June 2012

Specialty Practitioner of the Year: Deadline Quickly Approaching!

There are only a few weeks left to nominate a fellow section member for our 2012 Specialty Practitioner of the Year Award, so take some time today to consider who among your colleagues you feel is deserving of this prestigious honor. The nomination deadline is July 31, and nominations may be made via our online NOMINATION FORM.

Exercise Best Avoided Before FENO Measurement

A new study out of Norway concludes children should refrain from physical activity before being measured for exhaled nitric oxide (FENO). The investigators reached that conclusion after subjecting 330 non-asthmatic children age 8-16 to FENO measurement at baseline and then again at one and 30 minutes post exercise. Immediately following a standardized treadmill exercise test, FENO was reduced by 27.4% on average. At 30 minutes, the decline was 16.1%. Children with symptoms of allergic rhinoconjunctivitis saw a greater decline at one minute than those without allergic rhinoconjunctivitis, 4.2 ppb vs. 2.6 ppb. Decline was also more significant among children whose baseline FENO was ≥20 ppb. The study was published ahead of print in the Clinical Respiratory Journal on April 23. READ ABSTRACT

Lung Sensory Nerves Play a Role in Ozone-Exacerbated Asthma

Researchers from the University of California Davis are shedding some light on the role of lung sensory nerves in ozone-exacerbated asthma. The study was carried out in 113 Brown-Norway rats who were sensitized and challenged with nDer f 1 allergen. The rats breathed ozone for eight hours prior to their third challenge, then were divided into three groups: (1) control; (2) vagus perineural capsaicin treatment (PCT) with or without hexamethonium; and (3) vagotomy. Results showed:

• Ozone inhalation resulted in a significant increase in lung resistance and an exaggerated response to subsequent allergen challenge.
• PCT abolished the ozone-induced increase in lung resistance and significantly reduced the increase in lung resistance induced by a subsequent allergen challenge, while hexamethonium treatment reestablished bronchoconstriction induced by allergen challenge.
• Vagotomy resulted in a significant increase in the bronchoconstriction induced by ozone inhalation and subsequent challenge with allergen.

The authors conclude, “Vagal C-fibers initiate reflex bronchoconstriction, vagal myelinated fibers initiate reflex bronchodilation, and mediators released within the airway initiate bronchoconstriction.” The study was published ahead of print in Respiratory Physiology & Neurobiology on April 12. READ ABSTRACT

IOS May Find More Cases of Early COPD

Swedish investigators publishing ahead of print in Respiratory Medicine on May 19 suggest the impulse oscillometry system (IOS) may have a role to play in the identification of people with early COPD. Noting that IOS allows for the determination of respiratory impedence indices that could be of value in early COPD, they analyzed data from a previous population-based study of 450 subjects who had undergone both spirometry and IOS, and answered a questionnaire about their respiratory symptoms and diseases. Results showed subjects who self-reported a respiratory condition but could not be diagnosed with COPD using GOLD criteria had a higher FEV1 when compared to those who reported a respiratory condition and were diagnosed with COPD using GOLD criteria, 100% vs. 87%. However, these subjects were just as likely to have higher pulmonary resistance and lower pulmonary reactance as measured by IOS as those who had COPD according to GOLD criteria. “IOS may have the potential to detect pathology associated with COPD earlier than spirometry,” conclude the authors. READ ABSTRACT

PFTs May Predict Heart Disease Risk

Could pulmonary function testing help predict which people are most likely to develop cardiovascular disease? Yes, report Italian researchers who followed a large cohort of subjects over ten years. In total, 12,933 subjects had a high-quality flow/volume maneuver, 8132 had suitable plethysmography, and 3422 had an acceptable carbon monoxide diffusion measurement. Reduced pulmonary function expressed by FVC, FEV1, and TLC were inversely associated with a higher cardiovascular risk score in both men and women. The finding held true even after the results were adjusted to take other factors, such as age, height, smoking habits, total cigarette exposure, pulmonary disease, body mass index, social status, and physical activity into account. No association, however, was seen between a risk of cardiovascular disease and the FEV1/FVC ratio, residual volume, and DLCO. “These results suggest that pulmonary monitoring could be useful to more accurately predict cardiovascular risk,” write the authors. The study was published ahead of print in the European Journal of Preventive Cardiology on May 18. READ ABSTRACT