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April 2009
Notes from the Section
- A new continuing education
opportunity from the AARC will soon be arriving in your mailbox. Read
the “Improving Symptom Control in Patients with Chronic Respiratory
Disease” booklet and then take the online POST-TEST
to earn 4 FREE CRCEs. The booklet is being supported by an education
grant from Sepracor.
- Do you know a section member
who has gone above and beyond, either for the section or on the job?
Then nominate him or her for our 2009 Specialty Practitioner of the
Year Award. Nominations are being accepted now on the SECTION
WEB SITE.
- AARC reps lent a hand to
the development of a new Blood Gas Guideline from the Clinical and Laboratory
Standards Institute. READ
STORY
Diagnosing Severity with
IOS Requires More Complex Parameters
German researchers publishing in the March 25 Epub edition of Pneumologie
find impulse oscillometry (IOS) can be used to diagnose the severity
of obstructive pulmonary disease when more complex parameters are
used. The
study was conducted among 65 patients with bronchial asthma and
179 with COPD who underwent IOS and other standard tests. An obstruction
was
diagnosed in 94% by means of body plethysmography, 78% by pneumotachymetry,
and
depending on the parameter, 87-94% by IOS. All IOS parameters,
except R20, were able
to identify mild and medium obstructions; severe obstructions were
better
detected by means of the frequency-dependant resistance FDR and
reactance at 5 Hz, X5, although R5, X5, and Zrs, tended to underestimate
the
degree of obstruction. The authors conclude, “Bronchial obstruction can
reliably be diagnosed by IOS when, in cases of severe obstruction,
more complex parameters like FDR and X5 are included.” READ ABSTRACT
Hypoxic Challenge Tests:
When are They Needed for Air Travel?
The British Thoracic Society (BTS) has recommended that patients
with a resting SaO2 between 92-95% and an additional risk factor,
such kyphoscoliosis
(KS) or neuromuscular disease (NMD), undergo a Hypoxic Challenge
Test to
determine the need for supplemental oxygen during air travel.
Researchers from St. James’s University Hospital in the United
Kingdom confirm this recommendation in a study involving 19 adult
patients with
KS and/or
NMD who were considered at risk for nocturnal hypoventilation.
Fifteen of the patients met the criteria set by the BTS for in flight
oxygen regardless
of their baseline oxygen saturation. “This finding suggests
that all patients with severe extrapulmonary restrictive lung
disease
should undergo assessment with Hypoxic Challenge Tests prior to air
travel,” write
the authors. The study appeared in the March 23 Epub edition
of Thorax.
READ ABSTRACT
EBC Teamed with Mass Spectrometry
Useful in Diagnosing Respiratory Conditions
A new study out of the University of North Carolina at Chapel
Hill finds mass spectrometry can be used in the measurement
of exhaled
breath condensate
(EBC), and such measurements reveal important information about
respiratory conditions. The investigators reached those conclusions
after conducting
two studies: a cross-sectional analysis of 28 healthy, 40 cystic
fibrosis (CF), and 11 asthmatic children; and a longitudinal
analysis of 26
CF children before and after treatment of a pulmonary exacerbation.
Results showed:
- EBC adenosine, AMP, and
urea were readily detected and quantified by mass spectrometry, and
analysis suggested significant dilutional variability.
- Using biomarker/urea
ratios to control for dilution, the EBC AMP/urea ratio was elevated
in CF versus control and the adenosine/urea ratio was elevated
in asthma versus control.
- Changes in EBC purine/urea
ratios correlated with changes in percent predicted FEV1 after CF
exacerbation treatment.
- Similar results were
observed using dilution factors calculated from serum to EBC urea
ratios or EBC electrolytes, and the comparable ratios of
EBC electrolytes to urea in CF and control validated use
of airway urea as an EBC dilution marker.
The study was published in
the March 20 Epub edition of the American Journal of Physiology/Lung
Cellular
and Molecular
Physiology.
READ ABSTRACT
Six Second Exhalation Time
for FeNO Acceptable for Children
Decreasing the standard exhalation time for fractional
exhaled nitric oxide (FeNO) from 10 seconds to
6 seconds is feasible
in children,
report Dutch
researchers publishing in the March 16 Epub edition
of Pediatric Pulmonology. Children with an FVC
below 3 liters
also prefer
the 6 second time over
the 10 second time. The study was conducted among
98 children between the ages of 5 and 17 who were
tested
in a pediatric
pulmonary outpatient
clinic.
FeNO values were measured during 10 and 6 second
tests conducted in random order. No significant
differences were seen in
median values, and the
mean difference between FeNO-6 and FeNO-10 was
-0.3 ppb. Sixty percent of children
with an FVC of less than 3 liters preferred the
FeNO-6 method. “We
found good agreement between FeNO-6 and FeNO-10,
so they can be used interchangeably,” write
the authors. READ ABSTRACT
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