FEV6 assessment in spirometric abnormalities screening: the first population-based study in italian pharmacies.

Panminerva Med. 2013 Mar;55(1):87-92

Authors: Solidoro P, Braido F, Baratta F, Bagnasco D, Esposito R, Aggeri M, Brusa P

Abstract
Aim: In recent years, the FEV1/FEV in six seconds ratio has been proposed and validated as a parameter for screening of airways obstruction and restriction. In this context an electronic spirometry screening of pharmacy customers could lead to significant benefits such as improving the appropriateness of diagnostic test prescription and facilitating the early diagnosis of asthma and chronic obstructive pulmonary disease (COPD). Methods: Customers of 500 pharmacies in the italian Piemonte region were proposed to test their ventilatory function by an electronic spirometer, PiKo-6®, to find out probably obstruction (pO) and probably restriction (pR). All tests have been carried out by purposely trained pharmacists. Moreover, data regarding sampled subjects' gender, age, height, weight, smoke, pharmacology and therapies used were registered. A web application has been created to collect and analyze the data. Results: Male smokers confirmed a percentage of pO similar to the one predicted in obstructive lung disease (OLD) in international literature (7%); higher percentages of pO (8%) and pR (35%) were instead found in underweight people. When the data are broken down into therapeutic categories, the highest number of pO (12%) and pR (38%) was found in patients in therapy with bronchodilators, in diabetis patients (pR 41%), and in people treated with diuretics (pO 7%, pR 46%) Conclusion: Data seem to suggest the six-second spirometry as a valid screening tool for the detection of possible airway obstruction and restriction in pharmacies setting. Results point out the possibility of rationalizing the access to medical visits and of optimizing prescriptive appropriateness. The above mentioned points will lead to save public money and will strengthen the role of the Community Pharmacy as health posts of Italian Health National System.

PMID: 23474666 [PubMed - in process]

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Inspiratory Capacity during Exercise: Measurement, Analysis, and Interpretation.

Pulm Med. 2013;2013:956081

Authors: Guenette JA, Chin RC, Cory JM, Webb KA, O'Donnell DE

Abstract
Cardiopulmonary exercise testing (CPET) is an established method for evaluating dyspnea and ventilatory abnormalities. Ventilatory reserve is typically assessed as the ratio of peak exercise ventilation to maximal voluntary ventilation. Unfortunately, this crude assessment provides limited data on the factors that limit the normal ventilatory response to exercise. Additional measurements can provide a more comprehensive evaluation of respiratory mechanical constraints during CPET (e.g., expiratory flow limitation and operating lung volumes). These measurements are directly dependent on an accurate assessment of inspiratory capacity (IC) throughout rest and exercise. Despite the valuable insight that the IC provides, there are no established recommendations on how to perform the maneuver during exercise and how to analyze and interpret the data. Accordingly, the purpose of this manuscript is to comprehensively examine a number of methodological issues related to the measurement, analysis, and interpretation of the IC. We will also briefly discuss IC responses to exercise in health and disease and will consider how various therapeutic interventions influence the IC, particularly in patients with chronic obstructive pulmonary disease. Our main conclusion is that IC measurements are both reproducible and responsive to therapy and provide important information on the mechanisms of dyspnea and exercise limitation during CPET.

PMID: 23476765 [PubMed]

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Malignancy and Acute Pulmonary Embolism: Risk Stratification Including the Right to Left Ventricle Diameter Ratio in 1596 Subjects.

J Thorac Imaging. 2013 Mar 7;

Authors: Cai B, Bedayat A, George E, Hunsaker AR, Dill KE, Rybicki FJ, Kumamaru KK

Abstract
PURPOSE:: To test the hypothesis that subjects with a known malignancy at the time of acute pulmonary embolism (PE) have different clinical characteristics and predictors of 30-day all-cause mortality when compared with subjects with no known malignancy. MATERIALS AND METHODS:: A retrospective (August 2003 to March 2010) cohort of 1596 consecutive positive (for acute PE) computed tomography pulmonary angiograms (CTPAs) performed at a single, large, urban teaching hospital was separated into those from subjects with (n=835) and those from subjects without (n=761) a known malignancy. Clinical characteristics were compared between groups, and a logistic regression model determined predictors of 30-day all-cause mortality for each group. RESULTS:: Subjects with malignancy were older (60.8±13.9 vs. 54.5±18.8 y, P<0.001), had fewer risk factors for PE, and had a higher 30-day all-cause mortality (19.6% vs. 3.2%, P<0.001). The malignancy group had fewer predictors of death compared with the nonmalignancy group; advanced age, presence of coronary artery disease, history of stroke, and chronic obstructive lung disease were significantly more predictive of death in the nonmalignancy population. An enlarged right ventricle on CTPA (right to left ventricular diameter ratio >1.0) had a higher risk of 30-day death only among subjects with no known malignancy at the time of the CTPA (odds ratio=4.08, 95% confidence interval: 1.67-9.96). CONCLUSIONS:: Among subjects who present with acute PE, those with a malignancy had different clinical characteristics and predictors of mortality when compared with the cohort of subjects with no known malignancy. A computed tomography-derived right to left ventricular diameter ratio predicts 30-day all-cause mortality only for those subjects who do not have a malignancy.

PMID: 23478511 [PubMed - as supplied by publisher]

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Susceptibility genes for lung function: from adulthood to school age.

Acta Paediatr. 2013 Mar 10;

Authors: Brehm JM, Celedón JC

Abstract
For more than 50 years, scientists have debated whether common genetic determinants are responsible for two obstructive airway diseases: asthma and chronic obstructive pulmonary disease (COPD). According to the "Dutch hypothesis", phenotypic differences between asthma and COPD are explained by divergent environmental exposures, the most important of which are cigarette smoking or environmental tobacco smoke (ETS).(1) Although this theory does not fully explain major differences in clinical manifestations, cellular mediators or risk factors for asthma and COPD,(2) an interesting and related hypothesis is that genetic determinants of lung function in early life are risk factors for COPD in individuals who smoke. ©2013 The Author(s)/Acta Paediatrica ©2013 Foundation Acta Paediatrica.

PMID: 23480517 [PubMed - as supplied by publisher]