Objective: to determine the ability of participants in the Burden of Obstructive Lung Disease (BOLD) study to meet quality goals for spirometry test session quality and to assess factors contributing to good quality.

Methods: Following 2 days of centralized training, spirometry was performed pre- and post-bronchodilator (BD) at 14 international sites, in random population-based samples of persons aged ≥40 years, following a standardized protocol. The quality of each test session was evaluated by the spirometer software and an expert reading center. Descriptive statistics were calculated for key maneuver acceptability variables. A logistic regression model identified the predictors of acceptable quality test sessions.

Results: About 96%...

Background: Conventional pulmonary rehabilitation programs improve exercise tolerance but have no effect on pulmonary function in patients with chronic obstructive pulmonary disease (COPD). The role of controlled breathing using respiratory biofeedback during rehabilitation of patients with COPD remains unclear.

Objectives: To compare the effects of a conventional 4-week pulmonary rehabilitation program with those of rehabilitation plus controlled breathing interventions. Methods: A randomized controlled trial was performed. Pulmonary function (FEV₁), exercise capacity (6-min walking distance, 6MWD), health-related quality of life (chronic respiratory questionnaire, CRQ) and cardiac autonomic function (rMSSD) were evaluated.

Results: Forty COPD patients (mean ± SD age 66.1 ± 6.4, FEV₁ 45.9 ± 17.4% predicted) were randomized to rehabilitation (n = 20) or rehabilitation plus controlled breathing (n = 20). There were no statistically significant differences between the two groups regarding the change in FEV₁ (mean difference –0.8% predicted, 95% CI –4.4 to 2.9% predicted, p = 0.33), 6MWD (mean difference 12.2 m, 95% CI –37.4 to 12.2 m, p = 0.16), CRQ (mean difference in total score 0.2, 95% CI –0.1 to 0.4, p = 0.11) and rMSSD (mean difference 2.2 ms, 95% CI –20.8 to 25.1 ms, p = 0.51).

Conclusions: In patients with COPD undergoing a pulmonary rehabilitation program, controlled breathing using respiratory biofeedback has no effect on exercise capacity, pulmonary function, quality of life or cardiac autonomic function.

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Subcutaneous immunotherapy (SCIT) is effective and safe when properly prescribed and administered. However, a certain risk of severe side effects exists, even when the reaction is managed correctly. These potential adverse effects stimulated the search for new administration routes (nasal, bronchial, oral, sublingual), which were expected to be safer. Not all of these alternative routes provided an improved benefit-safety profile compared with SCIT.

The sublingual route (SLIT) seemed to be a good candidate for the clinical practice because of its satisfactory safety profile and is now considered an acceptable alternative to SCIT in adults and children.

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Sublingual immunotherapy (SLIT) represents a significant advance and it seems particularly suitable in pediatric patients. There are favorable results for food allergy in controlled trials.

For latex allergy, the results of several trials are encouraging. For atopic dermatitis, previous experience with subcutaneous immunotherapy and some earlier trials suggest the possible application of SLIT in children with mild to moderate dermatitis and sensitization to dust mite, but this recommendation is considered insufficiently evidence based. In hymenoptera allergy, the only trial available is a proof-of-concept study in large local reactions that needs to be confirmed in well-controlled studies.

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