October 2012

Notes from the Section

• Our Fall Bulletin is ONLINE now, with an overview of diagnostics presentations at AARC CONGRESS 2012, great information to share with your patients about nasal rinses, and part 2 of our series on smoking cessation in the mentally ill.
• Speaking of the AARC Congress, if you’ll be in New Orleans, Nov. 10–13, be sure to attend our section membership meeting. We’ll be gathering on Sunday from 4:30–5:00 p.m. Check your program onsite for the room number.

Joint Statement on Cardiopulmonary Exercise Testing

The American Heart Association has published a joint scientific statement on clinical cardiopulmonary exercise (CPX) testing with the European Association for Cardiovascular Prevention. The joint statement reviews the body of original research in CPX and justifies which variables should be assessed for each given indication. A one page, color coded reporting sheet is included for each indication, and tables are provided for heat failure, unexplained exertional dyspnea, suspected or confirmed hypertrophic cardiomyopathy, suspected or confirmed pulmonary arterial hypertension/ secondary pulmonary hypertension, COPD or interstitial lung disease, suspected myocardial ischemia, and suspected mitochondrial myopathy. A universal CPX reporting form outlining the information that needs to be collected according to the specific conditions is included as well. “The ultimate goal of the statement is to both increase awareness of the value of CPX and the number of health care professionals feeling able to undertake clinically meaningful CPX interpretations,” says Marco Guazzi, MD, European co-chair of the writing group. READ PRESS RELEASE

Airway Inflammation Similar in Overweight and Normal Weight People with Asthma

Italian investigators publishing ahead of print in Respiration on Sept. 10 link being overweight to greater airflow obstruction and poorer asthma control. But airway inflammation alone is probably not to blame. The researchers arrived at that conclusion after measuring fractional exhaled nitric oxide (FeNO) levels in 348 patients, 145 of whom were considered overweight. Overweight patients had poorer asthma control as measured by the Asthma Control Test and lower FVC, FEV1, and FEV1/FVC values than their normal weight peers. They also had lower levels of FEF(25-75) even after the values were normalized for FVC. However, no differences were seen in FeNO values. “The findings of the present study support the view that other factors besides airway inflammation alone may explain the relationship between asthma and an elevated BMI,” write the authors. READ ABSTRACT

Truncal Obesity Impacts Functional Performance in COPD

A new study out of Chicago State University finds truncal obesity may indirectly affect the ability of COPD patients to perform activities of daily living. Investigators reached that conclusion after studying 76 patients with mild to severe COPD. All underwent standard tests to measure disease severity, truncal fat, functional capacity, and functional performance. Functional performance was not directly affected by truncal obesity, but it was indirectly impacted via greater breathlessness in this group. Twenty-nine percent of the variability in functional performance was accounted for by the six minute walk test distance, dyspnea, and DLCO. “We anticipate that clinicians will use knowledge derived from this study to develop interventions to reduce or minimize truncal fat (truncal obesity) and its effects on people with COPD,’ write the authors. The study was published ahead of print by the Journal of Nursing Scholarship on Aug. 9. READ ABSTRACT

HRV and COPD

University of Rochester investigators who set out to compare host, virologic, and environmental factors associated with symptomatic and asymptomatic human rhinovirus (HRV) infection in people with COPD find HRV is common in these patients, but more so during illness. The study was conducted among 127 COPD patients who were evaluated every two months over a one year period. HRVs were detected in 29 patients, 20 times during illnesses and 11 times during routine office visits. HRV was detected in nasal samples taken during 14.7% of respiratory illnesses overall vs. 0.4% of the routine visits. Sputum samples were positive during 19.4% of illnesses compared to 5.2% of routine visits. When the researchers looked at factors that could lead to HRV in these patients they found that only contact with school aged children upped the risk. “Attention to good hand hygiene and avoidance of direct contact with ill children may help patients with COPD avoid HRV related illness,” they write. The study was published ahead of print by the Journal of Clinical Virology on Sept. 19. READ ABSTRACT