This study aimed to investigate the immediate effects of manual therapy (MT) on the respiratory functions of healthy young individuals. The study included 104 participants, consisting of university students (87 females, 17 males, mean age 20.1 ± 2.2). Participants were randomly assigned to the MT (experimental; n = 52) and sham-MT (control; n = 52) groups. The experimental group underwent thoracic manipulations and mobilizations along with diaphragm mobilization. In the control group, the hands were placed on the same regions, but no specific intervention was applied. All participants underwent respiratory function testing before and after the intervention using a portable spirometer (PEF- Peak expiratory flow; FEV 1- Forced expiratory volume in 1 s; FVC- Forced vital capacity and FEV1/FVC- Tiffeneau index). In the experimental group, there was a significant increase in the mean PEF value following MT application from 296.3 ± 110.8 to 316.1 ± 119.1 (p = 0.018). Conversely, the mean PEF value in the control group showed a slight decrease from 337.1 ± 93.3 to 324.5 ± 89.2 (p = 0.002). No significant changes were observed in FVC, FEV1, or FEV1/FVC values pre- and post-intervention in either groups. A single MT session led to a significant improvement in PEF in healthy young individuals. Further research is needed to explore the long-term effects of MT on respiratory functions and its potential implications in clinical practice.Trial registration ClinicalTrials.gov: NCT05934240 (06/07/2023).

BACKGROUND: We investigated the association of peak expiratory flow (PEF) with dementia; cognitive impairment, no dementia (CIND); and transition from CIND to dementia, and possible underlying neuropathological mechanisms.
METHODS: A population-based cohort of adults aged 60+ was followed over 15 years to detect dementia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria), CIND (assessed through a cognitive battery), and progression from CIND to dementia, in relation to baseline PEF observations. A subsample (n = 462) had 6-year follow-up data on brain magnetic resonance imaging markers of neurodegeneration and small vessel disease.
RESULTS: In fully adjusted models, poor PEF performance (< 10th vs. ≥ 80th percentile) was associated with increased hazards for dementia (hazard ratio [HR] = 1.89; 95% confidence interval [CI] = 1.23-2.92) and CIND (HR = 1.55; 95% CI = 1.01-2.38) and CIND progression to dementia, although not statistically significantly (HR = 2.44; 95% CI = 0.78-6.88). People with poor PEF also experienced the fastest ventricular enlargement (β coefficient = 0.67 mL/year; 95% CI = 0.13-1.21) and had the highest likelihood of developing lacunes (odds ratio = 5.05; 95% CI = 1.01-25.23).
CONCLUSIONS: Poor lung function contributes to cognitive deterioration possibly through accelerated brain atrophy and microvascular damage.
CONCLUSIONS: Poor lung function increased the risk of dementia and mild cognitive impairment (MCI). Poor lung function accelerated the progression from MCI to dementia. Poor lung function was linked to brain microvascular damage and global brain atrophy.

UNASSIGNED: Stroke, prevalent globally, particularly impacts low- and middle-income countries. Decreased lung function is one of the risk factors for stroke, and there is a lack of sufficient research on the association between the two, especially based on evidence from representative large samples. We aimed to explore the association between lung function and stroke incidence.
UNASSIGNED: We collected data from 13,371 participants from the 2007-2012 U.S. national cross-sectional study and 11,192 participants from the Chinese national cohort study during the 2011-2018 follow-up period. Multivariate logistic regression and Cox proportional hazards regression were used to assess cross-sectional and longitudinal associations of peak expiratory flow with stroke risks. Additionally, we used publicly available GWAS data from a European population to conduct Mendelian randomization analysis, further exploring the potential causal relationship.
UNASSIGNED: The results of the cross-sectional study suggest that a decline in peak expiratory flow may be associated with an increased risk of stroke. The cohort study revealed that, compared to the first tertile group, the risk of stroke incidence in the second and third tertile groups of PEF decreased by 19% (hazard ratio (HR) = 0.810, 95%CI = 0.684-0.960) and 21.4% (HR = 0.786, 95%CI = 0.647-0.956), respectively. Mendelian randomization analysis clarified that higher PEF levels are significantly associated with a reduced risk of stroke (OR = 0.852, 95%CI = 0.727-0.997).
UNASSIGNED: Decreased lung function is a risk factor for stroke. As a simple and accurate indicator of lung function, PEF can be used to monitor lung function in community populations and patients for primary stroke prevention.

China\'s Clean Air Act (CCAA) has been demonstrated to reduce the public health burden of ambient air pollution. Few studies have assessed the health effects of CCAA on lung function. We aimed to investigate the effects of CCAA and PM2.5 exposures on peak expiratory flow (PEF) in middle-aged and older people in China. Three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. We performed a difference-in-difference (DID) model and mixed effect method to assess the association between CCAA, PM2.5, and PEF. To increase the reliability, multiple environmental factors were considered, and spline function was utilized to fit the spatial autocorrelations. We found that the risk of decreased PEF in the policy intervention group was reduced by 46% (95% CI: 23%~62%). The estimate showed a 10μg/m3 increase in PM2.5 would increase the risk of decreased PEF by 10% (95% CI: 3%~18%). The results of the mixed effect model showed a 10 μg/m3 increase in PM2.5 concentration was associated with a 2.23% (95% CI: 1.35%~3.06%) decrease in the PEF. These results contributed to the limited epidemiology evidence on demonstrating the effect of PM2.5 on lung function.

UNASSIGNED: Peak Expiratory Flow (PEF) is associated with a variety of adverse health outcomes in older adults; however, the relationship between PEF and frailty remains uncertain, and this study investigated the relationship between PEF and frailty within an olderly Asian demographic.
UNASSIGNED: Data were sourced from the Chinese Health and Retirement Longitudinal Study (CHARLS). Individuals in the study, all 60 years or older, underwent baseline PEF assessments quantified as standardized residual (SR) percentile values. The evaluation of frailty was conducted based on the criteria established by Fried. Participants without frailty at the outset were tracked over a four-year period, during which the relationships between PEF and frailty were examined through logistic regression and discrete-time Cox regression analyses.
UNASSIGNED: Among 5,060 participants, cross-sectional analysis revealed that the prevalence of frailty was 2-3 times higher in the lower 10-49th and < 10th SR percentile groups compared to the 80-100th SR percentile group. The longitudinal study corroborated these results, showing an adjusted hazard ratio (HR) of 2.01 (95% CI, 1.15-3.51) for PEF SR percentiles below the 10th, in contrast to those between the 80th and 100th percentiles.
UNASSIGNED: PEF independently predicts and determines frailty in older adults. Declines in PEF greater than expected are associated with the development of frailty. Subsequent studies are encouraged to delve deeper into the connection between respiratory function and frailty in diverse contexts.

OBJECTIVE: To cross-sectionally and longitudinally investigate the correlations of sarcopenia and its components with peak expiratory flow (PEF) among Chinese community-dwelling elderly people.
METHODS: The data were extracted from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4053 participants aged ≥ 60 years were enrolled from CHARLS 2011, and 2810 were followed up until 2015. Participants were classified into no-sarcopenia, non-severe sarcopenia, and severe sarcopenia groups based on skeletal muscle mass index (SMI), hand grip strength (HGS), and physical performance [gait speed, five-repetition chair stand test (5CST) and short physical performance battery (SPPB)]. Multivariate linear and logistic regression analyses were used to evaluate the associations of sarcopenia and its components with PEF cross-sectionally and longitudinally.
RESULTS: In the cross-sectional analysis, the prevalence of non-severe sarcopenia was 14.6% and severe sarcopenia was 4.9%. The results of linear regression analysis revealed that sarcopenia and its components were all correlated with PEF and PEF%pred. In the longitudinal analysis, compared with non-sarcopenia, subjects with severe sarcopenia were associated with a higher risk of PEF (OR = 2.05, 95%CI = 1.30-3.26) and PEF%pred (OR = 1.83, 95%CI = 1.17-2.86) decline. The changes in physical performance were correlated with changes in PEF and PEF%pred. No associations were observed between changes in SMI and PEF as well as PEF%pred.
CONCLUSIONS: We demonstrated the associations of baseline sarcopenia status with PEF and longitudinal PEF decline. Also, the changes in physical performance were associated with changes in PEF during a 4-year follow-up. It indicates that improving sarcopenia, especially physical performance may increase PEF.

BACKGROUND: The multiple modes of SARS-CoV-2 transmission including airborne, droplet, contact and faecal-oral transmissions that cause coronavirus disease 2019 (COVID-19) contribute to a public threat to the lives of people worldwide. Heavy aerosol production by coughing and the big peak expiratory flow in patients with respiratory infections (especially SARS-CoV-2) during recovery from general anaesthesia are the highest risk factors for infection in healthcare workers. To perform sedation before extubation significantly reduced the incidence of coughing during recovery from general anaesthesia. However, there are few studies on endotracheal tube removal under BIS-guided sedation in postanaesthesia care unit (PACU). We speculated that the BIS-guided sedation with dexmedetomidine and propofol would better prevent coughing caused by tracheal extubation and reducing peak expiratory flow.
METHODS: Patients with general anaesthesia were randomly assigned to Group S (dexmedetomidine was infused in the operating room for 30 min, and the bispectral index (BIS) value was maintained 60-70 by infusion propofol at 0.5~1.5 μg/ml in the PACU until the endotracheal tubes were pulled out) and Group C (no dexmedetomidine and propofol treatment, replaced with the saline treatment). The incidence of coughing, agitation and active extubation, endotracheal tube tolerance and the peak expiratory flow at spontaneous breathing and at extubation were assessed.
RESULTS: A total of 101 patients were randomly assigned to Group S (51 cases) and Group C (50 cases). The incidence of coughing, agitation and active extubation was significantly lower (1(51), 0(51) and 0(51), respectively) in Group S than (11(50), 8(50) and 5(50), respectively) in Group C (p < 0.05 or p < 0.01, respectively); the scores of cough were significantly reduced (1(1, 1)) in Group S than (1(1, 2)) in Group C (p < 0.01); and the endotracheal tube tolerance was significantly improved (0(0, 1)) in Group S than (1(1, 3)) in Group C (p < 0.001). The peak expiratory flow at spontaneous breathing and at extubation was significantly reduced (5(5, 7) and 6.5(6, 8), respectively) in Group S than (8(5, 10) and 21(9, 32)) in Group C (p < 0.001).
CONCLUSIONS: BIS-guided sedation with dexmedetomidine and propofol significantly prevented coughing and reduced peak expiratory flow during recovery from general anaesthesia, which may play an important role in preventing medical staff from contracting COVID-19.
BACKGROUND: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) \"retrospectively registered\".

Lung function decline is associated with sarcopenia, known as loss of skeletal muscle mass. The serum creatinine to cystatin C ratio (CCR) has been proposed as a biomarker of muscle mass. The associations between CCR and lung function decline are unknown.
The study used two waves of data from China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Serum creatinine and cystatin C were collected at baseline survey (2011). Lung function was assessed by peak expiratory flow (PEF) at 2011 and 2015. Linear regression models adjusted for potential confounders were conducted to analyze the cross-sectional association between CCR and PEF, and the longitudinal association between CCR and annual decline in PEF.
Totally, 5812 participants aged over 50 years (50.8% women; mean age 63.3 ± 6.5 years) were enrolled in a cross-sectional analysis in 2011, and further 4164 individuals were followed up in 2015. Serum CCR was positively associated with PEF and the PEF% pred. Per 1 SD higher of CCR was associated with 41.55 L/min increases in PEF (p < 0.001) and 10.77 (%) increase in PEF% pred (p < 0.001). Longitudinal analyses indicated that higher CCR level at baseline was related to slower annual decline in PEF and PEF% pred. And this relationship was significant only in women and in never smokers.
Higher CCR was associated with slower longitudinal PEF decline in women and never smokers. CCR may be a valuable marker to monitor and predict lung function decline in middle-aged and older adults.

Impaired cognitive function can co-exist in chronic respiratory diseases. However, it is not clear if peak expiratory flow (PEF) impacts changes in cognitive function. Our objective was to explore whether peak expiratory flow moderates trajectories of memory, visuospatial abilities, and executive function in individuals with chronic respiratory diseases.
This was an analysis of individuals with lung diseases from the National Health and Aging Trends Study. Multivariable-adjusted generalized linear mixed models were used to estimate trajectories of immediate and delayed recall, and clock drawing over a 10-year follow-up. The interaction between PEF and time were plotted using sex-specific values for peak expiratory flow at 10th, 50th and 90th percentiles.
In females, interactions of time-by-PEF were found for both immediate (n = 489, t = 2.73, p<0.01) and delayed recall (n = 489, t = 3.38, p<0.01). Females in the 10th vs. 90th percentile of PEF declined in immediate recall at 0.14 vs. 0.065 words/year, and 0.17 vs. 0.032 words/year for delayed recall. Among males, recall declined linearly over 10 years (immediate recall: n = 296, t = -3.08, p < 0.01; delayed recall: n = 292, t = -2.46, p = 0.02), with no interaction with PEF. There were no time-by-PEF interactions nor declines over time in clock drawing scores in both sexes (females: n = 484, t = 0.25, p = 0.81; males: n = 291, t = -0.61, p = 0.55).
Females with the lowest PEF values experienced the greatest rates of decline in immediate and delayed recall over 10 years of follow-up, whereas males experienced similar declines in memory outcomes across all levels of PEF. Clock drawing scores remained stable over 10 years in both sexes.

BACKGROUND: The correlation between impaired lung function and cardiovascular diseases (CVD) has attracted more and more attention. We aimed to assess the longitudinal association between decreased peak expiratory flow (PEF) and cardiovascular risk among Eastern Chinese general population.
METHODS: In total, 6295 participants aged>30 years and free of CVD at baseline were followed for up to 10 years in Eastern China. The adjusted hazard ratios (HRs) for CVD and mortality associated with decreased PEF were analyzed.
RESULTS: Among all participants, 421 CVD incident events were reported during 10-year follow-up, and a total of 272 participants died during the follow-up period, 94 of them from CVD. The HRs in the lowest group of PEF (PEF ≤218.33 L/min) were 1.31 (95% confidence interval [CI]:1.01 to 1.68) for high CVD incidence (172 vs 116), 2.43 (95% CI:1.72 to 3.42) for all-cause mortality (156 vs 48), and 3.94 (95% CI:1.96 to 7.92) for CVD mortality (59 vs 10) when compared with the highest group (PEF ≥321.68 L/min).
CONCLUSIONS: The decreased PEF was associated with increased CVD incidence, CVD and all-cause mortality in Eastern Chinese general population.