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June 2009
Notes from the Section
- The latest issue of the SECTION BULLETIN is
online now, with an article on two new methods to improve the diagnosis
of lung disease and a look
at how the pulmonary function lab can be the perfect place to take
advantage of the “teachable moment.”
- Nominations for our 2009 Specialty Practitioner of the Year are well
underway. Visit the SECTION WEB SITE to access the easy-to-use online
nominations form.
Spirometry Results May Not
Influence COPD Patients to Quit Smoking
Can you influence newly diagnosed COPD patients to quit smoking by
confronting them with the results of their pulmonary function tests?
Dutch researchers
find the answer is no in a study conducted among 296 smokers with
no prior diagnosis of COPD who were found to have mild-to-moderate
airflow
limitation via spirometry. The patients were randomly assigned
to either an experimental group, which was told about their spirometry
results,
or one of two control groups. The experimental group and control
group 1 both received counseling and nortriptyline to help them
quit
smoking.
Control group 2 received usual care for smoking cessation by a
general practitioner. While the quit rate was twice as high for the
experimental
group and control group 1, similar results were seen for the two,
suggesting no advantage in confronting patients with their pulmonary
function
test results. The study appeared in the April issue of the European
Respiratory
Journal. READ ABSTRACT
Measures Fail to Predict Responsiveness to Inhaled Corticosteroids
Neither exhaled nitric oxide (ENO) nor methacholine/adenosine 5;-monophosphate
(AMP) responsiveness are good predictors of which chronic cough
patients will respond to treatment with inhaled corticosteroids.
That’s
the key finding from Spanish researchers who studied 43 patients
with chronic cough. All underwent ENO measurement, spirometry, and
concentration-response
studies with both methacholine and AMP before beginning twice
daily treatment with inhaled fluticasone propionate. The patients
also kept a daily diary
of daytime and nighttime coughing during the four week treatment
period. “The
sensitivity and specificity of ENO for predicting the response
to ICS, using 20 ppb as the ENO cut off point, were 53% and 63%,
respectively,” write
the authors. “Differences in both prevalence and degree
of airway responsiveness to either methacholine or AMP between
fluticasone
responsive and nonresponsive subjects were also not significant.” The report was published in the May 1 Epub edition of CHEST. READ
ABSTRACT
Could Spirometry Help Identify
Risk for Bone Fractures?
The bone mineral density test is commonly used to identify people
at risk for osteoporosis and fractures. Now British researchers
find spirometry
can be used for the same purpose. Their study was conducted
among 8304 women and 6496 men who underwent spirometry along with
heel
quantitative
ultrasonography and then were followed for broadband ultrasound
attenuation (BUA) of the heel and incidence of hip fracture
over the next 7 to
10 years. Results linked lower mean FEV1 values with a significant
increase
in BUA, and mean FEV1 was also lower in the 84 women and 36
men who had a hip fracture during the follow up period. “Middle-aged
and older people with low respiratory function are at increased risk
of osteoporosis
and hip fracture,” write the investigators. “FEV1,
an easy, low-cost, and feasible clinical measure, may help
improve
the identification
of high-risk groups.” The study appears in the May issue
of the Journal of Bone and Mineral Research. READ ABSTRACT
Even Smaller Declines in
FEV1 May Suggest Asthma
Asthma is generally diagnosed in patients with a 20% change
in FEV1 during methacholine challenge testing. But what about
patients
with
a lower
decline in values? Researchers from Henry Ford Hospital looked
at 100 patients with a clinical suspicion of asthma but a
negative methacholine
challenge test (MCT) to see if decreases in sGaw, FEF 25–75,
and/or FEV1 could predict future diagnosis of asthma. While sGaw
and FEF
25–75
were
not correlated to a subsequent diagnosis, 43% of patients
with a 10–20% decrease in FEV1 received an asthma diagnosis during
the three
year
follow up. “Up to 20% of patients who have symptoms
suggestive of asthma but a negative MCT can still develop
asthma,” conclude
the authors. The study was published in the April issue of
the Journal of Asthma.
READ ABSTRACT
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