January 2010

Winter Bulletin Online Now
The winter edition of our section Bulletin is now ONLINE, with an update on the section meeting at the AARC Congress from Section Chair Melynn Wakeman and an article on standardized bronchodilator administration during adult PFTs. We also have a profile of our 2009 Specialty Practitioner of the Year.

Airway Differences in Asthma, COPD, Never-Smokers
Japanese researchers who set out to clarify airway differences in people with asthma, COPD, and healthy never-smokers using an impulse oscillation system (IOS) noted the following:

• In both asthma and COPD patients, a significant increase in respiratory resistance (Rrs5) and more negative value of respiratory reactance (Xrs5) at 5 Hz of oscillatory frequency with an increase in resonant frequency (fres) were observed when compared with healthy never-smokers.
• In asthma, a significant increase in respiratory resistance at 20 Hz (Rrs20) was also observed when compared with healthy never-smokers and COPD.
• The increases in Rrs5 and relative changes of Xrs5 to more negative were remarkable with increasing severity of COPD.
• Among asthma patients, these changes in Rrs5 and Xrs5 were also observed in asthmatics with normal FEV1/FVC.
• Xrs5 showed further changes to more negative in expiration of tidal breath in severe COPD, whereas no significant changes in Xrs5 to more negative in expiration was observed in healthy never-smokers and asthmatics with and without normal FEV1/FVC.

The study appeared in the Jan. 1 Epub edition of Internal Medicine. READ ABSTRACT

UCSF Researchers Further Validate New COPD Severity Score
University of California, San Francisco researchers have further validated their comprehensive survey-based COPD severity score. The score was previously validated without using lung function or other physiologic measurements. In the new study, researchers evaluated the 35-point score, which is based on symptoms, medication and oxygen use, and prior hospitalization or intubation for COPD, in 1202 patients who took part in a telephone survey and underwent spirometry and six minute walk testing. Higher score values were associated with poorer FEV1, FEV1% predicted, BODE Index, and distance walked in 6 minutes. COPD severity was also linked to poorer generic physical health status, disease-specific health-related quality of life, and a greater prospective risk of acute exacerbation of COPD defined as ED visits, hospitalizations, and either measure of hospital-based care. The research appeared in the Dec. 29 Epub edition of CHEST. READ ABSTRACT

Which Sedation Strategy is Best During Flexible Bronschoscopy in Patients with Respiratory Failure?
A new study out of Germany looked at the use of sedation during flexible bronchoscopy (FB) in patients with pre-existing respiratory failure. Transcutaneous PCO2, oxygen saturation, patient tolerance, time after FB until recovery, and application of drug dosage were assessed in 15 patients receiving midazolam with alfentanil and 15 receiving midazolam alone. No difference were seen in transcutaneous PCO2, but the measure did increase over time in both groups. Minimum oxygen saturation and the duration until recovery were comparable as well. However, the total amount of midazolam was lower in patients receiving combined sedation and these patients also reported significantly lower scores for pain and asphyxia and a clear tendency to less nausea and cough. The study was published in the Dec. 14 Epub edition of Respiration. READ ABSTRACT

FeNO Can Predict Asthma Control in Difficult-to-Treat Patients
Baseline exhaled nitric oxide (FeNO) levels may predict which difficult-to-treat asthmatics will respond to high doses of inhaled corticosteroids or systemic steroids. Spanish researchers came to that conclusion after following 102 patients who underwent a stepwise increase in treatment with a maximal fluticasone-salmeterol combination dose for one month. Patients who continued to have problems with asthma control were then given oral corticosteroids for an additional month. Fifty-three of the patients gained control using this approach. A FeNO value ≥30 ppb demonstrated a sensitivity of 87.5% and a specificity of 90.6% for the identification of responsive asthmatics. The study appeared in the Dec. 8 Epub edition of the European Respiratory Journal. READ ABSTRACT