October 2007

Notes from the Section

• The Fall issue of our quarterly Bulletin is online now, with great articles on maintaining quality in a private practice lab and a new spirometry training program for non-traditional personnel. Visit the SECTION WEB SITE and click on “Bulletins.”
• The Section Meeting at the AARC Congress in Orlando is scheduled for Sunday, December 2, at 4:40 p.m. Make plans now to attend.

Two Studies Examine Impact of New ATS/ERS Guidelines
Researchers from the U.S. and India have taken a closer look at how the new ATS/ERS guidelines for pulmonary function tests may be impacting the diagnosis of restrictive and obstructive lung disease. U.S. investigators found similar proportions of patients were identified as restricted using the GOLD guidelines and the new ATS/ERS guidelines, but significantly more were classified as obstructed using the ATS/ERS approach. What’s more, the classification tended to vary according to the method used. Women were more likely to have a change in classification than men.

Indian researchers examined the level of agreement between the new ATS/ERS strategy of using a reduction in FEV1 to categorize obstructive and restrictive abnormalities and the former strategy of classifying disease based on the reduction in VC. The study involved 2527 adult patients. They found the level of severity of restriction could not be described interchangeably between the old and new guidelines for all patients, with the new guidelines tending to give lower severity scores for restrictive lung diseases in up to 25% of patients.

The U.S. study appeared in the August 6 Epub edition of Respiratory Medicine. The Indian study was published in the September issue of Respirology. READ ABSTRACT READ ABSTRACT

Spirometric Screening has Wide Utility
New Zealand investigators argue spirometry is more than just a test of airflow limitation. It is a test that can predict premature death in smokers. Using spirometry to screen smokers could lead to greater use of interventions aimed at decreasing early mortality. They note, for example, that smoking cessation can attenuate FEV1 decline and, if people quit before the age of 45-50, FEV1 may be preserved within normal values. Timely initiation of inhaled medications and possibly even statins may also reduce morbidity and mortality in people with COPD. The report appeared in the October issue of the European Respiratory Journal. READ ABSTRACT

Standing and Sitting Positions and their Effect on Spirometric Values in the Obese
A new study out of Iran evaluated standing and sitting positions on spirometric values in obese asthma patients. Forty-nine adult patients with a mean body mass index (BMI) of 36.06 were compared with 51 non-asthmatics with a similar BMI. Results showed:

• The mean+/-SD of FVC in the sitting and standing positions were 3.04+/-0.93 lit and 3.03+/-0.96 lit, p=0.37 in obese asthmatic patients and 3.68+/-1.12 lit and 3.72+/- 1.11 lit, p=0.39 in the control group.
• The mean+/-SD of FEV1 in the sitting and standing positions were 2.38+/- 0.75 lit and 2.40+/- 0.81 lit, p=0.20 in obese asthmatic patients and 3.17+/- 0.92 lit and 3.21+/- 0.93 lit, p=0.07 in control subjects.

The authors conclude spirometric values in obese asthmatic patients are not affected by position. The study was published in the September issue of the Iranian Journal of Allergy, Asthma, and Immunology. READ ABSTRACT

FEV1/FEV6 Equals FEV1/FVC
The FEV1/FEV6 ratio is a good alternative to the FEV1/FVC ratio for the diagnosis of airway obstruction, report Brazilian researchers publishing in the September 24 Epub edition of the Brazilian Journal of Medical and Biological Research. They studied the two ratios in 1000 subjects, constructing two receiver operator characteristic curves in order to express the imbalance between the sensitivity and specificity of the FEV1/FEV6 ratio compared to two FEV1/FVC cut-off points for airway obstruction. According to an FEV1/FVC <0.70, the cut-off point for the FEV1/FEV6 ratio with the highest sum for sensitivity and specificity was 0.75. The authors also note, “The FEV1/FEV6 ratio has the additional advantage of being an easier maneuver for the subjects and for the lung function technicians, providing a higher reproducibility than traditional spirometry maneuvers.” READ ABSTRACT