Pulmonary function was assessed with a hand-held spirometer as previously described [63]. Measures included forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF) from which a composite measure was derived. Respiratory muscle strength was assessed using a hand-held device that contains a pressure sensitive transducer to measure maximal inspiratory and expiratory pressures from which a composite measure was derived [64].
