Elevated cardiovascular risk among adults with obstructive and restrictive airway functioning in the United States: a cross-sectional study of the National Health and Nutrition Examination Survey from 2007--2010
Background: Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States.
Methods: We used data from adults aged 20--79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.
Results: Among 7249 participants, 80.9% had a normal pulmonary function test, 5.7% had a restrictive impairment, 7.9% had mild obstructive impairment, and 5.5% had moderate or severe/very severe obstructive impairment. Participants with obstructive impairment had high rates of smoking and increased serum concentrations of cotinine. Compared to participants with normal pulmonary functioning, participants with at least moderate obstructive impairment had elevated concentrations of C-reactive protein but lower concentrations of total cholesterol and non-high-density lipoprotein cholesterol. Among participants aged 50--74 years, participants with at least a moderate obstructive impairment or a restrictive impairment had an elevated predicted 10-year risk for cardiovascular disease.
Conclusions: The high rates of smoking among adults with impaired pulmonary functioning, particularly those with obstructive impairment, point to a need for aggressive efforts to promote smoking cessation in these adults. In addition, adults with restrictive impairment may require increased attention to and fine-tuning of their cardiovascular risk profile.
Methods: We used data from adults aged 20--79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.
Results: Among 7249 participants, 80.9% had a normal pulmonary function test, 5.7% had a restrictive impairment, 7.9% had mild obstructive impairment, and 5.5% had moderate or severe/very severe obstructive impairment. Participants with obstructive impairment had high rates of smoking and increased serum concentrations of cotinine. Compared to participants with normal pulmonary functioning, participants with at least moderate obstructive impairment had elevated concentrations of C-reactive protein but lower concentrations of total cholesterol and non-high-density lipoprotein cholesterol. Among participants aged 50--74 years, participants with at least a moderate obstructive impairment or a restrictive impairment had an elevated predicted 10-year risk for cardiovascular disease.
Conclusions: The high rates of smoking among adults with impaired pulmonary functioning, particularly those with obstructive impairment, point to a need for aggressive efforts to promote smoking cessation in these adults. In addition, adults with restrictive impairment may require increased attention to and fine-tuning of their cardiovascular risk profile.
Diagnosis and treatment of latent infection with Mycobacterium tuberculosis
Abstract
In clinical practice latent infection with Mycobacterium tuberculosis is defined by the presence of a M. tuberculosis specific immune response in the absence of active tuberculosis. Targeted testing of individuals from risk groups with the tuberculin‐skin‐test or an interferon‐γ release assay is currently the best method to identify those with the highest risk for progression to tuberculosis. Positive predictive values of the immunodiagnostic tests are substantially influenced by the type of test, the age of the person who is tested, the prevalence of tuberculosis in the society and the risk group to which the person belongs. As a general rule, testing should only be offered when preventive chemotherapy will be accepted in the case of a positive test result. Preventive chem...
Serum procalcitonin is a valuable diagnostic marker in acute exacerbation of interstitial pneumonia.
Conclusions: Serum PCT is a useful marker for discriminating between AE‐IP and bacterial pneumonia. However, serum PCT is not useful as a prognostic marker for survival.© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology (Source: Respirology)
Hemodynamic effects of non‐invasive ventilation in patients with obesity‐hypoventilation syndrome.
We thank Drs. Esquinas and Petroianni for their interest in our study1. All the patients were included at the time of diagnosis and, therefore, none of them had previously received oxygen therapy or positive airway pressure. Given that respiratory failure was a newly diagnosed medical condition, the previous duration of hypoxemia is merely speculative. We totally agree that obesity‐hypoventilation syndrome (OHS) is a heterogeneous entity with a wide range of severities, and that respiratory failure and hemodynamic impairment have a multifactorial nature. Several mechanisms appear able to contribute to respiratory insufficiency in OHS. (Source: Respirology)
Non invasive mechanical ventilation in Obesity Hypoventilation Syndrome: are multimodal therapeutic strategies disease essential?
In this study, the authors did not specify how long the hypoxemia was present and the eventual oxygen therapy. The initial response of pulmonary vascular bed to hypoxemia is a vasoconstriction at the pulmonary arteriolar and capillary level. In OHS, a chronic hypoxemia determines pulmonary artery remodelling over time. The decrease of PASP after treatment of NIV may depend on the amount and duration of hypoxemia. Several nonrandomized studies reported the improvement of PH with NIV. The prevalence of OHS and its severity are linearly related to BMI. In this study BMI variation was not an endpoint. However, the condition of obesity is a risk factor for the development of cardiomyopathy characterized by eccentric ventricular hypertrophy and diastolic heart failure.4 This chronic elevated lef...