November 2011
Fall Bulletin Online Now
The latest edition of our quarterly Bulletin is up on the
SECTION WEBSITE now, so click over to read great articles on strategies to keep your lab viable in these changing times, the ideal pulmonary lab from a staffing point of view, and asthma and its relationship to sickle cell disease and acute chest syndrome.
ATS Publishes FENO Guidelines
The American Thoracic Society has published clinical practice guidelines on the interpretation of FENO levels stating that FENO offers added advantages to conventional tests used to assess inflammation in patients with chronic inflammatory airway diseases. Specifically, FENO can be helpful in:
- Detecting eosinophilic airway inflammation.
- Determining the likelihood of corticosteroid responsiveness.
- Monitoring airway inflammation to determine the potential need for corticosteroid.
- Unmasking otherwise unsuspected nonadherence to corticosteroid therapy.
A complete set of recommendations on when, why, and how to use and interpret FENO is included in the report. READ FULL REPORT
PFT Lab Variation Raises Concerns
A new study out of the Cleveland Clinic Foundation looks at variation in pulmonary function lab practices in 17 hospitals in Northeast Ohio. Researchers surveyed the labs on the type of equipment and tests they offered, the volume of testing in their labs, and the reference equations and interpretive strategies they were using. All 17 labs responded to the survey. The daily median number of tests performed came in at 16, and the daily median number of patients tested at six. The choice of reference equations used for spirometry, lung volumes, and diffusing capacity, and criteria used to define airflow obstruction and physiologic derangements such as restriction, hyperinflation, air trapping, and impaired diffusing capacity varied widely between the labs. The lower limit of normal was reported and used to define PFT abnormality in only three of the 17 labs. “The degree of variation raises concern about the consistency of the interpretation of results among laboratories and emphasizes the value of compliance with official guidelines to drive standardization,” write the authors. The study was published ahead of print in CHEST on Sept. 22. READ ABSTRACT
Higher Diacetyl Levels Lead to Abnormal Declines in FEV1
Flavoring plant workers in plants using 800 lbs of diacetyl a year or more are more likely to have abnormal FEV1 declines than workers at similar plants where less diacetyl is used. That’s the key finding from National Institute for Occupational Safety and Health researchers who reviewed serial spirometry data for flavoring plant workers at 20 companies. “Spirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV1 decline for preventive intervention, even when the FEV1 itself remains within the normal range,” write the investigators. The study was published ahead of print in the American Journal of Industrial Medicine on Sept. 19. READ ABSTRACT
Bronchoscopy May Help Predict Inhalation Injury Severity
In a new study involving 32 burn patients, U.S. researchers looked at bronchoscopic grading of injury to see if it would clinically correlate with indices of gas exchange over the first 72 hours. Among the findings:
- Measured carboxyhemoglobin levels increased significantly with higher abbreviated injury score (AIS) grade.
- Oxygenation indices worsened as the grade worsened by 24, 48, and 72 hours.
- The incidence of acute respiratory distress syndrome (ARDS) increased by grade of injury at 24 hours and remained statistically different at 48 and 72 hours.
- After adjustment for age, percent TBSA burn, and full-thickness component, severe inhalation injury was associated with an increased risk of ARDS at 24 and 72 hours, as well as mechanical ventilation for longer than 21 days and a trend toward multiple organ dysfunction syndrome and mortality.
“The bronchoscopic grading of inhalation injury moderately correlates with early indices of impaired gas exchange in this cohort and may be a promising tool for staging lower airway injury,” conclude the investigators. They call for additional study to determine whether AIS bronchoscopy staging predicts hospitalization outcomes in these patients. The study was published ahead of print by the Journal of Burn Care & Research on Sept. 21.
READ ABSTRACT 
