Conclusions - Systemic and pulmonary RAAS-activities are increased in iPAH-patients and associated with increased pulmonary vascular remodeling. Chronic inhibition of RAAS by losartan is beneficial in experimental PAH. PMID: 22859525 [PubMed - as supplied by publisher] (Source: American Journal of Respiratory and Critical Care Medicine)

Authors: Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M, Stockley RA, Sin DD, Rodriguez-Roisin R Abstract Chronic obstructive pulmonary disease (COPD) is a global health problem and since 2001 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD in order to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document ...

 

BACKGROUND: Current guidelines for the correct peak expiratory flow (PEF) maneuver include standing. In the hospital setting, PEF values are often ordered to assess response to asthma therapy for acute exacerbations. We have observed that the PEF is sometimes performed with the patient in bed.

METHODS: Healthy adults performed the PEF maneuver in random order (a) standing, (b) lying down at a ~45 degree angle on pillows, and (c) sitting up, slumped forward ~10 degrees with legs extended. PEF was recorded for 3 attempts in each of the 3 positions.

RESULTS: We enrolled 94 subjects (39M, 55F; mean age 24) in 2011. Mean PEF (L/min) in the standing position (669 + 42) was significantly higher than the lying (621 + 42) (p<0.0001) and sitting (615 + 42) positions in males (p<0.0001), and similarly in females, standing produced a significantly higher mean PEF (462 + 42) than lying (422 + 42) (p<0.0001) and sitting (447 + 42) (p<0.05).

CONCLUSIONS: Clinicians should ensure that PEF is obtained with patients out of bed and in the standing position.

BACKGROUND AND OBJECTIVES:The Joint Commission introduced 3 Children's Asthma Care (CAC 1-3) measures to improve the quality of pediatric inpatient asthma care. Validity of the commission's measures has not yet been demonstrated. The objectives of this quality improvement study were to examine changes in provider compliance with CAC 1-3 and associated asthma hospitalization outcomes after full implementation of an asthma care process model (CPM).

METHODS:The study included children aged 2 to 17 years who were admitted to a tertiary care children's hospital for acute asthma between January 1, 2005, and December 31, 2010. The study was divided into 3 periods: preimplementation (January 1, 2005-December 31, 2007), implementation (January 1, 2008-March 31, 2009), and postimplementation (April 1, 2009-December 31, 2010) periods. Changes in provider compliance with CAC 1-3 and associated changes in hospitalization outcomes (length of stay, costs, PICU transfer, deaths, and asthma readmissions within 6 months) were measured. Logistic regression was used to control for age, gender, race, insurance type, and time.

RESULTS:A total of 1865 children were included. Compliance with quality measures before and after the CPM implementation was as follows: 99% versus 100%, CAC-1; 100% versus 100%, CAC-2; and 0% versus 87%, CAC-3 (P < .01). Increased compliance with CAC-3 was associated with a sustained decrease in readmissions from an average of 17% to 12% (P = .01) postimplementation. No change in other outcomes was observed.

CONCLUSIONS:Implementation of the asthma CPM was associated with improved compliance with CAC-3 and with a delayed, yet significant and sustained decrease in hospital asthma readmission rates, validating CAC-3 as quality measure. Due to high baseline compliance, CAC-1 and CAC-2 are of questionable value as quality measures.