July 2010

Notes from the Section

• Click over now to read the SUMMER EDITION of our Section Bulletin. We have two great articles this time—one from Editor Rick Weaver on diffusing capacity and another from UCLA physician, Dr. James Hansen, who addresses bronchoreversibility.
• Know a fellow section member who goes above and beyond, either for the section or on the job? Then nominate him or her for our 2010 Specialty Practitioner of the Year award. Nominations are due by Aug. 31 and may be made via our online NOMINATIONS FORM.

ILP Reversibility After Short-Term Bronchodilators in COPD
Dutch researchers looked at the effects of inhaled salbutamol 400 mcg, ipratropium 80 mcg, and placebo on inspiratory lung parameters (ILPs) and FEV1, along with their relationship to dyspnea as measured by a Visual Analogue Scale (VAS), in a crossover, randomized, double-blind, placebo-controlled study involving 85 COPD patients. Results showed:

• All ILP and FEV1 values improved significantly after bronchodilator administration, except for forced inspiratory flow at 50% of the vital capacity after ipratropium administration.
• After administration of both bronchodilators, the mean percent changes from initial values did not significantly differ between the various ILPs and FEV1.
• The mean VAS score showed significant improvements after bronchodilator and placebo inhalation but did not significantly correlate with changes in lung function parameters. For each lung function parameter, patients were further classified as responders if the amount of change was greater than the coefficient of repeatability of the test. Response rates did not differ significantly between the various ILPs.
• No significant differences were found between responders and non-responders with respect to dyspnea after bronchodilator inhalation.

The study appeared in the June 18 Epub edition of Respiratory Physiology & Neurobiology. READ ABSTRACT

Reference Values: The Debate Continues
British researchers tackle the problems inherent in reference values for lung function in this month’s European Respiratory Journal, providing a historical perspective and highlighting some of the shortcomings identified in recent studies. According to the authors, “The use of inappropriate reference equations and misinterpretation, even when potentially appropriate equations are used, can lead to serious errors in both under and over diagnosis, with its associated burden in terms of financial and human costs.” They point to the misdiagnoses that can occur when fixed cut-offs, such as 80% predicted FEV1 or 0.70 FEV1/FVC, are used, particularly in small children and the elderly. “While percent predicted has historically been used to interpret lung function results, z-scores are more appropriate as they take into account the predicted value, as well as the between-subject variability of measurements,” write the investigators. READ ABSTRACT

High-Sensitivity C-Reactive Protein Falls Short as a Marker of Airway Inflammation in Asthma
A new study out of the Louisiana State University Health Sciences Center finds no significant link between high-sensitivity C-reactive protein (hsCRP) and standard asthma measures in people with mainly mild disease. The research was conducted among 54 asthma patients, age 6-58, who underwent medical history and physical examination along with asthma assessment according to the National Asthma Education and Prevention Program (NAEPP) control score, FeNO, and spirometry. hsCRP levels ranged from less than 0.5 to 14.1 mg/L, with a mean of 2.1. This compared to less than 0.5 mg/L expected in healthy individuals. Statistically significant associations were not seen between hsCRP and wheeze, NAEPP control score, FEV1, or FeNO. The study appeared in the June issue of the Annals of Allergy, Asthma & Immunology. READ ABSTRACT

Hospital Water Filters Linked to Bacteria
A Virginia Tech investigator suggests hospital water filters used for washing bronchoscopes may be a source of Mycobacterium avium complex. The case in question “yielded high numbers of Mycobacterium avium isolates sharing the same rep-PCR fingerprint pattern as M. avium isolates recovered from patient samples collected by bronchoscopy,” writes the author. “Five of the 22 (23%) M. avium patient bronchoscopy isolates and 42 of the 56 (75%) M. intracellulare patient bronchoscopy isolates could have been due to contamination from the water supply.” The report appeared in the July 1 Epub edition of the Journal of Medical Microbiology. READ ABSTRACT