March 2009

Notes from the Section

• Want to maximize your section membership? Then take advantage of our SECTION WEB SITE. The site features everything from resources you can put to use in your practice to back issues of the Section Bulletin and even these monthly eNews newsletters. If you haven’t signed up for the section e-mail list yet, you can do that on the site as well.
• The AARC has learned that the National Institutes of Health (NIH) will be issuing new grants for health care research as a part of the federal government’s economic recovery plan. The NIH Challenge Grants in Health and Science will disburse at least $200 million for studies on a wide range of topics, including those related to asthma, COPD, and obstructive sleep apnea. Applications may be submitted between March 27 and April 27. READ MORE

Physician Alert Ups AATD Testing, But Only to a Point
A new study out of the Cleveland Clinic Florida suggests adding a “physician alert” calling for alpha-1 antitrypsin deficiency (AATD) testing to the PFT reports of patients with airflow obstruction of GOLD Stage II or higher can increase the number of patients who are tested for the condition. But this tactic alone probably isn’t enough to significantly improve testing for the condition. The researchers compared the number of AATD tests performed on patients meeting the criteria before and after the physician alert was added. During the pre-alert period, 178 of 821 patients meet the criteria for testing, and 11, or 6%, were actually tested. During the post-alert period, 140 of 689 patients meet the criteria, and 18, or 13%, were tested. The authors note respiratory therapists performing the PFTs misclassified patients for testing at a very low rate, just 3.3%. The research appeared in the February issue of COPD. READ ABSTRACT

Maximal Oxygen Uptake Predicts IPF Mortality
A Canadian-led study finds baseline maximal oxygen uptake of less than 8.3 ml/kg/min is a predictor of mortality in patients with idiopathic pulmonary fibrosis (IPF). The researchers arrived at that conclusion after looking at data on 117 IPF patients, with survival calculated from the date of the first cardiopulmonary exercise test. The finding held true even after researchers adjusted the results to take other factors, such as age, gender, smoking status, baseline FVC, and baseline diffusion capacity for carbon monoxide into account. While the study did reveal an oxygen uptake level predicting mortality, it could not identify a unit change in maximal oxygen uptake capable of predicting survival. The research appears in the first March issue of the American Journal of Respiratory and Critical Care Medicine. READ ABSTRACT

Spirometry in the ED: A Better Assessment of Asthma Severity
Portable spirometry can be used successfully to assess children presenting to the emergency department with an acute exacerbation of asthma, report Yale University School of Medicine researchers publishing in this month’s Journal of Asthma. They tested portable spirometry on 34 patients with an average age of 12. Results showed 91 percent of the children were able to complete at least one attempt at spirometry, and 73 percent of all attempts were reproducible. Most importantly, spirometry was better able to assess severity of the exacerbation than clinical signs and peak expiratory flow. The investigators conclude, “Spirometry provides objective, non-invasive measurements of the severity of airway obstruction in the emergency department for children with acute exacerbations of asthma.” READ ABSTRACT

Lung Biopsies Improved with Use of Transbronchial Cryobiopsy
According to investigators from Germany, a novel technique using a flexible cryoprobe can significantly improve the diagnostic ability of bronchoscopy. Their study enrolled 41 patients with radiographic signs of diffuse lung disease who were selected for transbronchial biopsy. First the investigators collected conventional transbronchial biopsies using forceps during flexible bronchoscopy. Then the patients underwent biopsies using the flexible cryoprobe. The mean specimen area was significantly larger using the cryoprobe, 15.11 mm versus 5.82 mm, and the larger sample size led to a definitive diagnosis in a substantial number of the cases. “Transbronchial cryobiopsy is a novel technique which allows [the clinician] to obtain large biopsy samples of lung parenchyma that exceed the size and quality of forceps biopsy samples,” write the authors. “Prospective trials are needed to compare this technique with surgical lung biopsy for diagnosis of diffuse lung diseases.” The research appeared in the February 21 Epub edition of Respiration. READ ABSTRACT