Société Tunisienne des Maladies Respiratoires et d'Allergologie STMRA

Probability of cancer in pulmonary nodules detected on first screening CT.

Probability of cancer in pulmonary nodules detected on first screening CT.

N Engl J Med. 2013 Sep 5;369(10):910-9

Authors: McWilliams A, Tammemagi MC, Mayo JR, Roberts H, Liu G, Soghrati K, Yasufuku K, Martel S, Laberge F, Gingras M, Atkar-Khattra S, Berg CD, Evans K, Finley R, Yee J, English J, Nasute P, Goffin J, Puksa S, Stewart L, Tsai S, Johnston MR, Manos D, Nicholas G, Goss GD, Seely JM, Amjadi K, Tremblay A, Burrowes P, MacEachern P, Bhatia R, Tsao MS, Lam S

Abstract
BACKGROUND: Major issues in the implementation of screening for lung cancer by means of low-dose computed tomography (CT) are the definition of a positive result and the management of lung nodules detected on the scans. We conducted a population-based prospective study to determine factors predicting the probability that lung nodules detected on the first screening low-dose CT scans are malignant or will be found to be malignant on follow-up.
METHODS: We analyzed data from two cohorts of participants undergoing low-dose CT screening. The development data set included participants in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). The validation data set included participants involved in chemoprevention trials at the British Columbia Cancer Agency (BCCA), sponsored by the U.S. National Cancer Institute. The final outcomes of all nodules of any size that were detected on baseline low-dose CT scans were tracked. Parsimonious and fuller multivariable logistic-regression models were prepared to estimate the probability of lung cancer.
RESULTS: In the PanCan data set, 1871 persons had 7008 nodules, of which 102 were malignant, and in the BCCA data set, 1090 persons had 5021 nodules, of which 42 were malignant. Among persons with nodules, the rates of cancer in the two data sets were 5.5% and 3.7%, respectively. Predictors of cancer in the model included older age, female sex, family history of lung cancer, emphysema, larger nodule size, location of the nodule in the upper lobe, part-solid nodule type, lower nodule count, and spiculation. Our final parsimonious and full models showed excellent discrimination and calibration, with areas under the receiver-operating-characteristic curve of more than 0.90, even for nodules that were 10 mm or smaller in the validation set.
CONCLUSIONS: Predictive tools based on patient and nodule characteristics can be used to accurately estimate the probability that lung nodules detected on baseline screening low-dose CT scans are malignant. (Funded by the Terry Fox Research Institute and others; ClinicalTrials.gov number, NCT00751660.).

PMID: 24004118 [PubMed - indexed for MEDLINE]

Can exhaled nitric oxide differentiate causes of pulmonary fibrosis?

BACKGROUND: Interstitial lung diseases (ILD) comprise a heterogeneous group of disorders, and when diagnosed at the stage of pulmonary fibrosis, the underlying lung disease can sometimes be difficult to identify. The aim of the present study was to determine whether there are differences in FENO (fraction of exhaled nitric oxide) between different subtypes of fibrotic ILD.

METHODS: Sixty-one patients, with honeycombing on computed tomography (CT) scan, and whose FENO levels had been measured during chronic dyspnoea evaluation, were divided into four groups based on pulmonary fibrosis aetiology: idiopathic pulmonary fibrosis (IPF), chronic hypersensitivity pneumonitis (HP), connective tissue disease-associated ILD disorders (CTD-ILD), drug-induced pneumonia. The FENO values of each group were compared and CT scan features were analysed to identify the mechanisms involved in FENO change.

RESULTS: The median FENO value of patients with chronic HP was 51 ppb (IQR 36-74), higher than that of the other groups (22 ppb (IQR 17-30) in IPF, 19 ppb (IQR 17-21) in drug-induced pneumonia, and 25 ppb (IQR 17-37) for CTD-ILD; p = 0.008). At the cut-off value of 41 ppb, the optimal sensitivity and specificity to diagnose HP with FENO were respectively 76.9% and 85.4%. On CT scans, only extensive lobular areas with decreased attenuation, a recognized marker of bronchiolar disease, were associated with high FENO values (p = 0.0002).

CONCLUSION: FENO could be a tool for differentiating chronic HP from other types of pulmonary fibrosis. The mechanism involved seems to be bronchiolar disease.

The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV1 - A review.

Searches identified 14 studies investigating effects of reducing cigarette consumption on lung cancer, CVD, COPD or FEV1 decline. Three were case-control studies, six cohort studies, and five follow-up studies of FEV1. Six studies consistently reported lower lung cancer risk in reducers.

Compared to non-reducers, meta-analysis (random-effects) showed significantly lower risk (RR 0.81, 95% CI 0.74-0.88 for any reduction, and RR 0.78, 0.66-0.92 for the greatest reduction), with no between-study heterogeneity. Four cohort studies presented CVD results, the combined RR for any reduction being a non-significant 0.93 (0.84-1.03). An effect of reduction was not consistently seen for COPD or FEV1 decline. Four cohort studies presented all-cause mortality results, the combined RR of 0.91 (0.86-0.97) being significant. The RR of 0.95 (0.88-1.02) for total smoking-related cancer, from three studies, was non-significant.

The evidence has various weaknesses; few studies, few cases in reducers in some studies, limited dose-response data, incomplete adjustment for baseline consumption, questionable accuracy of the lifetime smoking history data in case-control studies, and bias in cohort studies if reducers are likelier than non-reducers to quit during follow-up.

Also, the variable definitions of reduction make meta-analysis problematic. Though the results suggest some benefits of smoking reduction, more evidence is needed.

Diagnostic value of lung function parameters and FeNO for asthma in schoolchildren in large, real-life population.

BACKGROUND AND OBJECTIVE: To establish a diagnostic value of fractional exhaled nitric oxide (FeNO), interrupter resistance measurement (Rint), specific resistance of the airways (sRaw), spirometric parameters in asthma diagnosis in schoolchildren.

METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of 6,439 children (aged 6-18) with symptoms suggestive of asthma, who attended our Pediatric Allergic Outpatient Clinic. Medical documentation of the patients was analyzed with special attention to the first ever obtained results (before the introduction of controller medication) of: FeNO, Rint, sRaw, spirometry, diagnoses of allergic diseases, and allergen sensitization (specific IgE results).

RESULTS: We included 3,612 children in the analysis. Older age, male gender, the presence of allergic rhinitis, sensitization to perennial and seasonal allergens, higher FeNO and Rint, and FEV1 /FVC <80% were significantly associated with asthma. We observed a significant association between FeNO and Rint in the prediction of asthma diagnosis. Optimal cutoff points to differentiate asthmatics from non-asthmatics were established. Thus, Rint >175.4% was defined as asthma-predicting Rint, and FeNO >15.8 ppb was defined as asthma-predicting FeNO. In all study subgroups, sensitivity for asthma-predicting Rint was significantly higher than for asthma-predicting FeNO with an inverse trend in specificity value.

CONCLUSION: Our results suggest that asthma-predicting Rint and, to a lesser extent, asthma-predicting FeNO, defined in the present study, could serve as a reliable tool to exclude asthma in schoolchildren. However, our results also indicate a clinically important fact that all lung function parameters or FeNO should be interpreted in the context of age, gender, allergy profile, and the presence of co-morbidities in schoolchildren. Pediatr Pulmonol. © 2013 Wiley Periodicals, Inc.

Pneumococcal disease in the Arabian Gulf: Recognizing the challenge and moving toward a solution.

Pneumococcal disease in the Arabian Gulf: Recognizing the challenge and moving toward a solution.

J Infect Public Health. 2013 Jul 31;

Authors: Feldman C, Abdulkarim E, Alattar F, Al Lawati F, Al Khatib H, Al Maslamani M, Al Obaidani I, Al Salah M, Farghaly M, Husain EH, Mokadas E

Abstract
Pneumococcal disease has substantial incidence, morbidity and mortality in older adults. Decreased birth rates and longer lifespans indicate that the global population is aging, although rates of aging differ between countries [1]. In 2010, the proportion of the population aged >60 years in the general Arab Region was 7%, and this proportion is expected to rise to 19% by 2050 for the region as a whole [2]; the United Nations estimates for the individual countries of the Arabian Gulf by 2050 are 25.7%, 24.9%, 20.7%, 26.7% and 10.5% in the Kuwait, Bahrain, Qatar, United Arab Emirates (UAE) and Oman, respectively, which are comparable to the 26.9% predicted for the USA and lower than that predicted in European countries, in which the 2050 estimates are 32.7%, 34.0% and 38.1% for France, the UK and Germany, respectively [1]. Globally and in the Gulf Region, pneumococcal disease is an increasingly important public health burden in the elderly. The burden of pneumococcal disease can be reduced by effective vaccination programs, but the recommendations on pneumococcal vaccination in adults vary widely. The major barriers to vaccine implementation among healthcare professionals are an incomplete awareness of pneumococcal disease and the vaccination options in adults. The Gulf Advocate Group calls for healthcare providers in the countries of the Arabian Gulf (Kuwait, Bahrain, Qatar, United Arab Emirates and Oman) to support awareness and education programs about adult pneumococcal disease, particularly in high-risk groups such as those >65 years of age, those with type 2 diabetes mellitus, hematological malignancy, organ and bone marrow transplantation or chronic kidney or lung diseases and pilgrims undertaking the Hajj to improve pneumococcal disease surveillance and optimize and disseminate recommendations for adult vaccination. The Gulf Advocate Group recommends following the U.S. Centers for Disease Control and Prevention (CDC) guidelines for pneumococcal vaccination [3,4].

PMID: 23999349 [PubMed - as supplied by publisher]

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Probability of cancer in pulmonary nodules detected on first screening CT.

Can exhaled nitric oxide differentiate causes of pulmonary fibrosis?

The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV1 - A review.

Diagnostic value of lung function parameters and FeNO for asthma in schoolchildren in large, real-life population.

Pneumococcal disease in the Arabian Gulf: Recognizing the challenge and moving toward a solution.

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