American Association for Respiratory Care
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AARC Diagnostics Section

January 2013

Winter Bulletin Online Now

The WINTER EDITION of our section Bulletin includes two great articles – one on building an isothermal lung and the other on options for integrating pulmonary lab data into the EMR – plus the final installment of our series on smoking cessation in the mentally ill. Notes columns from our section chair and outgoing Bulletin editor round out the issue.

Shorter Telomeres, More COPD?

Could telomere length really have anything to do with COPD? Noting that previous research showed a link, investigators from Denmark decided to study telomere length in 46,396 members of the general population. Results showed telomere length decreased significantly with increasing age, and decreasing telomere quartiles were associated with decreasing FEV1, FVC, and FEV1/FVC. The risk of developing COPD was also higher in people with shorter telomeres. However, once the findings were adjusted to take other factors into account, the association between COPD and telomere length was attenuated, leaving the investigators to conclude their data support only a modest correlation between telomere length and lung function. The study was published ahead of print by Thorax on Dec. 25. READ ABSTRACT

Six Minute Walk Distance Can Predict Mortality in COPD

Researchers from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints, or “ECLIPSE,” study have identified the minimal clinically important difference in the six minute walk distance in predicting mortality from COPD. The researchers analyzed data on 2112 patients taking part in the study, using death or first hospitalization as their index events. Change in six minute walk distance in the 12 month period leading up to the event was assessed. During the study 94 patients died and 323 experienced a first hospitalization. No link was seen between change in six minute walk distance and first hospitalization, but patients who had a fall in distance of 30 meters or more were more likely to have died. The study was published ahead of print by the American Journal of Respiratory and Critical Care Medicine on Dec. 21. READ ABSTRACT

Feedback Strategy Increases Medication Adherence

A new study out of Yeshiva University in New York finds children who are trained to predict their peak expiratory flow (PEF) and then receive feedback on the actual PEF are less likely to underestimate their asthma symptoms and more likely to adhere to their inhaled corticosteroid prescriptions. The research was conducted among 192 ethnic minority children living in inner city areas of the Bronx, NY. PEF predictions made by the children were entered into an electronic spirometer and compared with actual PEF recordings over a six week period. The children were assigned to one of two groups: in the first, children were able to see the actual PEF recordings; in the second, they were not. The investigators attached dosers to the children’s asthma medications to monitor use. “Feedback on PEF predictions for ethnic minority, inner city children may decrease under-perception of respiratory compromise and increase adherence to controller medications,” write the authors. “Children and their families may shift their attention to asthma perception and management as a result of this intervention.” The study appeared in the December edition of Thorax. READ ABSTRACT

FeNO Measures Up to Inhaled Mannitol

Measuring exhaled nitric oxide (FeNO) may be a good alternative to a challenge with inhaled mannitol when assessing nonsmoking, steroid-naïve subjects for airway hyperresponsiveness (AHR), report Danish investigators publishing ahead of print in Respiratory Medicine on Nov. 21. In their study, they measured FeNO and AHR to inhaled mannitol in 180 adolescents and young adults. Results showed:

  • The area under the curve for the receiver operating characteristics curve for FeNO to identify a positive response to mannitol was 91.9%.
  • The optimal cut-off was 25 ppb (185% predicted) and a sensitivity of 100% was achieved below 20 ppb (165% predicted).

The authors conclude, “a low FeNO indicates that extra diagnostic work-up using inhaled mannitol will add very little extra information.” READ ABSTRACT

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