May 2013

Support RT Legislation

The AARC PACT made its annual trip up Capitol Hill in March to support issues important to you and your patients, but the work is far from over. The AARC is urging all its members to take a moment to write or email their members of Congress in support of the Medicare Respiratory Therapist Access Act. So visit our Advocacy page to learn more about it and then use one of our letter templates to let your elected officials know you support the legislation.

PFT Labs Good Place for AATD Screening

Should your pulmonary function laboratory routinely screen selected patients for alpha-1 antitrypsin deficiency (AATD)? Researchers from the Cleveland Clinic believe the answer is yes. In an article published in a supplement to the March 10 edition of COPD, they note that fewer than 10% of Americans with AATD have been diagnosed and suggest that targeted testing of people with COPD or chronic liver disease could significantly improve that number. Early diagnosis has many benefits for people with the condition, including identification of at-risk family members, lower smoking likelihood, and consideration of augmentation therapy. “Efforts to enhance detection of AATD individuals have included various approaches, including educational campaigns, provision of free test kits, issuance of reminders with medical reports or within an electronic medical record, and empowering respiratory therapists to conduct testing for AATD in pulmonary function laboratories,” write the authors. “Such programs have identified individuals with severe deficiency of alpha-1 antitrypsin in up to 12% of subjects, with considerable variation across series by testing criteria.” READ ABSTRACT

DLCO in Ex-Smokers without Airflow Limitation

Canadian investigators publishing ahead of print in Thorax on April 19 took a closer look at the role of abnormal DLCO in ex-smokers without airflow limitation. The research involved 38 ex-smokers without COPD, 19 of whom had abnormal DLCO, along with ex-smokers diagnosed with stage 1 COPD. All were evaluated using spirometry, plethysmography, the St. George’s Respiratory Questionnaire (SGRQ), the six minute walk test (6MWT), x-ray CT, and hyperpolarised helium-3 (3He) MRI. 6MWT distance (6MWD), SGRQ scores, 3He MRI apparent diffusion coefficients (ADC), and CT attenuation values below -950 HU (RA950) were included in the results:

• Of the 38 ex-smokers without COPD, 19 subjects had abnormal DLCO with significantly worse ADC (p=0.01), 6MWD (p=0.008), and SGRQ (p=0.01), but not RA950 (p=0.53) compared with 19 ex-smokers with normal DLCO.
• Stage I COPD subjects showed significantly worse ADC (p=0.02), RA950 (p=0.0008), and 6MWD (p=0.005), but not SGRQ (p=0.59) compared with subjects with abnormal DLCO.
• There was a significant correlation for 3He ADC with SGRQ (r=0.34, p=0.02) and 6MWD (r=-0.51, p=0.0002).

The authors believe these findings illustrate the impact of mild or early stage emphysema, along with a better understanding of abnormal DLCO and hyperpolarised 3He MRI, in ex-smokers without COPD. READ ABSTRACT

Diagnostic Errors are the Most Deadly

Medication errors and surgical mistakes capture a lot of the attention when it comes to medical errors, but Johns Hopkins investigators who reviewed 25 years of U.S. malpractice claim payouts find diagnostic errors are responsible for the largest fraction of claims, the most severe patient harm, and the highest total penalty payouts, amounting to $38.8 billion between 1986 and 2010. The researchers analyzed medical malpractice payments data from the National Practitioner Data Bank, finding that diagnostic errors resulted in death or disability almost twice as often as other error categories. While more diagnostic error claims were rooted in outpatient care than inpatient care, (68.8% vs. 31.2%), inpatient diagnostic errors were more likely to be lethal (48.4% vs. 36.9%). The majority of diagnostic errors were missed diagnoses, and per-claim payments were highest in cases of serious neurologic harm, including quadriplegia and brain damage resulting in the need for lifelong care. The study was published in the April 22 edition of BMJ Quality and Safety. READ PRESS RELEASE

ATS Workshop Report: PFTs in Selected Children under Six

The American Thoracic Society’s Assembly on Pediatrics’ Working Group on Infant and Preschool Lung Function Testing held workshops in 2009 and 2010 to review six lung function tests common in young children: infant raised-volume rapid thoracic compression and plethysmography, preschool spirometry, specific airway resistance, forced oscillation, the interrupter technique, and multiple-breath washout. The working group conducted a comprehensive review of the literature on the use of these tests as they apply to children under the age of six with cystic fibrosis, bronchopulmonary dysplasia, and recurrent wheeze. In a new paper published in the April edition of the Annals of the American Thoracic Society, the group reviews the current state-of-the-art for these tests using a standardized format allowing for easy comparison between the measures. They conclude, “Although insufficient evidence exists to recommend incorporation of these tests into the routine diagnostic evaluation and clinical monitoring of infants and young children with cystic fibrosis, bronchopulmonary dysplasia, or recurrent wheeze, they may be valuable tools with which to address specific concerns, such as ongoing symptoms or monitoring response to treatment, and as outcome measures in clinical research studies.” READ ABSTRACT