Obesity and Lung Disease A Guide to Pathophysiology

Evaluation and Management 2nd Edition Anne E. Dixon

2025 easy download

https://ebookfinal.com/download/obesity-and-lung-disease-a-guide-to-
pathophysiology-evaluation-and-management-2nd-edition-anne-e-dixon/

★★★★★
4.7 out of 5.0 (55 reviews )

Quick PDF Download

ebookfinal.com
 Obesity and Lung Disease A Guide to Pathophysiology
Evaluation and Management 2nd Edition Anne E. Dixon Pdf
Download

EBOOK

Available Formats

■ PDF eBook Study Guide Ebook

EXCLUSIVE 2025 ACADEMIC EDITION – LIMITED RELEASE

Available Instantly Access Library

We have selected some products that you may be interested in
Click the link to download now or visit ebookfinal.com
for more options!.

Obesity Epidemiology Pathophysiology and Prevention Second

Edition Debasis Bagchi

https://ebookfinal.com/download/obesity-epidemiology-pathophysiology-
and-prevention-second-edition-debasis-bagchi/

Lung Injury Mechanisms Pathophysiology and Therapy 1st

Edition Robert H. Notter

https://ebookfinal.com/download/lung-injury-mechanisms-
pathophysiology-and-therapy-1st-edition-robert-h-notter/

Proteoglycans in Lung Disease Lung Biology in Health and

Disease 1st Edition Hari G. Garg

https://ebookfinal.com/download/proteoglycans-in-lung-disease-lung-
biology-in-health-and-disease-1st-edition-hari-g-garg/

Obesity Evaluation and Treatment Essentials Second Edition

Steelman

https://ebookfinal.com/download/obesity-evaluation-and-treatment-
essentials-second-edition-steelman/
Lung Biology in Health Disease Volume 150 Severe Asthma
Pathogenesis and Clinical Management 2nd Edition Stanley J
Szefler
https://ebookfinal.com/download/lung-biology-in-health-disease-
volume-150-severe-asthma-pathogenesis-and-clinical-management-2nd-
edition-stanley-j-szefler/

Lung Development and Regeneration Lung Biology in Health

and Disease 1st Edition Donald J. Massaro

https://ebookfinal.com/download/lung-development-and-regeneration-
lung-biology-in-health-and-disease-1st-edition-donald-j-massaro/

Obesity and Cardiovascular Disease 1st Edition Gianluca

Iacobellis

https://ebookfinal.com/download/obesity-and-cardiovascular-
disease-1st-edition-gianluca-iacobellis/

Pleural Disease Second Edition Lung Biology in Health and

Disease Demosthenes Bouros

https://ebookfinal.com/download/pleural-disease-second-edition-lung-
biology-in-health-and-disease-demosthenes-bouros/

Pathophysiology of disease 1st edition Edition Hammer

https://ebookfinal.com/download/pathophysiology-of-disease-1st-
edition-edition-hammer/
Obesity and Lung Disease A Guide to Pathophysiology
Evaluation and Management 2nd Edition Anne E. Dixon
Digital Instant Download
Author(s): Anne E. Dixon, Erick Forno
ISBN(s): 9783031526954, 3031526953
Edition: 2nd
File Details: PDF, 13.76 MB
Year: 2024
Language: english
Respiratory Medicine
Series Editors: Sharon I. S. Rounds · Anne E. Dixon · Lynn M. Schnapp

Anne E. Dixon
Erick Forno Editors

Obesity
and Lung
Disease
A Guide to Pathophysiology, Evaluation,
and Management
Second Edition
Respiratory Medicine

Series Editors
Sharon I. S. Rounds, Brown University, Providence, RI, USA
Anne E. Dixon, University of Vermont, Larner College of Medicine
Burlington, VT, USA
Lynn M. Schnapp, University of Wisconsin - Madison, Madison, WI, USA
Respiratory Medicine offers clinical and research-oriented resources for
pulmonologists and other practitioners and researchers interested in respiratory
care. Spanning a broad range of clinical and research issues in respiratory medicine,
the series covers such topics as COPD, asthma and allergy, pulmonary problems in
pregnancy, molecular basis of lung disease, sleep disordered breathing, and others.
The series editors are Sharon Rounds, MD, Professor of Medicine and of
Pathology and Laboratory Medicine at the Alpert Medical School at Brown
University, Anne Dixon, MD, Professor of Medicine and Director of the Division of
Pulmonary and Critical Care at Robert Larner, MD College of Medicine at the
University of Vermont, and Lynn M. Schnapp, MD, George R. And Elaine Love
Professor and Chair of Medicine at the University of Wisconsin-Madison School of
Medicine and Public Health.
Anne E. Dixon • Erick Forno
Editors

Obesity and Lung Disease

A Guide to Pathophysiology, Evaluation,
and Management

Second Edition
Editors
Anne E. Dixon Erick Forno
Department of Medicine Pulmonary, Allergy, and Sleep Medicine
University of Vermont Larner Department of Pediatrics
College of Medicine Indiana University School of Medicine
Burlington, VT, USA Indianapolis, IN, USA

ISSN 2197-7372     ISSN 2197-7380 (electronic)

Respiratory Medicine
ISBN 978-3-031-52695-4    ISBN 978-3-031-52696-1 (eBook)
https://doi.org/10.1007/978-3-031-52696-1

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2013, 2024
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.

This Humana imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

If disposing of this product, please recycle the paper.

Contents

1 
Effects of Obesity on Lung Function��������������������������������������������������������   1
Gregory G. King
2 Obesity-Mediated Alterations in Immune Function,
Host Defense, and Lung Disease �������������������������������������������������������������� 21
Anna Reichenbach, Silvia Cabrera Guerrero, and Deepa Rastogi
3 
Obesity, the Microbiome, and Lung Disease ������������������������������������������ 43
Jennifer L. Ingram and Yvonne J. Huang
4 
Genetics and Genomics of Obesity and Lung Diseases�������������������������� 73
Erick Forno
5 
The Western Dietary Pattern and Respiratory Health�������������������������� 83
Bronwyn S. Berthon, Lily M. Williams, Hayley A. Scott,
Evan J. Williams, and Lisa G. Wood
6 
Pathogenesis of Obstructive Sleep Apnea in Obesity������������������������������ 125
Susheel P. Patil and Jason Paul Kirkness
7 Obesity Hypoventilation Syndrome �������������������������������������������������������� 151
Alejandra C. Lastra, Nancy Stewart, and Babak Mokhlesi
8 
Obesity and Asthma: Epidemiology and Clinical Presentation������������ 181
Jessica Reyes-Angel and Erick Forno
9 
Obesity and Asthma: Metabolic Dysregulation�������������������������������������� 201
Fernando Holguin
10 
Obesity and Asthma: Endotypes and Mechanisms�������������������������������� 211
Arjun Mohan, Muhammad Adrish, and Njira L. Lugogo
11 
Asthma Management in Obesity�������������������������������������������������������������� 229
Anne E. Dixon and Sharmilee M. Nyenhuis
12 Obesity and Chronic Obstructive Pulmonary
Disease (COPD)������������������������������������������������������������������������������������������ 249
Frits M. E. Franssen

v
vi Contents

13 
Obesity, Metabolic Syndrome, and Pulmonary Hypertension�������������� 267
Jessica B. Badlam
14 
Association of Obesity and Thromboembolic Disease���������������������������� 289
Margarita Kushnir and Henny Billett
15 
Obesity and Respiratory Infections Including COVID-19�������������������� 301
Peter Mancuso
16 
Obesity and Lung Health in Children������������������������������������������������������ 321
Jason E. Lang and Dharini Bhammar
17 
Obesity and Acute Respiratory Distress Syndrome�������������������������������� 347
William G. Tharp and Renee D. Stapleton
18 Obesity and Mechanical Ventilation�������������������������������������������������������� 365
Lorenzo Berra and Luigi G. Grassi
19 
Obesity and COVID-19 in the Intensive Care Unit�������������������������������� 387
MaryEllen Antkowiak

Index������������������������������������������������������������������������������������������������������������������ 403
Contributors

Muhammad Adrish Section of Pulmonary, Critical Care and Sleep Medicine,

Baylor College of Medicine, Houston, TX, USA
MaryEllen Antkowiak Department of Medicine, Larner College of Medicine,
University of Vermont, Burlington, VT, USA
Jessica B. Badlam Division of Pulmonary Disease and Critical Care Medicine,
University of Vermont Medical Center, Burlington, VT, USA
Lorenzo Berra Massachusetts General Hospital, Boston, MA, USA
Harvard Medical School, Boston, MA, USA
Bronwyn S. Berthon Immune Health Research Program, Hunter Medical Research
Institute, The University of Newcastle, Newcastle, NSW, Australia
Dharini Bhammar Department of Internal Medicine, The Ohio State University,
Columbus, OH, USA
Henny Billett Division of Hematology, Department of Oncology, Montefiore
Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
Anne E. Dixon Department of Medicine, Larner College of Medicine, University
of Vermont, Burlington, VT, USA
Erick Forno Department of Pediatrics, Indiana University School of Medicine,
Indianapolis, IN, USA
Pulmonary, Allergy, and Sleep Medicine, Riley Children’s Hospital,
Indianapolis, IN, USA
Frits M. E. Franssen Department of Research and Education, CIRO, Horn, The
Netherlands
Department of Respiratory Medicine, Maastricht University Medical Center,
Maastricht, The Netherlands
Luigi G. Grassi Ca Granda Maggiore Hospital, Milan, Italy

vii
viii Contributors

Silvia Cabrera Guerrero Children’s National Hospital, Washington, DC, USA

George Washington University School of Medicine and Health Sciences,
Washington, DC, USA
Fernando Holguin Division of Pulmonary and Critical Care Medicine, Department
of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
Yvonne J. Huang Division of Pulmonary/Critical Care Medicine, Department of
Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Department of Microbiology and Immunology, University of Michigan, Ann
Arbor, MI, USA
Jennifer L. Ingram Division of Pulmonary, Allergy and Critical Care Medicine,
Department of Medicine, Duke University, Durham, NC, USA
Department of Pathology, Duke University, Durham, NC, USA
Department of Surgery, Duke University, Durham, NC, USA
Gregory G. King Department of Respiratory and Sleep Medicine, Royal North,
Shore Hospital, St Leonards, NSW, Australia
The Woolcock Institute of Medical Research and Northern Clinical School,
University of Sydney, Sydney, NSW, Australia
Jason Paul Kirkness Division of Pulmonary, Critical Care and Sleep Medicine,
University of Miami Miller School of Medicine, Miami, FL, USA
Margarita Kushnir Division of Hematology, Banner MD Anderson Cancer
Center, Phoenix, AZ, USA
Jason E. Lang Division of Pulmonary & Sleep Medicine, Department of Pediatrics,
Duke Clinical Research Institute, Duke University School of Medicine,
Durham, NC, USA
Alejandra C. Lastra Section of Pulmonary and Critical Care, The University of
Chicago, Chicago, IL, USA
Njira L. Lugogo Division of Pulmonary and Critical Care Medicine, University of
Michigan, Ann Arbor, MI, USA
Peter Mancuso Department of Nutritional Sciences, Graduate Program in
Immunology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
Arjun Mohan Division of Pulmonary and Critical Care Medicine, University of
Michigan, Ann Arbor, MI, USA
Babak Mokhlesi Division of Pulmonary, Critical Care and Sleep Medicine, Rush
Lung Center, Rush University Medical Center, Chicago, IL, USA
Sharmilee M. Nyenhuis Department of Pediatrics, University of Chicago,
Chicago, IL, USA
Contributors ix

Susheel P. Patil Division of Pulmonary, Critical Care, and Sleep Medicine,

University Hospitals, Cleveland, OH, USA
Deepa Rastogi Children’s National Hospital, Washington, DC, USA
George Washington University School of Medicine and Health Sciences,
Washington, DC, USA
Anna Reichenbach Children’s National Hospital, Washington, DC, USA
Jessica Reyes-Angel Division of Pediatric Pulmonary Medicine, UPMC Children’s
Hospital of Pittsburgh, Pittsburgh, PA, USA
Department of Pediatrics, University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA
Hayley A. Scott Immune Health Research Program, Hunter Medical Research
Institute, The University of Newcastle, Newcastle, NSW, Australia
Renee D. Stapleton Division of Pulmonary and Critical Care Medicine, Department
of Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
Nancy Stewart Division of Pulmonary, Critical Care and Sleep Medicine, The
University of Kansas, Lawrence, KS, USA
William G. Tharp Department of Anesthesiology, University of Vermont Larner
College of Medicine, Burlington, VT, USA
Evan J. Williams Immune Health Research Program, Hunter Medical Research
Institute, The University of Newcastle, Newcastle, NSW, Australia
Lily M. Williams Immune Health Research Program, Hunter Medical Research
Institute, The University of Newcastle, Newcastle, NSW, Australia
Lisa G. Wood Immune Health Research Program, Hunter Medical Research
Institute, The University of Newcastle, Newcastle, NSW, Australia
Effects of Obesity on Lung Function
1
Gregory G. King

Contents
Introduction 2
 dipose Tissue and Respiratory Mechanics
A 3
Intra-abdominal and Intrathoracic Pressures 3
Respiratory System Compliance 4
Lung Volumes 6
Spirometry 8
Breathing Pattern 9
Peripheral Airway Function: Oscillometric Impedance and Nitrogen Washout 9
Expiratory Flow Limitation During Tidal Breathing 11
Intrinsic PEEP and Dynamic Hyperinflation 12
Breathless During Exercise 12
Ventilation Distribution 13
Gas Exchange 13
Effects of Obesity on Respiratory Function in Disease 13
Interpretation of Lung Function 14
References 15

G. G. King (*)
Department of Respiratory and Sleep Medicine, Royal North Shore Hospital,
St Leonards, NSW, Australia
The Woolcock Institute of Medical Research and Northern Clinical School, University of
Sydney, Sydney, NSW, Australia
e-mail: [email protected]

© The Author(s), under exclusive license to Springer Nature 1

Switzerland AG 2024
A. E. Dixon, E. Forno (eds.), Obesity and Lung Disease, Respiratory Medicine,
https://doi.org/10.1007/978-3-031-52696-1_1
2 G. G. King

Introduction

The accumulation of adipose tissue, leading to the development of obesity, has a

profound effect on human physiology, including significant effects on respiratory
function due to the mechanical effects of excess adipose tissue on the balance of
forces that normally act on the lung. In addition, adipose tissue produces hormones
and other mediators, collectively termed adipokines, which are associated with low-­
grade systemic inflammation that can act indirectly on the respiratory system.
However, at present, it is unclear whether this causes any measurable impairment in
respiratory function. The changes in lung function associated with obesity can lead
to respiratory symptoms in otherwise healthy people, which are accentuated in
those with respiratory disease, as a result of interaction between disease pathophysi-
ology and the direct and indirect effects of obesity. The outcomes of this interaction
are complex and differ according to the disease and the outcome of interest. The
major effects of obesity on lung function are summarized in Fig. 1.1 and suggest
that, at least in adults and older adolescents, many of the changes in lung function
result from changes in respiratory system mechanics and reduction in operating
lung volume, whereas others may be due to other non-volume-related factors. In
this chapter, the effects of obesity on lung function and the relationships

Fig. 1.1 The effects of obesity on lung function, illustrating likely mechanisms. See text for more
detailed discussion
1 Effects of Obesity on Lung Function 3

summarized in Fig. 1.1 will be reviewed along with the effects of these impairments
on respiratory symptoms. Some of the changes in lung function seen with obesity in
the paediatric population will be covered in Chap. 16 later in this book.

Adipose Tissue and Respiratory Mechanics

In adults over age 20, obesity is defined as a body mass index (BMI) >30 kg/m2.
However, BMI is a non-specific measure of body mass that includes both fat and
lean mass, without any account of differences in fat distribution. Central obesity is
associated with increased adipose tissue in the anterior chest and abdominal walls
and visceral organs, whereas peripheral obesity reflects adiposity located peripher-
ally on limbs, or in subcutaneous tissue. The effect of obesity on respiratory func-
tion is likely to be determined by the distribution of fat mass. Therefore, the increase
in abdominal and chest wall fat in central obesity is more likely to push the chest
wall inwards and push the diaphragm in a cranial direction, thus reducing thoracic
volume at functional residual capacity (FRC) and expiratory reserve volume (ERV).
A reduction in FRC is the most recognized abnormality in lung function due to
obesity, but it varies greatly between individuals—there being only a moderate rela-
tionship with BMI [1]. The heterogeneity in lung volume response is likely due to
variations in total fat mass, distribution of that fat, effects of ageing on the mechani-
cal properties of the lung, airways and chest wall, and variations in chest and lung
compliances. In addition, visceral fat is more metabolically active than subcutane-
ous fat, and its increase or dysfunction may therefore make a greater contribution to
low-grade systemic inflammation in obesity. Adipose tissue is also found inside the
thoracic cavity, predominantly as pericardial fat, which, when combined with
obesity-­associated increase in the volume of the heart and major blood vessels, can
reduce the volume of the thoracic cavity [2].

Intra-abdominal and Intrathoracic Pressures

Obesity is associated with chronic increases in intra-abdominal pressure that may

affect the pleural space by altering pressure across the diaphragm. Intra-abdominal
pressure is increased in obese subjects compared to non-obese [3, 4] and is greater
in men than women [4], likely due to the greater prevalence of central obesity in
men. Indeed, intra-abdominal pressure correlates with markers of central obesity,
such as the sagittal abdominal diameter [3, 4]. In addition, in contrast to intra-­
abdominal pressure, studies in supine anaesthetized subjects [3, 4] have shown that
abdominal obesity, measured by waist circumferences and by sagittal abdominal
diameter, is not correlated with pleural pressures. Since the relationship between
abdominal pressure and pleural pressure is mediated by the diaphragm, the lack of
correlation between the two may be due to compensatory increase in passive tension
in the diaphragm in response to increased intra-abdominal pressure in the obese.
Alternatively, factors other than increased abdominal pressures, such as changes in
4 G. G. King

a b c

Fig. 1.2 Compliance curves for the chest wall (CCW), lung (CL) and respiratory system (Crs) in
normal-weight (a) and obese individuals (b, c). Functional residual capacity (FRC) as indicated by
the solid line, where Crs is zero, is reduced in the obese individual. Crs, which is represented by the
slope of the linear portion, of the solid line above FRC, is reduced

the mechanical properties of the chest wall, may also contribute to the altered lung
volumes in obesity. Imaging studies of abdominal and thoracic fat have shown that
both regions make a significant contribution to impairments of lung function in the
obese [5].
Pleural pressures are also increased (i.e. less negative) in obese compared to non-­
obese adults at FRC. This is likely due to a rightward shift of the pressure-volume
curve of the chest wall due to mass loading (i.e. compliance is unchanged; see
below and Fig. 1.2) such that the outward recoil pressure from the chest wall is
reduced at any given volume, which lowers FRC, thus raising pleural pressure by
being on the lower part of the lung’s pressure-volume curve. However, pleural pres-
sure at FRC may even exceed atmospheric pressure in the dependent parts of the
lungs [3, 4], which would occur with greater mass loading of the chest wall and with
reduced lung elastic recoil (which would occur with age). The functional conse-
quence is closure of small airways with potential effects on gas exchange and inspi-
ratory threshold loading (increased inspiratory effort required to overcome the
positive pressure for lung inflation to occur).

Respiratory System Compliance

One might expect that the stiffness (or its inverse being compliance) of the respira-
tory system, which comprises the lungs and chest wall, may be increased in obesity,
due to structural alterations associated with obesity. There are, however, only a few
studies that examine this, which are old and involve few subjects, with varying
methodologies. Measurements of chest wall compliance require an absence of
respiratory muscle activity since muscle activity stiffens the chest wall, which is
difficult to achieve in non-paralysed subjects. Furthermore, supine oesophageal
measurements in obesity pose problems of measurement noise and interpretation.
1 Effects of Obesity on Lung Function 5

This probably explains the conflicting findings from those few studies. Taken
together, data suggest that both chest wall and lung stiffness may be increased in
some obese subjects, with considerable heterogeneity between individuals which
has not been explored. What is important however, from a clinical standpoint, is not
whether chest wall or lung mechanics are altered, but that there is considerable
variation in mechanical alterations due to obesity, which will have variable effects
on symptoms and underlying disease.
There are two seminal studies looking at respiratory system compliances in
awake obese individuals; both are from the 1960s and performed in adults [6, 7].
With small numbers of n = 12 obese subjects in upright and supine positions [6] and
n = 15 obese subjects in supine posture [7], oesophageal pressures were measured
over a range of lung volumes, which were induced by either sucking or blowing air
into a ‘tank respiratory’ (or ‘iron lung’) [7] or a body plethysmograph [6] to achieve
passive inflation or deflation. This allowed subjects to remain in the ‘relaxed’ state
where respiratory muscles were not activated. In both studies, chest wall compli-
ance was decreased, particularly in those with obesity-hypoventilation syndrome
[6]. In a more recent study of 14 obese, seated males, using a different methodology,
chest wall compliance was not affected by obesity [8]. There are three studies of
obese subjects under anaesthesia and paralysis, which removed respiratory muscle
contribution to chest wall compliance [9–11]. Chest wall compliance was reduced
in two studies by the same group [10, 11], but was normal in the other [9].
The results of studies looking at lung compliance are also conflicting. Lung com-
pliance was normal in the two studies from the 1960s [6, 7], as well as in a subse-
quent study of nine subjects [12]. The studies of anaesthetized and paralysed
individuals, however, revealed reduced lung compliances [9–11]. Again, these con-
flicting results need to be interpretated in light of the methodological challenges.
Static lung compliance is measured as the slope of volume versus pressure, over an
arbitrary volume starting at end-expiratory lung volume where the relationship
should be linear. However, airway closure makes the curve ‘S’ shaped, becoming
flatter (lower compliance) at lower lung volumes (which is what typically happens
to FRC in obesity), and so compliance measurements are affected by the volumes
over which they are calculated [12]. Increased pulmonary blood volume [13] and
increased alveolar surface tension due to a reduction in FRC may also potentially
contribute. Differences in methodology between studies including differences in
posture, effects of anaesthesia and mechanical ventilation and patient selection
mean that no strong conclusions can be made about whether obesity has any effect
on lung compliance.
Aside from uncertainties of whether chest and lung compliances are reduced in
obesity, the effects of mass loading seem much clearer. This is purely the effect of
greater weight on the chest wall and abdomen, which compresses the respiratory
system (reducing FRC) and increases the work of breathing, independently of any
change in compliance. Mass loading experiments suggest that loading the chest wall
produces a rightward shift of the chest wall’s pressure-volume curve (see Fig. 1.2b)
without a change in shape (compliance) [14]. FRC is decreased, and the respiratory
system compliance curve, which is the summation of the chest wall and lung curves,
6 G. G. King

is also right-shifted and the slope (compliance) may or may not be affected. Mass
loading of the abdomen, however, does reduce the compliance of the chest wall
(Fig. 1.2c) [14], which would then alter total respiratory system compliance. Thus,
during inspiration, the pressure required for any given tidal inspiration is greater,
due to the summation of mass loading effects on the chest wall and abdomen. The
differential effects of obesity on the chest wall versus abdomen may also partly
explain the conflicting results in the literature.

Lung Volumes

Relaxation Volume: FRC

Obesity has a major effect on resting lung volume, causing a reduction in lung vol-
ume at relaxation, when the recoil pressures of the lung and chest wall are equal and
opposite (Fig. 1.2). The relaxation volume of the lung usually equates to the func-
tional residual capacity (FRC), which is very commonly reduced in obesity [1, 10].
FRC is exponentially related to BMI [1, 10], with reduction in FRC being detected
even in overweight individuals [1]. This is illustrated in Fig. 1.3, which shows the
relationship between BMI and FRC in a study of young adults, aged 28–30 years
[15]. The reduction in FRC is also manifested by an increase in inspiratory capacity
(IC). With increasing severity of obesity, the reduction in FRC may become so
marked that the FRC approaches residual volume (RV), leaving the individual with
a negligible expiratory reserve volume (ERV) [1]. In fact, in many studies, the
reduction in ERV is one of the earliest and most marked changes in lung function
that occurs with increasing weight [16].
The relationship between BMI and FRC, shown in Fig. 1.3, is steeper in men
than in women. This difference in slope is likely to result from differences in the
prevalence of central obesity between men and women. Central obesity, associated

Fig. 1.3 Relationship

between BMI and FRC in
young men (open squares,
solid line) and women
(solid triangles, dashed
line)
1 Effects of Obesity on Lung Function 7

with greater fat deposition on the trunk and abdomen, is likely to have a greater
effect on respiratory system compliance than peripheral fat distribution. Reductions
in lung volumes are associated with both abdominal fat, measured by waist circum-
ference [17], waist-to-hip ratio [18] or abdominal height [19], and thoracic or upper
body fat, measured by sub-scapular skinfold thickness [20] or biceps skinfold thick-
ness [16]. Sutherland et al. [5] used a wide range of body fat variables to determine
the effect of fat distribution on lung volumes in healthy adults. Lung volumes were
only loosely associated with BMI; however, both dual-energy X-ray absorptiometry
(DEXA) and non-DEXA-derived measures of upper body fat showed highly signifi-
cant negative correlations with FRC and ERV in both men and women. Both
abdominal obesity and thoracic fat mass were similarly correlated with lung vol-
umes. Improvements in lung volumes such as FVC, FRC and ERV, following mod-
erate weight loss, were related to the cumulative loss of fat from the chest and
subcutaneous abdominal and visceral fat, all of which may affect the mechanical
function of the respiratory system [21].

Total Lung Capacity

In contrast, the effects of obesity on the upper and lower limits of lung volumes,
total lung capacity (TLC) and RV are modest. Increasing body weight is associated
with only small decrease in TLC [1, 22, 23], and RV is usually well preserved but
may even be reduced in severe obesity [2, 22, 24–26]. As a result, the RV/TLC ratio
remains normal or slightly increased in obese individuals [1, 25].
The magnitude of the reduction in TLC with increasing weight is proportionally
smaller than the effect on FRC, at least until BMI exceeds 35 kg/m2 [1]. Lung
restriction of the magnitude associated with restrictive lung disease, defined as TLC
below the lower limit of normal, is not commonly associated with obesity in the
absence of other diseases. Prospective studies show that TLC increases with weight
loss in both mild [27] and morbidly obese [28] subjects.
The reduction in TLC in the obese is likely at least partly due to impaired down-
ward movement of the diaphragm, due to increased abdominal mass and/or compli-
ance, which limits the room for lung expansion on inflation. In addition, deposition
of fat in sub-pleural spaces [29] or elsewhere in the intrathoracic cavity might
directly reduce lung volume by reducing the volume of the chest cavity. An explor-
atory study to investigate the mechanism for reduced TLC in obesity used MRI to
measure intrathoracic volumes in obese and non-obese men and found increased
mediastinal volume in the obese due to an increase in the volume of intrathoracic
fat, the heart and major blood vessels [2]. At full inflation, the proportion of the
intrathoracic volume occupied by inflated lungs was only 78% of the total in the
obese compared with 88% in the controls, suggesting that the increased mediastinal
volume may prevent full lung expansion in the obese and may therefore explain the
slight loss of TLC with increasing BMI. However, the marked loss of TLC in obese
subjects with lung restriction (TLC <80% predicted) was not explained by increased
mediastinal volume, suggesting that other factors, such as reduced expansion of the
8 G. G. King

thoracic cage and reduced diaphragmatic excursion, may also be important in this
subgroup [2]. Since respiratory muscle strength and maximum inspiratory and expi-
ratory pressures have been shown to be intact in obesity [24, 30, 31], it is unlikely
that these would be an important determinant of obesity-related reduction in TLC.

Spirometry

Vital capacity (VC) is reduced due to a small reduction in TLC, but relative preserva-
tion of RV. There is a progressive linear decrease in VC with increasing BMI that
parallels the decrease in TLC [1]. Similarly, increasing BMI is also associated with a
decrease in both FEV1 and FVC [26, 32, 33]. However, this effect is small, and both
FEV1 and FVC are usually within the normal range in healthy obese adults [32, 33]
and children [34]. As a result, the FEV1/FVC ratio, which is a marker of airway
obstruction, is usually well preserved or increased [20, 26, 33–35], even in morbid
obesity [25]. Figure 1.4 shows data from a population of 1971 adults aged between
17 and 73 years [32] based on the per cent of predicted values. Although FVC is
affected to a greater extent than FEV1 as BMI increases, FEV1/FVC ratio remains
normal across the weight groups, even in the severely obese group. Studies looking
at the effect of body fat distribution on spirometry have shown that abdominal obe-
sity is a stronger predictor than either weight or BMI of reductions in FEV1 and FVC
[19, 36], with one very large study of over 130,000 people suggesting that abdominal
obesity may also be a risk for reduced FEV1/FVC ratio [36]. Moreover, weight gain
following smoking cessation [37] or with increasing age [38] is associated with
reductions in both FEV1 and FVC; the effect is greater on FVC than on FEV1 and
greater in men than women, presumably because men gain more abdominal fat than
women. It is important to note that these findings may differ in children, in whom
FEV1 and FVC may actually be high among those with obesity, with greater increases

Fig. 1.4 Mean spirometric

values, according to weight
category, in adults (adapted
from data in Schachter
et al. Thorax 2001). FEV1
(diamonds) and FVC
(triangles), as per cent
predicted, and FEV1/FVC
(squares) as a percentage
Random documents with unrelated
content Scribd suggests to you:
 Machine Learning - Quick Reference
Winter 2025 - Center

Prepared by: Researcher Johnson

Date: August 12, 2025

Exercise 1: Experimental procedures and results

Learning Objective 1: Current trends and future directions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Ethical considerations and implications
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 3: Ethical considerations and implications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 4: Case studies and real-world applications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Problem-solving strategies and techniques
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 5: Learning outcomes and objectives
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Comparative analysis and synthesis
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Practical applications and examples
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Research findings and conclusions
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Literature review and discussion
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 10: Diagram/Chart/Graph]
Appendix 2: Literature review and discussion
Practice Problem 10: Ethical considerations and implications
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 11: Interdisciplinary approaches
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Problem-solving strategies and techniques
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Critical analysis and evaluation
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Fundamental concepts and principles
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Critical analysis and evaluation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 16: Diagram/Chart/Graph]
Important: Current trends and future directions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Historical development and evolution
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 18: Best practices and recommendations
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Current trends and future directions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Introduction 3: Case studies and real-world applications
Note: Current trends and future directions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Historical development and evolution
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 23: Diagram/Chart/Graph]
Key Concept: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Learning outcomes and objectives
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Research findings and conclusions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 26: Best practices and recommendations
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Experimental procedures and results
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Background 4: Key terms and definitions
Important: Theoretical framework and methodology
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 31: Practical applications and examples
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Problem-solving strategies and techniques
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Interdisciplinary approaches
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 34: Diagram/Chart/Graph]
Important: Case studies and real-world applications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 36: Diagram/Chart/Graph]
Practice Problem 36: Case studies and real-world applications
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Statistical analysis and interpretation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 38: Current trends and future directions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Practice Problem 39: Assessment criteria and rubrics
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Unit 5: Fundamental concepts and principles
Definition: Interdisciplinary approaches
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 42: Literature review and discussion
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 43: Diagram/Chart/Graph]
Important: Fundamental concepts and principles
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Case studies and real-world applications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 45: Diagram/Chart/Graph]
Definition: Best practices and recommendations
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 46: Diagram/Chart/Graph]
Key Concept: Theoretical framework and methodology
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Critical analysis and evaluation
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 48: Historical development and evolution
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 49: Case studies and real-world applications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Topic 6: Interdisciplinary approaches
Example 50: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 51: Current trends and future directions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Study tips and learning strategies
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Statistical analysis and interpretation
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Critical analysis and evaluation
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Assessment criteria and rubrics
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Critical analysis and evaluation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 58: Critical analysis and evaluation
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 59: Learning outcomes and objectives
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 60: Diagram/Chart/Graph]
Exercise 7: Assessment criteria and rubrics
Practice Problem 60: Learning outcomes and objectives
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 61: Diagram/Chart/Graph]
Key Concept: Literature review and discussion
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Comparative analysis and synthesis
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Fundamental concepts and principles
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 64: Interdisciplinary approaches
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Study tips and learning strategies
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 67: Diagram/Chart/Graph]
Definition: Theoretical framework and methodology
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Historical development and evolution
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Theoretical framework and methodology
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Test 8: Research findings and conclusions
Example 70: Case studies and real-world applications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 71: Diagram/Chart/Graph]
Key Concept: Historical development and evolution
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 72: Diagram/Chart/Graph]
Remember: Ethical considerations and implications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Comparative analysis and synthesis
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 74: Diagram/Chart/Graph]
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

ebookfinal.com