pressures is part of assessment of respiratory system. Portable handheld devices have made measurements more accessible in clinics, but reliable consumer devices are still uncommon. A novel respiratory health meter (WellO2-RHM) was developed as a self-administered meter for respiratory training device (WellO2). Aims and objectives: We aimed to investigate the short-term repeatability of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) measured with a WellO2-RHM in healthy volunteers using a time interval of one week. We hypothesized, that within that time interval with no respiratory training, MIP and MEP values would be repeatable and reproducible. Methods: Healthy volunteers (14 males and 10 females) performed MIP and MEP measurements with a WellO2-RHM in two occasions one week apart. The highest individual values of 3-8 successive measurements were recorded. All measurements were guided by the same trained technician. We assessed short-term repeatability by the Coefficient of Variation (CV), Intraclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEm). Results: Short-term repeatability measured with WellO2-RHM in healthy volunteers in terms of CV, ICC and SEm was for MIP 10.0 %, 0.825 (p<0.001) and 7 cmH2O and for MEP 9.1%, 0.895 (p<0.001) and 12 cmH2O, respectively. Conclusions: Short-term repeatability of MIP and MEP measured with a WellO2-RHM in healthy volunteers without any respiratory training was good; CV was within 10 % and ICC > 0.8 for both MIP and MEP. The results suggest that WellO2-RHM could be used for assessment of respiratory training effects.

Introduction: Intensive counterpressure breathing regimes improve lung function of asthmatics. However, the effects of the low or moderate load regimes are less studied. Aim: To study the effects of the moderate load counterpressure breathing on lung function of patients with pharmacologically treated asthma. Method: Adult volunteers with mild or moderate asthma (N=45) were randomized to two groups A (n=25) and B (N=20). Group A performed a daily 15 min counterpressure breathing with warm water steam inhalation by four weeks with a WellO2™ device while subjects in group B continued their normal life without intervention. The counterpressure on ex- and inhaling was adjusted to 30% of the individual MEP. All subjects used at least two inhaled pulmonary medicines throughout the study. Spirometry variables, MEP and MIP were measured before and after the intervention for the groups A and B using the same interval. Results: Baseline values of the lung function in the groups were comparative. The following endpoints increased significantly more in the group A than in the group B: MEP (mean +12.4 %, vs. +3,5%, p=0.047), MIP (mean +20.1 % vs. + 0.82%, p=0.046), VC (mean +3.7 % vs. 1.5%, p=0.017), and forced expiratory time (FET) (mean +15.5%, vs. -5,0%, p=0.024.). In the group A the increases from the baseline were very significant: MEP (p=0.004), MIP (p<0.001), VC (p<0.001), and FET (p<0.001). No side effects due to the intervention were observed. Conclusions: Moderate load counterpressure breathing combined with the steam inhalation for four weeks increases respiratory muscle power, VC and FET in patients with stable asthma on their normal lung medication.

Background: Both asthma and COPD may have a relation to occupational exposure. Especially occupational exposure in manual occupations has been linked with earlier mortality. Aim: To explore differences in mortality between different obstructive respiratory diseases together with an estimated occupational exposure with the use of a large, randomized population-based cohort. Methods: This study included 6062 individuals from the FinEsS-Helsinki study with 1014 deaths during a 24-year follow-up. We applied a Job-exposure Matrix to an occupational categorization to estimate an occupational exposure to airborne particles. The individuals were divided into groups according to their self-reported physician diagnosed asthma, COPD, or the combination of both, or without asthma or COPD, and combined with the exposure estimation. The survival model was adjusted for age, education level, sex, and tobacco smoking status, and used healthy without exposure as reference. Results: High occupational exposure together with asthma 2.06 (95%CI, 1.19-3.57), COPD 4.44 (2.62-7.53) and both diagnoses combined 8.79 (4.51-17.1), had the highest hazard ratios (HR) in in the crude model. High exposure alone had HR 1.93 (1.62-2.31). In the adjusted model, the HRs were: asthma 1.71 (0.93-3.12), COPD 1.80 (1.00-3.25), combined 1.94 (1.10-3.42), high exposure alone 1.35 (1.11-1.63). The combined group also showed a sub-hazard ratio for respiratory mortality 7.21 (3.92-13.3). Conclusions: High occupational exposure alone increases overall mortality but not respiratory related, while the combination of asthma and COPD carries the highest hazard of overall and respiratory mortality.

Introduction: Handheld respiratory pressure meters, such as MicroRPM, have been proven valid and repeatable for measurement of respiratory pressures, but they are intended primarily for clinical use. A novel respiratory health meter (WellO2-RHM) compatible with mobile application was developed as a self-administered meter for respiratory training device (WellO2). Aims and objectives: We sought to explore whether the WellO2-RHM would be a valid method for measurement of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP). Methods: Healthy volunteers (15 males and 11 females, mean age 32.1 ± 3.7 years) performed MIP and MEP measurements successively with the WellO2-RHM and MicroRPM. The highest values of 3-8 successive MIP and MEP measurements were recorded for analysis. In addition, their lung function parameters were measured with spirometry (Vyntus One). All measurements were guided by the same trained technician. Results: MIP and MEP results obtained with WellO2-RHM and MicroRPM correlated significantly (MIP r=0.840, p<0.001, MEP r=0.849, p<0.001). Correlation between MIP and MEP measurements with WellO2-RHM and lung function parameters were mostly significant: MIP vs. VC (r=0.579, p=0.002), FVC (r=0.554, p=0.003), FEV1 (r=0.563, p=0.003), IC (r=0.713, p<0.001), PEF (r=0.506, p=0.008), and MEP vs. VC (r=0.452, p=0.021), FVC (r=0.438, p=0.025), FEV1 (r=0.368, p=0.065), IC (r=0.557, p=0.009) and PEF (r=0.465, p=0.017). Conclusions: WellO2-RHM is a valid portable device for measurement of MIP and MEP with good correlation to the reference method of MicroRPM.

Background Smoking and occupational airborne exposures are known to increase asthma symptoms, but less is known about their influence by the age of asthma diagnosis. Objective To evaluate the effect of exposures to VGDF (vapors, gases, dusts and fumes), tobacco smoke and their combination for asthma symptoms comparing subjects with asthma diagnosed in childhood and adulthood. Methods A random sample of 16 000 adults aged 20–69 years were invited to a postal survey on obstructive pulmonary diseases in Finland in 2016. Those reporting physician-diagnosed asthma and age at diagnosis were included in the analysis and their reported VGDF-exposure and smoking habits were analyzed. Age 18 years was chosen to delineate child- and adult-diagnosed asthma. Results 8199 (51.5%) responded. Of the responders, 831 reported physician-diagnosed asthma. 41% of asthmatics reported child-diagnosed and 59% adult-diagnosed asthma. Current smoking was reported by 25.2% and 20.2% and VGDF exposure by 31.3% and 44.7% in child -diagnosed and adult-diagnosed asthma, respectively. Combined VGDF-exposure and current smoking was reported by 9.7% and 10.6%, respectively. Compared to the unexposed, those with asthma diagnosed in childhood and with combined current smoking and VGDF exposure, had higher prevalence of wheeze (69.7% vs 39.5%, p=0.009), sputum production (39.4% vs 11.4%, p=0.001) and morning dyspnea (42.4% vs 21.9%, p=0.002). Corresponding pattern was seen in those with asthma diagnosed in adulthood; for wheeze (78.8% vs 53.6%, p=0.007), sputum production (40.4% vs 25.0%, p=0.014) and morning dyspnea (65.4% vs 42.0%, p=0.008). Child-diagnosed asthmatics both without exposure history (46.5% vs 69.6%, p=0.001) and with combined exposure to smoking and VGDF (66.7% vs 94.2%, p=0.003) reported less often ≥3 symptoms compared to adult-diagnosed asthmatics, even though they reported less frequently use of asthma medication (60.7% vs 82.0%, p>0.001). Smoking asthmatics with adult-diagnosis and exposure to VGDF had the highest prevalence estimates of having multiple symptoms (94.2%) in our study. Conclusion Although asthmatics diagnosed in child- and adulthood reported symptoms related to exposure to smoking and VGDF, symptoms were reported more often by those with adult diagnosis. The results indicate the importance of targeted asthma treatment and follow-up by patient's exposure history and asthma diagnosis age.

The objective of this study was to evaluate associations between the breathing sound spectra and glottal dimensions in exercise-induced vocal cord dysfunction (EIVCD) during a bicycle ergometry test. Nineteen subjects (mean age 21.8 years and range 13-39 years) with suspected EIVCD were studied. Vocal folds were continuously imaged with videolaryngoscopy and breathing sounds were recorded during the bicycle exercise test. Twelve subjects showed paradoxical movement of the vocal folds during inspiration by the end of the exercise. In seven subjects, no abnormal reactions in vocal folds were found; they served as control subjects. The glottal quotient (interarytenoid distance divided by the anteroposterior glottal distance) was calculated. From the same time period, the tracheal-vocal tract resonance peaks of the breathing sound spectra were analyzed, and stridor sounds were detected and measured. Subjects with EIVCD showed significantly higher resonance peaks during the inspiratory phase compared to the expiratory phase (p < 0.014). The glottal quotient decreased significantly in the EIVCD group (p < 0.001), but not in the control group. 8 out of 12 EIVCD patients (67%) showed stridor sounds, while none of the controls did. There was a significant inverse correlation between the frequencies of the breathing sound resonance peaks and the glottal quotient. The findings indicate that the typical EIVCD reaction of a paradoxical approximation of the vocal folds during inspiration, measured here as a decrease in the glottal quotient, is significantly associated with an increase in inspiratory resonance peaks. The findings are applicable in the documentation of EIVCD findings using videolaryngoscopy, in addition to giving clinicians tools for EIVCD recognition. However, the study is limited by the small number of subjects.

Rationale: The simultaneous measurement of regional lung ventilation, aerosol deposition and the anatomic configuration of airways are crucial for the better understanding of the determinants of aerosol deposition heterogeneity. However, no single imaging modality currently allows the acquisition of all such data simultaneously. The goal of this study was to test the feasibility of KES imaging to this end. Methods: We used KES synchrotron radiation imaging [AJRCCM, 2009;180:296–303] to quantify regional lung ventilation, and the deposition of iodine (Iomeprol 88 mg/ml in NaCl 0.9%), delivered using an ultrasonic nebulizer (mass median aerodynamic diameter: 2.6±0.1 μm), in a healthy anesthetized, and mechanically ventilated rabbit (2.8 kg) in upright position. Regional ventilation images were obtained in 4 axial slices during inhalation of 70% Xe in O 2 . Regional iodine deposition images were obtained in 45 contiguous slices after 0, 5, 10, 15 and 20 minutes of nebulization. Results: See figure. Aerosol deposition showed significant spatial heterogeneity in normal lung. Inset: 3D rendering of central conducting airways (dark) and iodine (medium) and parenchyma (light grey). Conclusions: These data demonstrate the feasibility of K-edge subtraction imaging for the quantitative measurement of regional aerosol deposition, lung ventilation and airway morphology in vivo .

Objective: To examine the incidence of allergic rhinoconjunctivitis and asthma, and to assess allergic rhinoconjunctivitis as a risk factor for incident asthma, we performed a 11-year follow-up postal survey.Methods: The original study population was a random population sample of 8000 inhabitants of Helsinki aged 20-69 years in 1996. Participants in the first postal questionnaire survey, 6062 subjects, were invited to this follow-up study, and provided 4302 (78%) answers out of 5484 traced subjects in 2007.Results: Cumulative incidence of asthma from 1996 to 2007 was 4.0% corresponding to an annual incidence rate of 3.7/1000/year. After exclusion of those with asthma medication or physician-diagnosed chronic bronchitis or COPD at baseline in 1996, the cumulative incidence decreased to 3.5% (incidence rate 3.2/1000/year), and further to 2.7% (2.5/1000/year) when also those reporting recurrent wheeze or shortness of breath during the last year in 1996 were omitted from the population at risk. Remission of asthma occurred in 43 subjects and was 16.9% over 11 years. Cumulative 11-year incidence of allergic rhinoconjunctivitis was 16.9% corresponding to 16.8/1000/year, and cumulative remission was 18.1%. Incidence of allergic rhinoconjunctivitis was significantly lower among those who had lived in the countryside or on a farm during the first 5 years of life, but this was not true for asthma. In multivariate analysis, farm living during the first 5 years of life was protective for the development of allergic rhinoconjunctivitis, OR 0.75 (95%Cl 0.57-0.99). Allergic rhinoconjunctivitis was a significant independent risk factor for incident asthma, OR 2.15 (95%Cl 1.54-3.02). In the cohort, the prevalence of rhinoconjunctivitis increased from 38.0% in 1996 to 40.9% in 2007, physician-diagnosed asthma from 6.8% to 9.4%, while current smoking decreased from 31.3% to 23.3%.Conclusion: Incidence of allergic rhinoconjunctivitis was higher than in earlier studies, while asthma incidence remained on similar level, both being significantly higher in women. Allergic rhinoconjunctivitis doubled the risk for incident asthma. (C) 2011 Elsevier Ltd. All rights reserved.

INTRODUCTION:Our patient was admitted to the hospital due to shortness of breath. Although partial pressure of oxygen in arterial blood was normal, oxygen saturation measured with pulse oximetry (SpO(2)) was markedly decreased. SpO(2) and oxygen saturation of arterial blood (SaO(2)) stayed low during monitoring even with an increased fraction of oxygen in inspired air.METHODS:Report of a case.RESULTS:After extensive investigations, a rare haemoglobin variant, haemoglobin Titusville, with decreased oxygen binding capacity was discovered. This is the first haemoglobin Titusville case reported in Scandinavian countries.

8-Isoprostane is a potential in vivo marker for oxidant burden, but its usefulness in induced sputum of smokers and chronic obstructive pulmonary disease (COPD) has not been investigated.The current study investigated 58 subjects comprising 11 never-smokers, 11 ex-smokers, 13 healthy current smokers and 23 COPD with stage 0-III disease (according to the Global Initiative for Chronic Obstructive Lung Disease criteria). 8-Isoprostane was determined from induced sputum by enzyme immunoassay.Sputum 8-isoprostane levels were similar in the never-smokers and ex-smokers, but were elevated in the healthy smokers compared with nonsmokers, and in those with stage I-III COPD. Sputum 8-isoprostane levels could not differentiate nonsymptomatic smokers from those with Stage 0 COPD. There was a correlation between sputum 8-isoprostane level and lung function parameters (forced expiratory volume in one second/forced vital capacity and sputum neutrophils.In conclusion, sputum 8-isoprostane levels correlate with the severity of chronic obstructive pulmonary disease. However, they do not appear to differentiate healthy smokers from those who are at risk of developing chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease stage 0).

Study objectives: Muscle is one of the most commonly affected organs in mitochondrial disorders, and the symptoms are often exercise related. The cardiopulmonary exercise test with the determination of lactic acid formation could give supplementary information about the exercise-induced metabolic stress and compensatory mechanisms used in these disorders. The aim of this study was to evaluate the exercise capacity and lactate kinetics related to exercise in subjects with two genetically characterized mitochondrial disorders (multiple mitochondrial DNA deletions with PEO, MELAS) compared with lactate kinetics in subjects with metabolic myopathy (McArdle's disease) and in the healthy controls.Design: The subjects were consecutive, co-operative patients of Department of Neurology of Helsinki University Hospital. Molecular genetic analyses were used for group classification of the mitochondrial myopathy.Study subjects: The study groups consisted of 11 patients with multiple deletions (PEO) and five patients with a point mutation in the mitochondrial DNA (MELAS), four patients with a muscle phosphorylase enzyme deficiency (McArdle's disease) and 13 healthy controls. The clinical disease of the patients was relatively mild.Measurements and results: A graded exercise test with ventilatory gas analyses and venous blood lactic acid analyses was performed. The main finding was the prolonged accumulation of blood lactate after the exercise in the PEO and MELAS groups compared with the controls. An overcompensation in ventilation was found in the MELAS and PEO group.Conclusions: The blood lactate accumulation after exercise occurs in patients with multiple mitochondrial DNA deletions or MELAS even in patients with only mild exercise intolerance. Cardiopulmonary exercise can be used in the diagnostic process of patients with mitochondrial myopathies.