November 2008

Notes from the Section

• If you’re planning to attend the AARC Congress in Anaheim, this Dec. 13–16, be sure to come by the section meeting, scheduled for Tuesday, 12 noon–12:30 p.m.
• Learn more about the AARC Congress and what it has to offer RT diagnosticians in the Advance Program.
• And for an inside look into other aspects of the meeting—including some great videos of last year’s event and a link to things to see and do in Orange County that was constructed especially for the AARC—go here.

Eosinophil AR and FENO in Children
Researchers from the United Kingdom who studied the relationship between the eosinophil apoptotic rate (AR) and exhaled nitric oxide (FENO) in children noted positive relationships between eosinophil AR and FENO, eosinophil AR and percent eosinophil count, and FENO and percent eosinophil count. The study was conducted among 31 children with a mean age of 11 and median FENO range of 15.6 parts per billion. Twenty one had asthma and 17 were atopic. Sputum eosinophil AR was assessed in 19 of the children, 16 of whom were asthmatics. The authors conclude, “There is a positive relationship between FENO and eosinophil AR. Nitric oxide may be involved in regulation of eosinophil AR in the airways.” The study appeared in the October 28 Epub edition of Pediatric Pulmonology. READ ABSTRACT

The FEV1 and COPD
Writing in the October issue of COPD, Dennis Doherty, MD, reviews the role of FEV1 in diagnosing COPD, noting that the third National Health and Nutrition Examination Survey (NHANES III) documented the ability of spirometry to detect mild airflow problems in many asymptomatic smokers and the NHANES III reference equations are better suited to the task than most of the other predicted value standards. However, other standards are being used as well that he believes may be misclassifying younger adults as normal while classifying older adults as abnormal. Despite the limitations, he believes spirometry remains the best available tool for early diagnosis of COPD, but suggests spirometry results be combined with “other endpoints in order to better reflect overall patient status.” READ ABSTRACT

Surveillance Bronchoscopy Benefits Lung Transplant Patients
Australian researchers publishing in this month’s Journal of Heart and Lung Transplantation confirm the value of routine surveillance bronchoscopy (SB) and transbronchial biopsy (TBB) in lung transplant (LT) patients. They reviewed 353 procedures performed on 124 LT patients over one calendar year. SBs revealed high rates of acute rejection, particularly in the first year post-transplant, while the rate of asymptomatic infection diagnosed on bronchoalveolar lavage (BAL) remained high regardless of the time post-transplant. Complication rates were similar to those reported previously for the procedures, with the exception of sedation-related complications. The authors conclude, “This study confirms that SB can frequently detect clinically significant infection and rejection with very low complication rates. The data support SB with TBB up to 12 months post-LT, and ongoing use of SB with BAL (only) to detect clinically silent infection beyond 1 year post-LT.” READ ABSTRACT

ACCP Issues Consensus Statement on Work-Related Asthma
The American College of Chest Physicians has issued a new consensus statement on diagnosis and management of work-related asthma (WRA). The document defines WRA to include both occupational asthma (asthma induced by sensitizer or irritant work exposures) and work-exacerbated asthma (preexisting or concurrent asthma worsened by work factors). The report notes serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests can increase diagnostic certainty in these cases. The authors suggest the prevalence of WRA warrants the consideration of diagnosis in all workers with new or worsening symptoms of asthma, along with the implementation of preventative measures to minimize exposure of other workers to the same substances. The statement was published in the September issue of CHEST. READ ABSTRACT