{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T20:34:15Z","timestamp":1770323655257,"version":"3.49.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T00:00:00Z","timestamp":1464739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Expiratory flow limitation at resting tidal volume (EFLTV) presents a severe mechanical constraint in chronic lung diseases and has not yet been studied longitudinally in cystic fibrosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To study the effect of EFLTV as it emerged from simple spirometry on lung function and clinical status in cystic fibrosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Best year spirometry that included tidal flow\/volume curves and the related clinical data were retrospectively collected over 12\u2009\u00b1\u20093.0 yr\/person from 108 subjects with cystic fibrosis. The year in which forced expiratory flow, midexpiratory phase (FEF25\u201375%, L\/s) was equal to tidal peak expiratory flow (L\/s) was defined as EFLTV-onset year.<\/jats:p>\n                    <jats:p>Measurements and Main Results: EFLTV occurred in 55 (51%) subjects, at age 23\u2009\u00b1\u20096 years. At EFLTV onset, tidal peak expiratory flow and FEF25\u201375% values were 1.44\u2009\u00b1\u20090.23 L\/s and FEV1 was 62\u2009\u00b1\u200910% predicted. Within the following 2 years, FEV1 dropped to 48\u2009\u00b1\u200911% predicted, and 35 (63%) of the subjects reported shortness of breath at rest. Hospital days increased from 5.3\u2009\u00b1\u200924.6 to 24.12\u2009\u00b1\u20099.0 d\/yr (P\u2009=\u20090.0001). Of the 55 subjects, 29 (53%) received transplant or died, with survival time being 6.9\u2009\u00b1\u20093.9 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EFLTV onset may be an important pathophysiological event that could influence the natural history of lung function decline in subjects with cystic fibrosis. This may lead to a significant deterioration in lung function in the following 2 years alongside an increase in the number of hospitalization days. The monitoring of FEV1 alone does not offer as good a threshold signal, because values are only moderately reduced. Therefore, identifying EFLTV appearance is potentially a signal for therapeutic intervention. Further studies are warranted to confirm our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.201508-485oc","type":"journal-article","created":{"date-parts":[[2016,5,24]],"date-time":"2016-05-24T18:58:47Z","timestamp":1464116327000},"page":"825-832","source":"Crossref","is-referenced-by-count":4,"title":["Consequences of Expiratory Flow Limitation at Rest in Subjects with Cystic Fibrosis"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9989-3640","authenticated-orcid":false,"given":"Daphna","family":"Vilozni","sequence":"first","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1215-4501","authenticated-orcid":false,"given":"Moran","family":"Lavie","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1271-7469","authenticated-orcid":false,"given":"Miryam","family":"Ofek","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ifat","family":"Sarouk","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4421-8063","authenticated-orcid":false,"given":"Bat-El","family":"Bar-Aluma","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0427-571X","authenticated-orcid":false,"given":"Adi","family":"Dagan","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moshe","family":"Ashkenazi","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Segel","sequence":"additional","affiliation":[{"name":"Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ori","family":"Efrati","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonary Unit, The National Center for Cystic Fibrosis, The Edmond and Lily Safra Children's Hospital, and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2016,6,1]]},"reference":[{"key":"2026020502560780100_bib1","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/S0140-6736(03)12567-6","article-title":"Cystic fibrosis","volume":"361","author":"Ratjen","year":"2003","journal-title":"Lancet"},{"key":"2026020502560780100_bib2","first-page":"434","article-title":"Prognosis","volume-title":"Cystic fibrosis","author":"Wood","year":"1984"},{"key":"2026020502560780100_bib3","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1093\/oxfordjournals.aje.a008664","article-title":"Determinants of mortality from cystic fibrosis in Canada, 1970-1989","volume":"143","author":"Corey","year":"1996","journal-title":"Am J Epidemiol"},{"key":"2026020502560780100_bib4","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1002\/ppul.20879","article-title":"Annual assessment spirometry, plethysmography, and gas transfer in cystic fibrosis: do they predict death or transplantation","volume":"43","author":"Rosenthal","year":"2008","journal-title":"Pediatr Pulmonol"},{"key":"2026020502560780100_bib5","first-page":"1","article-title":"Methods development for epidemiologic investigations of the health effects of prolonged ozone exposure. 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