November-December 2012

Specialty Practitioner of the Year

The section was proud to bestow its 2012 Specialty Practitioner of the Year award on Mary Lackey. Mary received the honor at AARC Congress 2012 in New Orleans. Stay tuned for more on Mary in the winter edition of our Section Bulletin, out early next year.

Obesity Associated Severe Asthma: A Distinct Phenotype?

British investigators who compared clinical characteristics among normal weight, overweight, and obese adults with severe asthma conclude obesity associated severe asthma may represent a distinct clinical phenotype. The study involved 666 severe asthma patients with BMIs ranging from 22.5 to 34.0. Compared with the normal weight and overweight groups, patients in the obese group had greater asthma medication requirements and were also significantly more likely to suffer from gastroesophageal reflux disease and require proton pump inhibitor therapy. Obese patients had higher bone density, reduced FVC, raised Kco, decreased serum IgE levels, and a greater tendency to have eczema as well. They were less likely to have a history of nasal polyps. The study was published ahead of print by CHEST on Oct. 8. READ ABSTRACT

eNO in Heart Failure

A new study out of the Cleveland Clinic finds the increase in exhaled nitric oxide (eNO) levels seen after exercise in patients with stable chronic systolic heart failure can be attributed to the presence of underlying pulmonary venous hypertension that is most likely secondary to advanced diastolic dysfunction. They reached that conclusion after studying 34 consecutive ambulatory patients who underwent symptom-limited cardiopulmonary stress testing and echocardiography. The patients were tested for eNO immediately following exercise. Asymmetric dimethylarginine (ADMA) and the L-arginine/ADMA ratio were used to assess systemic endothelial dysfunction. Results showed:

• The mean eNO was 23 ± 9 ppb.
• eNO levels were higher in patients with diastolic dysfunction stages 2 or 3 than in those with stage 1 or normal diastology.
• eNO had a positive correlation with estimated systolic pulmonary artery pressure and indexed left atrium volume, but it did not correlate with cardiopulmonary exercise test parameters, ADMA, or symptom score.

The study appeared in the Oct. 18 edition of the Journal of Cardiac Failure. READ ABSTRACT

Lung Function at School Age in VLBW Children

Very low birth weight (VLBW) children may suffer from long lasting lung impairment. That’s the take home message from Italian researchers who compared lung function results among 120 VLBW children, including 22 with prior bronchopulmonary dysplasia (BPD), and 46 age-matched controls who were born at term. The children were tested at eight to nine years of age. Compared with the term children, the VLBW children had significantly lower adjusted values (z-score) of forced vital capacity (z-FVC), forced expiratory volume in 1 sec (z-FEV1), forced expiratory flow 25-75% (z-FEF25-75), carbon monoxide lung diffusion capacity (z-DLCO), and DLCO/alveolar volume (z-DLCO/VA). They had significantly higher residual volume (z-RV) and RV/total lung capacity (RV/TLC) ratio (%).VLBW children who had experienced BPD had significantly higher RV/TLC ratios when compared to those without BPD. Overall, lung function abnormalities were seen in 63% of VLBW children with evidence of airway obstruction and diffusing capacity impairment. Weak associations were seen between gestational age and z-FVC, and between birth weight, z-FEV1, and RV/TLC ratio. A negative correlation was noted between the duration of oxygen treatment and z-DLCO/Va. FeNO levels did not differ between the groups. The study was published ahead of print by Pediatric Pulmonology on Nov. 5. READ ABSTRACT

Allergen Challenge for Patients with Suspected Dysphonia Due to Allergies

Pittsburgh researchers who subjected five inhalant allergic adults with suspected dysphonia from allergies to an inhaled allergen challenge find a primary causal relationship between allergen exposure and impaired vocal function. All five patients underwent two experimental conditions. In one they were challenged with an orally inhaled diluent placebo. In the second, they were challenged with an orally inhaled allergen. The tests were conducted on separate days and in random order. Patients were measured for vocal function before and after the challenges using phonatory threshold pressure (PTP) at the 80th percentile pitch. Greater PTP was required post allergen challenge, leading the investigators to conclude that allergen exposure may play a role in impaired vocal function. They also believe the testing method described in their study provides a safe model for laryngeal inhalant allergen challenge. The study was published ahead of print by the International Forum of Allergy & Rhinology on Nov. 5. READ ABSTRACT