Search Results (779)

Fractional vegetation cover (FVC) plays a significant role in assessing ecological quality and protection, as well as soil and water conservation. As a typical rare-earth resource county in China, Dingnan County has experienced rapid development due to rare-earth mining, resulting in significant alterations to vegetation cover. To elucidate the spatio-temporal changes in vegetation within Dingnan County over the past 35 years and the effects of natural and human factors on these changes, the spatial and temporal variations in FVC were analyzed using Landsat-TM/OLI multispectral images taken in 1988, 1995, 1997, 2002, 2006, 2013, 2017, and 2023. The findings indicate that (1) vegetation coverage in Dingnan County decreased from 1988 to 2002, followed by a gradual increase; (2) high vegetation cover is predominantly found in forested areas that maintain their natural state, while the central town and mining areas exhibit generally low coverage; (3) there are regional differences in the relationship between vegetation cover and environmental factors in Dingnan County. This research facilitates the alignment of ion-type rare-earth mining with ecological protection, thereby promoting the sustainable development of the mining area and providing scientific guidance for local governments to formulate more effective management and protection strategies for the mining ecosystem. Additionally, this research offers a scientific foundation for mining areas globally to develop sustainable policies and informed decision-making regarding environmental protection and sustainable development. Full article

In the context of drought events caused by global warming, there is limited understanding of vegetation loss caused by drought and the subsequent recovery of vegetation after drought ends. However, employing a single index representing a specific vegetation characteristic to explore drought’s impact on vegetation may overlook vegetation features and introduce increased uncertainty. We applied the enhanced vegetation index (EVI), fraction of vegetation cover (FVC), gross primary production (GPP), leaf area index (LAI), and our constructed remote sensing vegetation index (RSVI) to assess vegetation drought in Central Asia. We analyzed the differences in drought experiences for different climatic regions and vegetation types and vegetation loss and recovery following drought events. The results indicate that during drought years (2012 and 2019), the differences in vegetation drought across climatic regions were considerable. The vegetation in arid, semiarid, and Mediterranean climate regions was more susceptible to drought. The different indices used to assess vegetation loss exhibited varying degrees of dynamic changes, with vegetation in a state of mild drought experiencing more significantly during drought events. The different vegetation assessment indices exhibited significant variations during the drought recovery periods (with a recovery period of 16 days: EVI of 85%, FVC of 50%, GPP of 84%, LAI of 61%, and RSVI of 44%). Moreover, the required recovery periods tended to decrease from arid to humid climates, influenced by both climate regions and vegetation types. Sensitivity analysis indicated that the primary climatic factors leading to vegetation loss varied depending on the assessment indices used. The proposed RSVI demonstrates high sensitivity, correlation, and interpretability to dry–wet variations and can be used to assess the impact of drought on vegetation. These findings are essential for water resource management and the implementation of measures that mitigate vegetation drought. Full article

Background: Long COVID-19 has been characterized by the presence of symptoms lasting longer than 4 weeks after the acute infection. The pathophysiology of clinical manifestations still lacks knowledge. Objective: The objective of this paper was to evaluate metabolite abundance in the saliva of long COVID patients 60 days after hospital discharge. Methods: A convenience sample was composed of 30 post-discharge patients with long COVID and seven non-COVID-19 controls. All COVID-19 patients were evaluated by demographic characteristics, spirometry, 6 min walk test (6mWT), Saint George Respiratory Questionnaire (SGRQ), and body composition. Metabolomics was performed on saliva. Results: The long COVID-19 patients were 60.4 ± 14.3 years-old, and 66% male. Their lean body mass was 30.7 ± 7.3 kg and fat mass, 34.4 ± 13.7 kg. Spirometry evaluation showed forced vital capacity (FVC) of 3.84 ± 0.97 L with 96.0 ± 14.0% of the predicted value, and forced expiratory volume in the first second (FEV₁) of 3.11 ± 0.83 L with 98.0 ± 16.0 of the predicted value. The long COVID-19 patients had reduced maximal inspiratory (90.1 ± 31.6 cmH₂O) and maximal expiratory (97.3 ± 31.0 cmH₂O) pressures. SGRQ showed domain symptoms of 32.3 ± 15.2, domain activities of 41.9 ± 25.6, and domain impact 13.7 ± 11.4, with a mean of 24.3 ± 14.9%. Physical capacity measured by distance covered in the 6mWT was 418.2 ± 130 m with a 73.3% (22.3–98.1) predictive value. The control group consisted of 44.1 ± 10.7-year-old men with a body mass index of 26.5 ± 1.66 Kg/m². Metabolomics revealed 19 differentially expressed metabolites; expression was lower in 16 metabolites, and 2 metabolites were absent in the COVID-19 patients compared to controls. Calenduloside G methyl ester (p = 0.03), Gly Pro Lys (p = 0.0001), and creatine (p = 0.0001) expressions were lower in patients than controls. Conclusions: Long COVID-19 patients present less abundance of calenduloside G methyl ester, Gly Pro Lys, and creatine in saliva than healthy controls. Lower creatine abundance may be related to reduced physical capacity and fatigue Full article

Fractional vegetation cover (FVC) plays a key role in ecological and environmental status assessment because it directly reflects the extent of vegetation cover and its status, yet vegetation is an important component of ecosystems. FVC estimation methods have evolved from traditional manual interpretation to advanced remote sensing technologies, such as satellite data analysis and unmanned aerial vehicle (UAV) image processing. Extraction methods based on high-resolution UAV data are being increasingly studied in the fields of ecology and remote sensing. However, research on UAV-based FVC extraction against the backdrop of the high soil reflectance in arid regions remains scarce. In this paper, based on 12 UAV visible light images in differentiated scenarios in the Ebinur Lake basin, Xinjiang, China, various methods are used for high-precision FVC estimation: Otsu’s thresholding method combined with 12 Visible Vegetation Indices (abbreviated as Otsu-VVIs) (excess green index, excess red index, excess red minus green index, normalized green–red difference index, normalized green–blue difference index, red–green ratio index, color index of vegetation extraction, visible-band-modified soil-adjusted vegetation index, excess green minus red index, modified green–red vegetation index, red–green–blue vegetation index, visible-band difference vegetation index), color space method (red, green, blue, hue, saturation, value, lightness, ‘a’ (Green–Red component), and ‘b’ (Blue–Yellow component)), linear mixing model (LMM), and two machine learning algorithms (a support vector machine and a neural network). The results show that the following methods exhibit high accuracy in FVC extraction across differentiated scenarios: Otsu–CIVE, color space method (‘a’: Green–Red component), LMM, and SVM (Accuracy > 0.75, Precision > 0.8, kappa coefficient > 0.6). Nonetheless, higher scene complexity and image entropy reduce the applicability of precise FVC extraction methods. This study facilitates accurate, efficient extraction of vegetation information in differentiated scenarios within arid and semiarid regions, providing key technical references for FVC estimation in similar arid areas. Full article

Background: Respiratory complications in patients with amyotrophic lateral sclerosis (ALS), due to the involvement of respiratory muscles, are the leading cause of death, and respiratory physiotherapy (RP) focuses on addressing these complications. Objectives: The objective was to evaluate the effectiveness of an RP intervention that combines the four specific techniques (inspiratory muscle training, lung volume recruitment, manually assisted coughing, and diaphragmatic breathing training) in patients with ALS. Methods: A quasi-experimental study was carried out, and a specific RP programme was implemented in 15 patients with ALS (12 sessions, 30 min/session, one session/week, duration of three months), based on directed ventilation techniques, lung volume recruitment, manually assisted coughing, and the use of incentive spirometry and a cough assist device, along with a daily home exercise programme. Respiratory functions were assessed (pre- and post-intervention, with follow-up at three months) using Forced Vital Capacity (FVC) and Peak Expiratory Cough Flow (PECF); functionality was assessed using the Revised ALS Functional Rating Scale (ALSFRS-R) and the Modified Barthel Index by Granger. Results: FVC experienced an increase after three months of the intervention initiation (p = 0.30), which was not sustained at the three-month follow-up after the intervention ended. All other variables remained practically constant after treatment, with their values decreasing at follow-up. Conclusion: A specific RP intervention could have beneficial effects on respiratory functions, potentially preventing pulmonary infections and hospitalisations in patients with ALS. It may improve FVC and help stabilize the patient's functional decline. Considering the progressive and degenerative nature of the disease, this finding could support the usefulness of these techniques in maintaining respiratory function. Full article

As global climate change intensifies, arid land ecosystems face increasing challenges. Vegetation, a key indicator of climate variation, is highly responsive to meteorological factors such as temperature (Tem), precipitation (Pre), and soil moisture (SM). Understanding how fractional vegetation cover (FVC) responds to climate change in arid regions is critical for mitigating its impacts. This study utilizes MOD13Q1-NDVI data from 2000 to 2022, alongside corresponding Tem, Pre, and SM data, to explore the dynamics and underlying mechanisms of SM and FVC in the context of climate change. The results reveal that both climate change and human activities exacerbate vegetation degradation, underscoring its vulnerability. A strong correlation between FVC and both Tem and Pre suggests that these factors significantly influence FVC variability. In conclusion, FVC in the lower reaches of the Heihe River is shaped by a complex interplay of Tem, Pre, SM, and human activities. The findings provide a scientific basis and decision-making support for ecological conservation and water resource management in the lower reaches of the Heihe River, aiding in the development of more effective strategies to address future climate challenges. Full article

Background/Objectives: The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation. Methods: We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months. Results: The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL. Conclusions: In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary–cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients. Full article

Background: Speech production is a possible way to monitor bulbar and respiratory functions in patients with amyotrophic lateral sclerosis (ALS). Moreover, the emergence of smartphone-based data collection offers a promising approach to reduce frequent hospital visits and enhance patient outcomes. Here, we studied the relationship between bulbar and respiratory functions with voice characteristics of ALS patients, alongside a speech therapist’s evaluation, at the convenience of using a simple smartphone. Methods: For voice assessment, we considered a speech therapist’s standardized tool—consensus auditory-perceptual evaluation of voice (CAPE-V); and an acoustic analysis toolbox. The bulbar sub-score of the revised ALS functional rating scale (ALSFRS-R) was used, and pulmonary function measurements included forced vital capacity (FVC%), maximum expiratory pressure (MEP%), and maximum inspiratory pressure (MIP%). Correlation coefficients and both linear and logistic regression models were applied. Results: A total of 27 ALS patients (12 males; 61 years mean age; 28 months median disease duration) were included. Patients with significant bulbar dysfunction revealed greater CAPE-V scores in overall severity, roughness, strain, pitch, and loudness. They also presented slower speaking rates, longer pauses, and higher jitter values in acoustic analysis (all p < 0.05). The CAPE-V’s overall severity and sub-scores for pitch and loudness demonstrated significant correlations with MIP% and MEP% (all p < 0.05). In contrast, acoustic metrics (speaking rate, absolute energy, shimmer, and harmonic-to-noise ratio) significantly correlated with FVC% (all p < 0.05). Conclusions: The results provide supporting evidence for the use of smartphone-based recordings in ALS patients for CAPE-V and acoustic analysis as reliable correlates of bulbar and respiratory function. Full article

Background/Objectives: The primary life-threatening complication in spinal–bulbar muscular atrophy (SBMA) is ventilatory failure. The present study analyzes the longitudinal patterns of respiratory function tests over a follow-up of 11 years. Methods: We collected data from 9 genetically confirmed SBMA patients. Spirometric measurements [maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and forced vital capacity (FVC)], serum biochemical indices and SBMA functional rating scale (SBMAFRS) were collected every 6 months for 11 years. An average time curve was utilized to assess the changes in both pulmonary tests and serum biochemical indices of the patients. One-way repeated-measures ANOVA was applied to assess statistical differences. The Spearman’s rank correlation coefficient was utilized to evaluate the correlations between the respiratory function tests and serum biochemical and clinical indices. Results: A progressive decrease was observed in the respiratory function tests; the slope of the linear regression was significantly non-zero (p < 0.0001) for all three time curves. A major decrease was observed for MEP (52%) and MIP (42%), while this was minor for FVC (25%). SBMAFRS score correlated with FVC (r = 0.27), MIP (r = 0.53) and MEP (r = 0.51). MIP and MEP correlated with creatine phosphokinase (r = 0.3, r = 0.25, respectively) and MIP with creatinine levels (r = 0.31). Conclusions: This longitudinal study shows a progressive decline of spirometric data throughout life in SBMA patients. The decline appears to be related to clinical deterioration and muscle denervation. Spirometric measures relative to maximal strength of the respiratory muscles (MIP and MEP) may have a better predictive value for pulmonary and muscular decline than FVC. Full article

Background and Objectives: Small airway fibrosis plays a critical role in the progression of chronic obstructive pulmonary disease (COPD). Previous research has suggested that Urotensin-II (U-II) and transforming growth factor-β (TGF-β) may contribute to pathological fibrosis in various organs, including the cardiovascular system, lungs, and liver. However, their specific relationship with airway fibrosis in COPD has not yet been thoroughly investigated. This study aims to evaluate the concentrations of U-II and TGF-β in individuals with COPD, as well as in healthy smokers and non-smokers, to explore their potential roles in COPD-related fibrosis. Materials and Methods: The study included three distinct groups: a healthy non-smoker control group (n = 98), a healthy smoker group (n = 78), and a COPD group (n = 80). All participants in the COPD group had a smoking history of at least 10 pack-years. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, with only patients classified as GOLD stage 2 or higher being included in the study. Urotensin-II (U-II) and transforming growth factor-β (TGF-β) levels were measured using a commercially available ELISA kit. Results: COPD patients had a significantly lower FEV₁ (58 ± 15.4%) compared to smokers (79 ± 4.5%) and non-smokers (92 ± 3.7%) (p < 0.001). Similarly, COPD patients had a lower FEV₁/FVC ratio (55 ± 9.4%) compared to smokers (72 ± 4.2%) and non-smokers (85 ± 3.6%) (p < 0.01 and p < 0.05, respectively). SaO₂ was significantly lower in COPD patients (87%) compared to smokers (96.5%) and non-smokers (98%) (COPD vs. smokers: p < 0.05 and smokers vs. non-smokers: p > 0.05). U-II levels were significantly higher in COPD patients (175.10 ± 62.40 pg/mL) compared to smokers (118.50 ± 45.51 pg/mL) and non-smokers (85.29 ± 35.87 pg/mL) (p < 0.001 and p < 0.05, respectively). COPD patients also had significantly higher levels of TGF-β (284.60 ± 60.50 pg/mL) compared to smokers (160.00 ± 41.80 pg/mL) and non-smokers (92.00 ± 25.00 pg/mL) (p < 0.001 and p < 0.05, respectively). Conclusions: Our study supports the growing body of evidence that U-II and TGF-β play central roles in the development and progression of fibrosis in COPD. The negative correlation between these markers and lung function parameters such as FEV₁ and FEV₁/FVC indicates that they may be key drivers of airway remodeling and obstruction. These biomarkers could serve as early indicators of fibrotic changes in smokers, even before the onset of COPD. Full article

Background/Objective: Patients with severe asthma (SA) and non-cystic fibrosis bronchiectasis (BE) without microbiological colonization represent a unique and understudied population. Type 2-targeted biologic therapies have emerged as a promising treatment for these patients. However, predictive factors for achieving clinical remission remain unclear. This study aims to identify the predictive factors for achieving clinical remission in patients with severe asthma and non-colonized bronchiectasis undergoing type 2-targeted biologic therapies. Methods: A retrospective longitudinal analysis was conducted on 14 patients with severe asthma and non-cystic fibrosis bronchiectasis without microbiological colonization. Clinical remission was assessed at baseline (T0) and after 12 months (T1) of biologic therapy. Clinical remission was defined according to the Severe Asthma Network Italy (SANI) criteria, including the absence of oral corticosteroid use, no asthma-related symptoms, stable lung function, and no exacerbations. Logistic regression was performed to identify predictors of remission. ROC curves were constructed to evaluate the predictive accuracy of lung function parameters, specifically FEV1 and FVC. Results: After 12 months of biologic therapy, 28.6% of patients (n = 4) achieved clinical remission. The mean FEV1 percentage at baseline was significantly higher in the remission group (92.25 ± 15.64%) compared to the non-remission group (65.10 ± 23.36%, p = 0.034). Logistic regression analysis identified baseline FEV1 as a significant predictor of remission (OR = 1.008, p = 0.050). ROC curve analysis revealed that an FEV1 cutoff of 72.5% had a sensitivity of 100% and a specificity of 70% (AUC = 0.900, p = 0.024) for predicting clinical remission. Conclusions: FEV1 is a crucial predictor of clinical remission in patients with severe asthma and non-colonized bronchiectasis treated with type 2-targeted biologic therapies. An FEV1 threshold of 72.5% can guide clinicians in identifying patients most likely to achieve remission. These findings underline the importance of preserving lung function to optimize therapeutic outcomes in this complex population. Full article

Background/Objectives: This systematic review evaluated the impact of nusinersen therapy on respiratory health and function in individuals with spinal muscular atrophy (SMA) and determined whether nusinersen improves pulmonary function, focusing on differences based on patient age and the timing of treatment initiation. Methods: A systematic search of PubMed, Ovid Medline, ScienceDirect, and Web of Science databases was conducted up to January 2024 in accordance with the PRISMA guidelines. Thirteen studies were included, comprising clinical trials, observational studies, and case series that focused on respiratory outcomes in SMA patients treated with nusinersen. The data on study design, participant characteristics, nusinersen intervention, respiratory outcomes, and adverse events were extracted. The Joanna Briggs Institute Critical Appraisal Tool was used to assess study quality. A narrative synthesis was conducted to address the heterogeneity of the studies. Results: This review found a general trend of improvement in pulmonary function, specifically in forced vital capacity (FVC), although the extent and duration of improvement varied across the studies. Peak cough flow (PCF) and peak expiratory flow (PEF) showed positive trends in some studies, although the results were not consistently significant. Respiratory function improvements were frequently observed, particularly in younger patients and those treated earlier. Conclusions: Nusinersen appears to enhance respiratory function and improve motor outcomes in SMA patients, especially with early treatment. However, further research is needed to fully understand its mechanisms and long-term effects on respiratory health in SMA. Full article

Obstacle course races (OCR) have experienced significant growth in recent years, with millions of participants worldwide. However, there is limited research on the specific physiological demands and injury prevention strategies required for these events. This study aimed to analyze the physiological responses and injury risks in participants of a 5 km (Sprint) and 13 km (Super) OCR. Sixty-eight participants were assessed for cortical arousal, leg strength, isometric handgrip strength, blood lactate, heart rate, blood oxygen saturation, body temperature, urine composition, spirometry values, hamstring flexibility, lower limb stability, foot biomechanics, and scapular kinematics, one hour before and immediately after the races. The results showed a significant decrease in leg strength (Sprint: r = −0.56, p < 0.01; Super: r = −0.54, p = 0.01) and urine pH (Sprint: r = −0.70, p = 0.03; Super: r = −0.67, p = 0.01) in both distances, with increases in urine colour, protein, and glucose (Sprint: p < 0.04). In the 13 km race, lower limb stability decreased significantly post-race (r = −0.53, p = 0.01). Positive correlations were found between performance and pre-race handgrip strength (Sprint: r = 0.71, p = 0.001; Super: r = 0.72, p = 0.01) and spirometry values (FVC, FEF 25–75%, FEV1) (Sprint: r = 0.52, p = 0.031; Super: r = 0.48, p = 0.035). Thermoregulation capacity, reflected in a higher pre-race body temperature and lower post-race body temperature, also correlated with improved performance (r = 0.49, p = 0.046). Injury risk increased post-race, with a significant decline in lower limb stability (p < 0.05). These findings highlight the importance of targeted training programs, focusing on grip strength, leg strength, respiratory muscle training, and hydration strategies to optimize performance and reduce injury risk in OCR athletes. Full article

Background/Objectives: Obstructive sleep apnea (OSA) and obstructive lung diseases (OLD) are common and interdependent respiratory disorders, where one condition may contribute to the development and worsening of the other (OLDOSA syndrome). The term OLDOSA syndrome includes two different conditions: Overlap syndrome (OVS: OSA + chronic obstructive pulmonary disease, COPD) and Alternative Overlap syndrome (aOVS: OSA + Asthma). Data on the interactions between lung function and respiratory monitoring during sleep in OLDOSA patients are few and controversial. Our study aims to evaluate the impact of lung function impairment on sleep breathing disorders, paying attention to the lack of literature about comparisons between OVS, aOVS, and the impact of small airways disease (SAD) in these patients. Methods: In total, 101 patients with a diagnosis of OSA and asthma or COPD underwent pulmonary function tests (PFTs) and nocturnal home sleep cardiorespiratory monitoring (HSCM). Exclusion criteria: Obesity hypoventilation syndrome (OHS) and other non-respiratory sleep disorders. Results: Sleep time with oxygen saturation below 90% (T90) was negatively correlated with forced expiratory volume in the first second, % of predicted (%FEV₁), forced vital capacity, % of predicted (%FVC), forced expiratory flow at 25–75% of the pulmonary volume, % of predicted (%FEF_25–75), and, after multivariable linear regression analysis, %FEF_25–75 remained an independent factor for T90 with a negative correlation in mild and moderate OSA. Obstructive apnea index (oAI) and FEV₁/FVC were negatively correlated in mild and moderate OSA. OVS presented with more severe OSA (higher AHI, oAI, and T90) and SAD (lower FEF_25–75) compared to aOVS. Conclusions: This study highlights a possible interdependence between OLD and OSA; obstruction of the large and small airways at PFTs contributes to the worsening of these patients’ nocturnal hypoxemia and obstructive events of the upper airway during sleep. Furthermore, this study shows that patients with OVS should be carefully monitored, as they present worse data at HSCM and have greater small airways involvement compared to aOVS. Full article

Background: Several studies have documented the detrimental impacts of secondhand smoke (SHS) exposure to a range of pediatric respiratory conditions, including asthma, bronchitis, and reduced lung function. The aim of the study was to investigate the influence of SHS exposure on lung function, physical fitness, and body mass index (BMI) in children aged 10 to 14 years. Methods: This cross-sectional study included children aged 10 to 14 years at the Elementary School “Trilj” in Trilj, Croatia. Data on SHS exposure were collected using a questionnaire. Antropometric and spirometry measurements were performed. Physical fitness was assessed using the shuttle run (BEEP) test. Results: This study included 157 children, 89 (56.69%) boys and 68 (43.31%) girls. Children exposed to every day SHS in households had significantly lower values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow (PEF) (p < 0.001) and higher z-score BMI levels (p = 0.018) in comparison to unexposed children. Logistic regression showed that children unexposed to SHS had higher odds for better results in the BEEP test (OR 62.45, 95% CI 21.26–179.24, p < 0.001). Children with poorer physical fitness, expressed by lower BEEP score levels, had significantly lower FVC, FEV1, FEV1/FVC, and PEF (p < 0.001). Conclusions: Every day SHS exposure in children was associated with poorer lung function, higher BMI, and poorer physical fitness. Full article