July 2013

Summer Bulletin Online Now

The Summer edition of our section Bulletin has just been posted, so head over to read great articles on maintenance issues with the Jaegar body plethysmography system and efforts to establish an international accreditation program for pulmonary labs. READ ISSUE

Age at Diagnosis Matters in Asthma

A new study out of the University of Michigan sheds some light on the differences between patients diagnosed with asthma before age 40 and those diagnosed after age 40. The research involved a cross section of asthma patients over age 65 who were defined as having long standing asthma (LSA) or late onset asthma (LOA). All underwent allergy prick tests, spirometry, and FENO measurements. After regression analysis, LSA subjects were more likely to demonstrate positive prick tests, 92% vs. 71%, and were more likely to have received a peak flow meter. Moderate or severe asthma was more common in LOA patients and these patients were also more likely to have been hospitalized, although that finding was no longer considered significant after regression analysis. Demographic information, medical comorbidities, spirometry, compliance, asthma control, and asthma quality of life were similar between the two groups. “Defining age of asthma onset may help improve treatment recommendations and outcomes for older adults,” conclude the authors. The study was published ahead of print by the Journal of Asthma on June 20. READ ABSTRACT

Posture and Pulmonary Function

Brazilian researchers found a link between posture and pulmonary function in a new study published ahead of print in the Revista Portuguesa de Pneumologia. They subjected 34 patients with a median age of 32.5 years to postural assessment via photogrammetry and pulmonary function testing that included spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide, and respiratory muscle strength. Body composition was also estimated using bioelectrical impedance. Results showed a significant correlation between horizontal alignment of the head in the anterior view and FEV1/FVC, total lung capacity, and residual volume. Postural assessment measures on the right and left lateral views also correlated with bronchial obstruction and respiratory muscle strength variables, and body mass index and the percentage of fat mass were associated with horizontal alignment of the head, horizontal alignment of the pelvis, and the frontal angle of the lower limbs. READ ABSTRACT

Endosonography Results in Greater Diagnostic Yield in Sarcoidosis

Endosonographic nodal aspiration outperformed bronchoscopic biopsy in confirming the presence of stage I/II sarcoidosis in a study published in the June 19 edition of JAMA. Dutch researchers evaluated the diagnostic yield of bronchoscopy vs. endosonography in 304 patients at 14 centers in six countries between March 2009 and November 2011; 149 were randomized to bronchoscopy and 155 to endosonography. Granulomas were found significantly more often at endosonography than bronchoscopy, 74% vs. 48%. The diagnostic yield to detect granulomas for endosonography vs. bronchoscopy was 80% vs. 53%. The diagnostic yield of bronchoscopy was 38% for stage I patients vs. 66% for stage II patients. That compared to 84% and 77%, respectively, for endosonography. READ PRESS RELEASE

Infant Lung Function Testing: More Study Needed

A 26-item survey on the clinical use of infant lung function (ILF) testing conducted by Duke University Medical Center researchers in 2010 is helping to clarify issues surrounding this testing. The survey was posted on the European Respiratory Society (ERS) website and survey respondents were recruited from laboratory directors and pediatric respirologists who were members of the ERS, American Thoracic Society, and Asian Pacific Society of Respirology. Among the 148 responses that were received, 98 reported having ILF equipment and performing testing in a clinical capacity. Results showed:

• Centers in North America were less likely to perform ≥50 studies/year than centers in Europe or other continents (13% vs. 41%).
• Most respondents used ILF data to either “start a new therapy” (78%) or “help decide about initiation of further diagnostic workup such as bronchoscopy, chest CT or serological testing” (69%).
• Factors reported as limiting clinical ILF testing were need for sedation, uncertainty regarding clinical impact of study results, and the time intensive nature of the study.

The authors believe these findings suggest, “The future of ILF testing is uncertain in the face of the limitations perceived by the survey respondents.” The research was published ahead of print by Pediatric Pulmonology on June 13. READ ABSTRACT