August 2011

Adopt-a-Company is Your Chance to Connect with Your Community
The AARC is partnering with DRIVE4COPD in a new campaign aimed at delivering COPD education and screening to the people who need it most: working Americans who may be at risk for this chronic lung condition but don’t even know it. Find out how you can help by adopting a company in your community. READ MORE

AARC Congress Online Now
Get the program and travel information you need about the 57th International Respiratory Convention and Exhibition in Tampa. GET PROGRAM

New COPD Guidelines Recommend Spirometry for Diagnosis Only
The American College of Physicians, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society have issued new guidelines that recommend the use of spirometry for diagnosis of COPD but not for screening, even in at-risk people such as smokers. The joint statement notes that screening spirometry could lead to unnecessary testing, increased costs, and unnecessary disease labeling, and that there are also no known preventive effects of treatment.

The guidelines also call for the use of:

• Inhaled bronchodilators, including long-acting beta agonists and anticholinergics, in symptomatic patients with an FEV1 less than 60% predicted.
• Monotherapy with either long-acting beta agonists or anticholinergics in patients with an FEV1 of 60% predicted or less.
• Pulmonary rehabilitation for symptomatic patients with an FEV1 of less than 50% predicted.
• Continuous oxygen therapy in patients with severe resting hypoxemia (defined as PaO2 ≤55 mm Hg or SpO2 ≤88%).

The new guidelines, which update previous guidelines issued by the ACP in 2007, were published in a recent issue of the Annals of Internal Medicine. READ ARTICLE

NIV No Barrier to Bronchoscopy, but Experience is Necessary
Respiratory failure patients being treated with noninvasive ventilation (NIV) can safely undergo fiberoptic bronchoscopy, find researchers publishing ahead of print in Critical Care on July 27. But experienced clinicians are needed to ensure success. The investigators reached those conclusions after studying 40 adult patients who required NIV prior to the decision to perform bronchoscopy. Bronchoscopy was completed in all of the patients without complication, but oxygen saturation did fall to <90% in two patients and endotracheal intubation was required within eight hours of the procedure in four patients. The mean PaO2/FIO2 ratio was 176±54 at baseline, improving to 240±130 at the end of bronchoscopy and 210±79 after 120 min. The transient mean PaCO2 increased by 9.4±8.1 mm Hg. Diagnostic information was gleaned from bronchoalveolar lavage in 68% patients. READ ABSTRACT

COPD Diagnosis in Primary Care Comes Up Short
University of Illinois at Chicago investigators find room for improvement in the primary care diagnosis of COPD. Their retrospective cohort study was conducted among 1052 patients who were at least 35 years of age, had made two primary care visits in internal medicine in 2007, had at least one respiratory or smoking cessation medication, or had a diagnosis of COPD or dyspnea in 2007. Only dyspnea on exertion and chronic cough were linked to the use of spirometry, and among the 159 patients diagnosed with COPD, only 58.5% met GOLD criteria for the condition. The authors conclude, “Clinicians use spirometry more often among patients with symptoms suggestive of COPD but not more often among patients with current or past tobacco use. For patients who had a spirometry and a diagnosis of COPD, primary care physicians were accurate in their diagnosis only half of the time.” The study was published ahead of print by the Journal of General Internal Medicine on June 29. READ ABSTRACT

Serum Eosinophil Count, Other Factors, Can Predict Sputum Eosinophilia
A new study out of New Zealand suggests the serum eosinophil count and FEV1, coupled with the clinical history, may provide a simple and practical alternative to assessment of sputum eosinophilia in the clinical setting. Researchers conducted standard tests in 80 patients, then used the results to develop a predictive model for sputum eosinophilia. The best predictors in the model were a combination of the FEV1% predicted, raised serum eosinophil, a positive smoking history, and a negative family history of asthma. “A full blood count can be performed at a substantially lesser cost and with greater accessibility than induced sputum,” note the authors. “We feel the time has come for the clinical utility of the serum eosinophil count to be revisited.” The study was published ahead of print in the Internal Medicine Journal on July 25. READ ABSTRACT

New Methodology to Assess Lung Function on the Way
Columbia University researchers who will be publishing in the Sept. issue of Clinical Physiology and Functional Imaging provide an overview of a new methodology to assess lung function called optoelectronic plethysmography (OEP). According to the authors, the technology uses infrared imaging to evaluate ventilatory kinematics. Images are read on the chest, back, and abdomen of subjects after markers are placed. While the system is limited to research settings at present, the investigators believe it may one day have “broad applicability to patient populations such as very young children, patients with neuromuscular disease and patients who cannot be tested with classical spirometry testing.” READ ABSTRACT