American Association for Respiratory Care
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AARC Diagnostics Section

January 2012

Winter Bulletin Online Now

Take a few moments to CLICK OVER and read the latest edition of our Section Bulletin. We have some great stories this time, including outgoing Editor Rick Weaver’s final “Notes” column, an informative article on coding changes for 2012 from Section Chair Matt O’Brien, and a profile of our 2011 Specialty Practitioner of the Year. We round the issue out with a look at the Global Lungs Initiative, a worldwide effort to improve lung function reference values.

Ventilation Heterogeneity Plays a Role in Asthma Control

Australian researchers who looked at the association between ventilation heterogeneity and asthma control before and after treatment with inhaled corticosteroids (ICS) in 105 patients find sensitive measures of small-airway function might be useful in monitoring the response to therapy in people with asthma. Results showed:

  • People with poorly controlled asthma had worse FEV1, fraction of exhaled nitric oxide measured at 200 mL/s (FENO), Scond, and Sacin values.
  • In the 50 patients who were treated with ICS, spirometric, FENO, residual volume/total lung capacity, airway hyperresponsiveness, and Scond values significantly improved.
  • Asthma control as measured by the Asthma Control Questionnaire (ACQ) also improved. The change in ACQ-5 score correlated with changes in FENO, Sacin, and Scond values.
  • Changes in Scond and Sacin values were noted as independent predictors of a change in asthma control.

The study was published ahead of print in the Journal of Allergy and Clinical Immunology on Dec. 19. READ ABSTRACT

Better FEV1 Equals Better Outcomes

A new study published ahead of print in Respiratory Research on Dec. 29 finds COPD patients who experience an improvement in FEV1 see positive changes in patient-reported outcomes as well. The investigators arrived at that conclusion after pooling the results of three studies involving 3313 patients. Participants were assessed using the Transition Dyspnea Index (TDI) and St. George’s Respiratory Questionnaire (SGRQ) at baseline and then again at 12, 26, and 52 weeks. COPD exacerbation rates were tabulated across categories of FEV1. Results were adjusted for baseline severity and inhaled corticosteroid use. As FEV1 increased, the TDI and SGRQ improved and the exacerbation rate declined. Adjusting the findings for other factors had little effect on the relationship between FEV1 and outcomes. “These results suggest that larger improvements in FEV1 are likely to be associated with larger patient-reported benefits across a range of clinical outcomes.” READ ABSTRACT

E-Cigarettes Have Immediate Impact on Pulmonary Functions

The “e-cigarette” is being touted as a safer alternative to traditional cigarettes. Researchers from Harvard who worked with colleagues in Greece call that claim into question in a new study that compared outcomes among healthy nonsmokers between the ages of 19–54 who were assigned to one of two groups: the first used an e-cigarette for five minutes with the cartridge attached; the second used an e-cigarette with the cartridge removed. An immediate decrease in exhaled FENO was seen in the treatment group, and total impedance and flow resistance increased. After the findings were controlled for baseline measurements, e-cigarette use (with cartridge) was linked to a significant decrease in FENO and an increase in impedance, resistance, and overall peripheral airway resistance. While the authors admit this study doesn’t address the long term effects of e-cigarette use, they believe these findings on short term use warrant further investigation of the product. The study was published ahead of print by CHEST on Dec. 22. READ ABSTRACT

DLCO Reference Equations Should be Geared to Age


In another study published ahead of print by CHEST on Dec. 22, Spanish investigators find reference equations derived from middle aged populations underestimate diffusing capacity of the lung for carbon monoxide (DLCO) by 2.1–22.3% in older females and 2.8–37.8% in older males. These equations also fall short in terms of measuring diffusing capacity for alveolar volume (DLCO/VA), with some overestimating DLCO/VA by up to 18% in females and 39.8% in males, and others underestimating DLCO/VA up to 22.2% in females and 11.9% in males. The study was conducted among 262 females and 169 males between the ages of 65-85. All were never-smokers selected from the general population. “These results underscore the importance of using prediction equations appropriate to the origin and age characteristics of the subjects being studied,” write the authors. READ ABSTRACT

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