September 2007

Congress is Back — We Need to Be Too
Congress is back in session, and that means we all need to redouble our efforts to contact our Senators and Representatives in support of key respiratory legislation, including bills to formally establish pulmonary rehabilitation as a Medicare benefit, repeal Medicare provisions calling for home oxygen patients to assume ownership of their equipment after 36 months, support allied health education, and allow for FDA regulation of tobacco. The AARC is also asking everyone to write their members of Congress, requesting that they support legislation to amend portions of the Part B Medicare law to allow certain respiratory therapists to deliver a broader array of services. You can learn more about these legislative initiatives and how to contact your members of Congress on the AARC’s CAPITOL CONNECTION web site.

Study Shows Underuse of Spirometry for COPD
Spirometry is significantly underused in the diagnosis of COPD, conclude researchers who published a retrospective review in the August issue of CHEST involving health records for more than 5000 COPD patients. Results showed only one in three patients had their COPD diagnosis confirmed by spirometry, with those over age 75 the least likely to have received the test. Spirometry was noted for only 15% of those over age 85. Writing in an accompanying editorial, Drs. Paul Enright and Philip Quanier caution against more widespread use of spirometry in the primary care setting, however, noting it could do more harm than good. A better tactic, they believe, is to offer spirometry to those smokers and former smokers identified as having a high probability of COPD. They also note a diagnosis of COPD should not be made without performing spirometry after an inhaled bronchodilator, unless the initial results show an FEV of <50% of predicted. READ ARTICLE

Specialist Reporting Needed for Adequate Primary Care Spirometry
British researchers who compared the reporting of primary care spirometry by primary care physicians and remote specialists find the quality of primary care spirometry “was so unsatisfactory that remote reporting of tests may be a means of establishing adequate spirometry.” The study involved six primary care practices that emailed 263 acceptable tests over a 3 month period for specialist review. Clinically significant disagreements were identified in the interpretation of acceptability in 32% of tests, of diagnosis in 29%, and of severity in 32%. The authors conclude, “Remote reporting of primary care spirometry was feasible. Its usefulness was confirmed by the high rate of additional clinically significant information to the reports of primary care clinicians.” The report appears in this month’s British Journal of General Practice. READ ABSTRACT

Assessing Outcome Measures for Methacholine Challenge in Preschoolers
A new study out of Estonia looked at the utility of using interrupter resistance (R(int)), transcutaneous oximetry, and auscultation as outcome measures for a tripling-dose methacholine (Mch) challenge in 57 children between the ages of 3 and 6. Nine healthy children, 17 with cough, and 25 with wheeze performed the study up to the point of PCW or all five Mch inhalations. The investigators defined a completed test as a change of 20% of predicted R(int) or termination by wheeze, desaturation, or cough. Using those criteria, 78% had adequate R(int) measurements on each occasion from start to completion, and a similar success rate was seen for tcpO(2) measurements. Significant change in R(int) or tcpO(2) preceded PCW in most of the cases. “Both R(int) and tcpO(2) measurements may allow detection of bronchial hyper-responsiveness at lower Mch doses and also provide a less subjective measure, but will not be feasible in all children,” write the authors. The study was published in the August 24 Epub edition of Respiratory Medicine. READ ABSTRACT

FENO, Eos% Provide More Accurate Asthma Diagnosis than Spirometry
Measuring the fraction of exhaled nitric oxide (FENO) and induced sputum eosinophil count (Eos%) provides a more accurate diagnosis of asthma than either spirometry or FENO assessment alone and is also easier to perform, report Spanish researchers publishing in the August 20 Epub edition of Respiratory Medicine. They compared the diagnostic methods in 50 patients with asthma symptoms, finding a higher sensitivity and diagnostic accuracy for FENO measurement than for spirometry. While the sensitivity and specificity of Eos% in induced sputum were 40% and 82%, respectively, and the diagnostic accuracy of Eos% was lower, the specificity increased to 76% when the inflammatory biomarkers were combined. READ ABSTRACT