February 2010

Section Needs Your Help and Support
In order to meet the needs of our members, we need more active member involvement. So take a few moments to E-MAIL Section Chair Melynn Wakeman and volunteer your services. Opportunities range from joining a committee to authoring an article for our quarterly Bulletin.

Frequent Hospitalizations Linked to Non-usual Pathogens
Why do some COPD patients seem to be caught in the revolving door of hospital readmissions? Spanish researchers asked that question in a study conducted among 116 COPD patients who had been hospitalized at least twice during the last 12 months. All were followed for 21 months and underwent a standard battery of tests. Results showed:

• Not all patients had severe disease according to either the degree of airflow limitation or the BODE index.
• Non-usual pathogens, mainly Pseudomonas aeruginosa, other gram-negative non-fermentative rods, and Enterobacteriaceae, were isolated among 71.1% of the sputum obtained during exacerbations.
• These pathogens were associated with poor prognosis and frequent hospitalization.

The authors conclude, “Airway infection by non-usual pathogens appears to be a key driver of frequent hospitalizations and mortality in COPD.” The report appeared in the Jan. 25 Epub edition of Respiratory Medicine. READ ABSTRACT

Nasal Eosinophilia Linked to Eosinophilic Inflammation in Asthma
Brazilian researchers who set out to compare the eosinophil counts in induced sputum and nasal lavage fluids in asthma found sputum eosinophilia was associated with a 52 times increase in the odds of nasal eosinophilia, whereas each 1% increase in bronchodilator response was associated with a 7% increase in the odds of nasal eosinophilia. The study was conducted among 140 adults who underwent a clinical evaluation, completed an asthma control questionnaire, and had pre- and post-bronchodilator spirometry in addition to the nasal and sputum samples. “This study brings further evidence that upper airway diseases are an important component of the asthma syndrome,” write the authors. “Furthermore, monitoring of nasal eosinophilia by quantitative cytology may be useful as a surrogate of sputum cytology [and] as a component of composite measurement for determining airway inflammation.” The study appeared in the Jan. 20 Epub edition of Clinical and Experimental Allergy. READ ABSTRACT

Height Loss Impacts PFTs
A new study out of Norway suggests vertebral deformities that cause loss of height in COPD patients should be taken into account when performing pulmonary function tests. In a study involving 465 COPD patients and 462 controls, the researchers compared measured height to recalled tallest height and height calculated from arm span. Results showed lung function was overestimated using current measured height in a significant number of the COPD patients, with the effects most pronounced for TLC and RV and less pronounced for FEV1 and FVC. “We therefore propose that in COPD patients with excessive height reduction, one might use RTH or ASH in calculating predicted values,” conclude the authors. They also believe these patients should be evaluated for coexisting vertebral deformities and osteoporosis. The study was published in the Jan. 28 Epub edition of the European Respiratory Journal. READ ABSTRACT

Vitamin D Linked to Lung Function, Steroid Response, in Asthma
Researchers from National Jewish Health find reduced vitamin D levels are associated with impaired lung function, increased airway hyperresponsiveness, and reduced glucocorticoid response in adults with asthma. The study was conducted among 54 asthmatic adults who underwent blood tests to determine vitamin D levels and standard pulmonary function tests to assess lung function. Specific findings included:

• Higher vitamin D levels were associated with greater lung function, with a 21.0±9.2 mL (mean±SE) increase in FEV1 for each ng/mL increase in vitamin D.
• Participants with vitamin D insufficiency (<30 ng/mL) demonstrated increased AHR, with a PC20 FEV1 of 1.03±0.2 mg/mL versus 1.92±0.2 in those with vitamin D ≥30 ng/mL.
• In ICS-untreated participants DEX-induced MKP-1 expression increased with higher vitamin D levels, with a 0.05±0.02-fold increase in MKP-1 expression observed for each ng/mL increase in vitamin D, a finding which occurred in the absence of a significant increase in IL-10 expression.

The investigators published their results in the Jan. 14 Epub edition of the American Journal of Respiratory and Critical Care Medicine. READ ABSTRACT