Diagnosis Of Obstructive Airways Disease Research Articles

Relationship between symptoms and results on spirometry in adults seen in non-tertiary public health facilities presenting with preserved ratio impaired spirometry.

Preserved ratio impaired spirometry (PRISm), defined by reduced forced expiratory volume in 1 second (FEV1) without meeting criteria for airway obstruction, is often encountered in clinical practice. The management of this heterogeneous condition in individuals with chronic respiratory symptoms is challenging, especially under limited diagnostic resources. Since 2020, all consecutive patients referred for spirometry at our institution have been invited to participate in our registry. Other than spirometry, no other physiological lung function testing is available in this public health service. Therefore, we reviewed our databank with the aim of assessing: i) the proportion of symptomatic patients aged 18 years or older referred for spirometry presenting with PRISm; ii) the rate of inhaled medication used in this group, suggesting a referral diagnosis of obstructive airway disease (OAD); and iii) the relationship between symptoms and results on spirometry in PRISM compared to a group with obstruction matched by FEV1. To this end, the COPD Assessment Test (CAT) and the Asthma Control Test (ACT) were conjointly responded to by 1032 participants, irrespective of the clinical suspicion. We found that 22% had PRISM, of whom 200 were paired with obstruction by FEV1 (68±10% of predicted). The CAT and ACT results were well-correlated in both groups (r=-0.727 and -0,698, respectively; p<0.001) and used to measure symptoms. Participants in the final sample (n=400) were aged 62±13 years; 70% were ever smokers; and 55% reported household exposure to biomass smoke (at least 5 years). The CAT responses were in the range of moderate symptoms (17±9) and ACT borderline for uncontrolled symptoms (19±5). The main differences were higher body mass index (33±7 versus 29±7 kg/m2; p<0.001) and proportion of females (72 versus 49%; p<0.001) in PRISm compared to obstruction. This group had lower exposure to tobacco (65 versus 76% of ever-smokers) but greater exposure to biomass smoke (61 versus 49%) (p<0.05 for all). The rate of inhaled medication use was as high in PRISm as in obstruction (80%). Notwithstanding matched FEV1, we found less prominent signs of airway disease in PRISM: marginally reduced FEV1/forced vital capacity (FVC) ratio (94±8% of predicted); higher expiratory flow between 25% and 75% of vital capacity, despite presumed lower lung volumes (lower FVC); and lower rate of bronchial hyperresponsiveness. In an identical multivariate model, FEV1 predicted symptoms of obstruction only. In conclusion, these data raise suspicion of a substantial rate of misclassification of individuals with PRISM as having OAD in healthcare facilities with constraints on diagnostic resources.

Obesity Hypoventilation (Pickwickian) Syndrome – ”The Tip of an Iceberg” in Morbidly Obese Patients

ABSTRACT Obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome, is a combination of obesity (body mass index (BMI) &gt;30 kg/m2), daytime hypercapnia (arterial carbon dioxide tension &gt;45 mm Hg) and sleep-disordered breathing, after exclusion of other disorders that may cause alveolar hypoventilation. Management of OHS requires a multifaceted approach in the form of weight loss, treatment of existing co-illnesses, pulmonary rehabilitation, and Bi-level positive airway pressure (Bi-PAP) therapy. A 58-year-old lady with a BMI of 50 kg/m2 with symptoms of obstructive sleep apnea (OSA) and OHS presented to the hospital with respiratory distress. She gave a history of breathlessness, snoring, and sleep disturbances for the last 7 years. She was managed by a physician with a diagnosis of obstructive airway disease without further evaluation of sleep disturbance. On admission, she was started on non-invasive ventilation during her initial management. After 72 hours of admission, the patient became stable, and overnight polysomnography was performed to confirm the diagnosis of OHS. After confirmation of the diagnosis, she was started on Bi-PAP therapy along with other supportive therapy for 7 days. She was discharged after 10 days of admission with nocturnal Bi-PAP therapy at home and was enrolled in a comprehensive pulmonary rehabilitation program. Patient is on regular follow-up and has been doing well since then.

Prospective study of hyperglycemia and its impact on the causation of severe exacerbations in chronic obstructive pulmonary disease (COPD) patients attending a tertiary care hospital

Background: Hyperglycemic states are always associated with sudden onset of illnesses of both infectious and non-infectious nature. Chronic obstructive pulmonary disease is a chronic, lifelong suffering illness with sudden exacerbations. Objectives: To compare the affiliation of hyperglycemia with the chance of sudden exacerbations in sufferers with an established diagnosis of obstructive airway disease (COPD). Materials Methods: A total of 263 patients with an established diagnosis of COPD were taken into this observational study. The duration of the study extended between Jan. 2022 to July 2023. Sufferers were divided into 3 classes following the guidelines of the American Diabetes Association; those classes were: low HbA1c level class (n=102), moderate HbA1c level (n=83), and severe HbA1c level (n=74). Results: Among the 263 participants, 72 (27.4%) suffered severe exacerbation. The share of sufferers tormented by a minimum of one episode of intense and sudden exacerbation becomes extensively higher among participants with high (36.3%) and moderate HbA1c levels (24.7%) when compared with low HbA1c levels (22.6%). On the MCRA, high HbA1c levels (HR=2.65, 95% CI: 1.92–4.31; P&amp;lt;0.01) and moderate HbA1c levels (HR=2.06, 95% CI: 1.64–3.29; P&amp;lt;0.01). Participants with hyperglycemia were significantly associated with a higher risk of the next severe exacerbation compared with a euglycemic state. Conclusion: irrespective of current/previously established diagnosis of diabetes, hyperglycemic states are associated with a higher risk of severe exacerbation in patients with COPD.

Peak Flow and Mini-spirometry in the Diagnosis of Obstructive Airway Diseases

Background: India is initiating measures to address Chronic Obstructive Pulmonary Disease(COPD) and Asthma, major causes of mortality and morbidity, at the primary care level. The efforts are limited by the lack of access to spirometry. Various alternatives are being tried out in resource limited countries. Methods: A hospital based cross-sectional study was done at two tertiary care hospitals in Trivandrum, South India, in patients with a clinical diagnosis of COPD or Asthma. Spirometry was done by a trained spirometry technician, along with peak-flow recording and a recording on portable mini-spirometer (COPD6 ®). The values obtained by the latter two were compared to those obtained by spirometry. Results: The study included 360 patients. PEFR showed a positive correlation with both FEV1/FVC as well as FEV1 (R2 of 0.35 and 0.65, respectively). FEV1/FEV6 and FEV1 on COPD6 also correlated positivity with FEV1 and FEV1/FVC on spirometry (R2 of 0.68 and 0.89, respectively). Sensitivity and specificity of PEFR to diagnose obstruction was best at a cut-off of 74% of predicted, as determined by ROC, giving sensitivity of 84.8% and specificity of 85.1%. Sensitivity and specificity of COPD6 to detect obstruction was 75.9% and 95.7%, respectively. Conclusion: Mini-spirometry (COPD6) and peak-flow measurement may be used as alternatives to spirometry in resource limited settings as in the primary care centers of India for the diagnosis of obstructive airway diseases.

A study to assess the utility of forced oscillometry in the diagnosis of obstructive airway disease and its correlation with spirometry

A study to assess the utility of forced oscillometry in the diagnosis of obstructive airway disease and its correlation with spirometry

Thoracic computed tomography measures have predictive value in the diagnosis of chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is diagnosed with pulmonary function tests (PFTs). However, since not all patients can be diagnosed with PFTs, some are diagnosed with radiological or clinical findings. The purpose of this study was to define the properties of obstructive airway disease through thoracic computed tomography (CT) and to identify the diagnostic efficacy of CT findings. A total of 160 patients who underwent PFT and thoracic CT assessment July 2018 - January 2019, were retrospectively analyzed. Based on PFT findings, patients were categorized into three groups as having normal, restrictive or obstructive airways. Age, height, weight, and body mass indexes of the groups were recorded. Pulmonary height, width, right-left hemi-diaphragm height, sterno-diaphragmatic angle and retrosternal transparent area length in axial sections were also recorded. Diagnostic efficacies of these parameters in the detection of obstructive airway disease were measured. Of the 160 patients (109 males, 51 females; mean age = 59.5), 91 (56.9) had normal PFT, 58 (36.2%) had obstructive and 11 (6.9%) had restrictive airway disease. Pulmonary height, width, sterno-diaphragmatic angle, and retrosternal transparent area length were significantly higher in patients with obstructive airway disease while the right-left hemi-diaphragm height was significantly lower (p&lt;0.001). About 60-75% sensitivity and specificity were obtained when identifying the obstructive airway disease with these parameters. These values obtained from the axial and sagittal sections could contribute to the diagnosis of obstructive airway disease.

Functional Predictors Discriminating Asthma-COPD Overlap (ACO) from Chronic Obstructive Pulmonary Disease (COPD).

BackgroundA significant proportion of patients with obstructive lung disease have clinical and functional features of both asthma and chronic obstructive pulmonary disease (COPD), referred to as the asthma–COPD overlap (ACO). The distinction of these phenotypes, however, is not yet well-established due to the lack of defining clinical and/or functional criteria. The aim of our investigations was to assess the discriminating power of various lung function parameters on the assessment of ACO.MethodsFrom databases of 4 pulmonary centers, a total of 540 patients (231 males, 309 females), including 372 patients with asthma, 77 patients with ACO and 91 patients with COPD, were retrospectively collected, and gradients among combinations of explanatory variables of spirometric (FEV1, FEV1/FVC, FEF25-75), plethysmographic (sReff, sGeff, the aerodynamic work of breathing at rest; sWOB), static lung volumes, including trapped gases and measurements of the carbon monoxide transfer (DLCO, KCO) were explored using multiple factor analysis (MFA). The discriminating power of lung function parameters with respect to ACO was assessed using linear discriminant analysis (LDA).ResultsLDA revealed that parameters of airway dynamics (sWOB, sReff, sGeff) combined with parameters of static lung volumes such as functional residual capacity (FRCpleth) and trapped gas at FRC (VTGFRC) are valuable and potentially important tools discriminating between asthma, ACO and COPD. Moreover, sWOB significantly contributes to the diagnosis of obstructive airway diseases, independent from the state of pulmonary hyperinflation, whilst the diffusion capacity for carbon monoxide (DLCO) significantly differentiates between the 3 diagnostic classes.ConclusionThe complexity of COPD with its components of interaction and their heterogeneity, especially in discrimination from ACO, may well be differentiated if patients are explored by a whole set of target parameters evaluating, interactionally, flow limitation, airway dynamics, pulmonary hyperinflation, small airways dysfunction and gas exchange disturbances assessing specific functional deficits.

Study on factors associated with post bronchodilator reversibility among patients presenting with dyspnea: An experience at a tertiary care academic hospital in Kerala.

Background:The change in FEV1 after administration of a short-acting bronchodilator has been widely used for diagnosis of obstructive airway diseases. Many factors can influence the post bronchodilator reversibilityAim:The aim of the present study was to estimate the presence of reversibility among the patients of obstructive airway disease and to identify the factors affecting itMethods:Patients who presented to the department of respiratory medicine with symptoms of dyspnea were evaluated with spirometry. Spirometry and post bronchodilator reversibility (BDR) was defined as per international guidelines. SPSS 17 was used for statistical analysis and P < 0.05 was considered significantResults:Out of 100 patients studied, 33 had BDR. Median age of the population was 58 ± 17 years. There were 72 non-smokers and 58 men. A total of 32 had chronic obstructive pulmonary disease (COPD), 56 had asthma, and 12 had normal spirometry. The median pre and post bronchodilator FEV1 was 1.34L/Sec and 1.46 L/sec respectively. Twenty-seven of asthma (41%) and 6 of COPD (19%) had BDR (P = 0.05). Other factors associated with BDR were smoking (P = 0.035). There was no statistically significant correlation found between eosinophilia, gender, severity of obstruction, BMI, height, weight and ageConclusion:The prevalence of post BDR in the study population was 33%. The factors affecting BDR were smoking status, and asthma. The study did not show any significant correlation between BDR and eosinophilia, gender, height and age.

The role of clinical signs and spirometry in the diagnosis of obstructive airway diseases: a systematic analysis adapted to general practice settings.

BackgroundIn general practice (GP), the diagnosis of obstructive airway diseases much relies on diagnostic questions, in view of the limited availability of lung function. We systematically assessed the relative importance of such questions for diagnosing asthma and chronic obstructive pulmonary disease (COPD), either without or with information from spirometry.MethodsWe used data obtained in a pulmonary practice to ensure the validity of diagnoses and assessments. Subjects with a diagnosis of COPD (n=260), or asthma (n=433), or other respiratory diseases (n=230), and subjects without respiratory diseases (n=364, controls) were included. The diagnostic questions comprised eight items, covering smoking history, self-attributed allergic rhinitis, dyspnea, cough, phlegm and wheeze. Optionally standard parameters of the flow-volume-curve were included. Decision trees for the diagnosis of COPD and asthma were constructed, moreover a probabilistic diagnostic network based on the results of path analyses describing the relationship between variables.ResultsIn the decision trees, age, sex, current smoking, wheezing, dyspnea upon mild exertion, self-attributed allergic rhinitis, phlegm, forced expiratory volume in one second (FEV1), and expiratory flow rates were relevant, depending on the diagnostic comparison, while cough, dyspnea upon strong exertion and ex-smoker status were not relevant. In contrast, the probabilistic network for the diagnosis of COPD and asthma versus controls incorporated all diagnostic questions, i.e., dyspnea upon mild or strong exertion, current smoking, ex-smoking, wheezing, cough and phlegm but from spirometry only FEV1. Depending on the individual pattern, the probability for COPD could raise from 25% to 81%, while the diagnostic gain for asthma was lower.ConclusionsThe study developed simple diagnostic algorithms for asthma and COPD that take into account the relative importance of clinical signs and history, as well as spirometric data if available. The diagnostic accuracy was especially high for COPD. These algorithms may be helpful as a starting point in the standardisation of diagnostic strategies in GP practices.Trial registrationThe study is registered under DRKS00013935 at German Clinical Trials Register (DRKS, Date of registration 01/03/2018).

Lung function testing assessment by impulse oscillometry in chronic lung disease

Abstract Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.

Differences in diagnostic patterns of obstructive airway disease between areas and sex in Sweden and Finland - the Nordic EpiLung study

Objective To investigate the current prevalence of physician-diagnosed obstructive airway diseases by respiratory symptoms and by sex in Sweden and Finland. Method In 2016, a postal questionnaire was answered by 34,072 randomly selected adults in four study areas: Västra Götaland and Norrbotten in Sweden, and Seinäjoki-Vaasa and Helsinki in Finland. Results The prevalence of asthma symptoms was higher in Norrbotten (13.2%), Seinäjoki-Vaasa (14.8%) and Helsinki (14.4%) than in Västra Götaland (10.7%), and physician-diagnosed asthma was highest in Norrbotten (13.0%) and least in Västra Götaland (10.1%). Chronic productive cough was most common in the Finnish areas (7.7–8.2% versus 6.3–6.7%) while the prevalence of physician-diagnosed chronic bronchitis (CB) or chronic obstructive pulmonary disease (COPD) varied between 1.7 and 2.7% in the four areas. Among individuals with respiratory symptoms, the prevalence of asthma was most common in Norrbotten, while a diagnosis of COPD or CB was most common in Västra Götaland and Seinäjoki-Vaasa. More women than men with respiratory symptoms reported a diagnosis of asthma in Sweden and Seinäjoki-Vaasa but there were no sex differences in Helsinki. In Sweden, more women than men with symptoms of cough or phlegm reported a diagnosis of CB or COPD, while in Finland the opposite was found. Conclusion The prevalence of respiratory symptoms and corresponding diagnoses varied between and within the countries. The proportion reporting a diagnosis of obstructive airway disease among individuals with respiratory symptoms varied, indicating differences in diagnostic patterns both between areas and by sex.

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

Background: Capnovolumetry is of interest as a method for the diagnosis of obstructive airway diseases, requiring little cooperation from the patient. Objective: To help in the interpretation of capnovolumetric parameters, we aimed to identify their correspondence to conventional lung function indices. Methods: We studied 978 patients from a diagnostic study with complete functional data and the clinical diagnosis of asthma, chronic obstructive pulmonary disease (COPD), or no respiratory disease. Using path analysis, four capnovolumetric parameters (slope of expiratory phase 3, ratio of slopes of phases 3 and 2, volume of phase 2, and the ratio area/volume of phase 3) previously identified as predictors of airway obstruction in terms of spirometry and body ple­thysmography, were analyzed regarding their relationship to each other and the diagnostic categories of asthma or COPD versus control, or obstruction versus no obstruction. We then identified four lung function parameters showing relationships as much as possible isomorphic to those between capnovolumetric parameters. Results: The four capnovolumetric parameters were related to COPD and obstruction via both direct and indirect influences, but only two of them to asthma. Regarding the correspondence to lung function parameters, the slope of expiratory phase 3 corresponded best to the ratio of residual volume to total lung capacity, the ratio of slopes of phases 3 and 2 to forced expiratory volume in 1 s, the volume of phase 2 to forced expired flow at 50% of vital capacity, and the ratio area/volume of phase 3 to forced vital capacity. Conclusions: Our results indicated an intricate relationship of capnovolumetric parameters to each other and to airway obstruction, asthma, or COPD. The correspondence to conventional lung function measures seemed to reflect the entities lung hyperinflation, overall ventilatory impairment, bronchoconstriction, and ventilated lung volume, in that order. These findings might be helpful for clinicians in the interpretation of capnovolumetry.

Opportunistic screening for COPD in primary care: a pooled analysis of 6,710 symptomatic smokers and ex-smokers.

ObjectiveTo investigate the prevalence and predictors of COPD in a large cohort of symptomatic smokers and ex-smokers in a primary care setting.MethodsGeneral practitioners (n=390) consecutively recruited individuals ≥35 years, with current or previous tobacco exposure, at least one respiratory symptom, and no previous diagnosis of obstructive airways disease; and obtained data on tobacco exposure, body mass index (BMI), and dyspnea (Medical Research Council dyspnea scale). All individuals with airflow obstruction, ie, FEV1/FVC <0.70 at initial lung function test, had diagnostic spirometry, including bronchodilator reversibility test. COPD was defined as respiratory symptom(s), tobacco exposure, and nonreversible airflow limitation.ResultsOf the 6,710 at-risk individuals screened with spirometry (52% male sex, mean age 58 years [SD 10.9]), 1,185 were diagnosed with COPD (17.7%). Apart from age and pack-years, multivariate logistics regression analysis, adjusted for FEV1, revealed that BMI <25 kg/m2 (OR 4.2, 95% CI 3.0–5.9, p<0.001), BMI 35+ kg/m2 (OR 1.6, 95% CI 1.2–2.3), self-reported dyspnea (OR 1.2, 95% CI 1.1–14, p=0.04), wheeze (OR 1.3, 95% CI 1.1–1.6, p=0.001), phlegm (OR 1.4, 95% CI 1.1–1.6, p<0.001), and MRC ≥3 (OR 1.6, 95% CI 1.2–2.0, p=0.001) were associated with a significantly higher likelihood of being diagnosed with COPD. No association was found between sex, cough, and recurrent respiratory tract infections and a diagnosis of COPD.ConclusionThe prevalence of COPD is high among smokers and ex-smokers with one or more respiratory symptoms seen in primary care, and the presence of wheeze, phlegm and dyspnea, together with both low BMI and obesity identify a subgroup with an even higher likelihood of COPD.

Predictors of COPD in symptomatic smokers and ex-smokers seen in primary care.

Even in subjects at high risk of chronic obstructive pulmonary disease (COPD), the diagnosis is often missed due to lack of awareness of symptoms and risk factors. The objective of this study was to identify predictors of a diagnosis of COPD in symptomatic current and ex-smokers seen in a primary care setting. General practitioners (n = 241) consecutively recruited subjects ≥ 35 years, with tobacco exposure, at least one respiratory symptom (i.e. cough, sputum, wheeze, dyspnoea and/or recurrent lower respiratory tract infections), and no previous diagnosis of obstructive airways disease. Information on age, smoking status, body mass index (BMI) and dyspnoea (Medical Research Council (MRC) dyspnoea scale) was obtained. Individuals with airway obstruction (i.e. forced expiratory volume in 1 second (FEV1)/forced vital capacity ratio (FVC) < 0.70) at initial spirometry had a diagnostic spirometry after administration of a bronchodilator. COPD was defined as the presence of symptoms, tobacco exposure and persistent airflow limitation. The most prevalent symptoms were cough (72%) and dyspnoea (48%). Of 3875 (50% females, mean age 57 years) subjects screened, 700 (18.1%) were diagnosed with COPD. Multivariate logistic regression analysis revealed that increasing age 50–59 years (OR 2.4, 95% CI 1.8–3.3), 60–69 years (OR 4.1, 95% CI 3.1–5.5), ≥70 years (OR 5.7, 95% CI 4.2–7.8), BMI < 25 (OR 2.3, 95% CI 1.9–2.7), being current smoker (OR 1.2, 95% CI 1.01–1.5), self-reported dyspnoea (OR 1.7, 95% CI 1.4–2.0), wheeze (OR 1.9, 95% CI 1.5–2.3) and sputum (OR 1.4, 95% CI 1.1–1.7) were associated with a significantly higher risk of being diagnosed with COPD. No association was found between gender, cough and recurrent respiratory tract infections and a diagnosis of COPD. Among symptomatic smokers and ex-smokers seen in primary care, self-reported sputum production, wheeze, dyspnoea and low BMI identify a subgroup with a higher likelihood of COPD.

The Effect of World Trade Center Exposure on the Timing of Diagnoses of Obstructive Airway Disease, Chronic Rhinosinusitis, and Gastroesophageal Reflux Disease.

In a cohort of rescue/recovery workers exposed to the dust that resulted from the collapse of the World Trade Center (WTC), we assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD). We also assessed whether OAD acted as a mediator of the association between exposure to the WTC rescue/recovery effort and CRS and GERD diagnoses. In this prospective cohort study, we analyzed Fire Department of the City of New York physician diagnoses of OAD, CRS, and GERD that were first documented between September 11, 2001, and September 10, 2011, among 8,968 WTC-exposed firefighters. We used piecewise exponential survival models to evaluate whether OAD was a risk factor for either CRS or GERD and to assess OAD as a possible mediator. An OAD diagnosis significantly increased the risks for subsequent CRS [relative rate (RR), 4.24; 95% CI, 3.78-4.76] and GERD (RR, 3.21; 95% CI, 2.93-3.52) diagnoses. Further, 21% of the WTC exposure effect (high vs. low intensity) on GERD and 13% of the effect (high vs. low intensity) on CRS were mediated by a prior OAD diagnosis. Individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD. Part of the effect of WTC exposure on CRS and GERD diagnoses is mediated by prior diagnoses of OAD; this mediation effect of OAD may reflect biological pathways or healthcare utilization practices.

When is overground endoscopy indicated and what can it tell us?

The development of overground endoscopy is an exciting addition to the veterinary surgeon's arsenal when investigating dysfunction of the upper portion of the respiratory tract of the horse. The equipment, of which there are a number of versions, allows the operator to acquire real time images of the upper portion of the respiratory tract under normal exercising conditions. To date a large number of horses from all the common equestrian disciplines have been examined and an array of abnormalities have been detected. The equipment is safe, reliable and well tolerated. In addition to its use for the purpose of investigation and diagnosis of obstructive airway disease, overground endoscopy has allowed the clinician to review the efficacy of therapeutic interventions and take a critical, evidence-based approach to treatment of the many dynamic diseases that affect the equine upper airway. It would be reasonable to conclude that overground endoscopy is now the gold standard technique for investigation of horses with clinical signs of poor performance or abnormal respiratory noise, and that the knock on positive effect on equine welfare as a result of the introduction of the technique is significant.

Back to the future: sagittal CT in the evaluation of COPD.

To identify features of obstructive airway disease on sagittal reconstruction,compare the accuracy of findings to traditional imaging characteristics of COPD, and determine the fraction of additional cases identified using new characteristics. The study was approved by the centre's Institutional Review Board and is HIPAA compliant. Two hundred sixteen patients with HRCT and spirometry within a 3-month window were included. Four radiologists evaluated each HRCT for traditional characteristics of COPD and new quantitative and qualitative features of obstruction on axial and sagittal reconstructions. Imaging characteristics were assessed for correlation with the spirometric diagnosis of obstructive airway disease. Quantitative and qualitative findings on sagittal reconstruction are highly specific for COPD (specificity >90%). Features of hyperinflation on sagittal reconstruction are more accurate predictors of obstruction than traditional axial measures, with greater interobserver reliability (hyperinflation left hemidiaphragm: accuracy: 70.08% ± 2.49%; kappa: 0.511 versus traditional measures: accuracy: 62.00% ± 5.38%; kappa: 0.407). Sagittal reconstruction identified 27-70% more patients with COPD than traditional axial findings (p < 0.05). Analysis of sagittal reconstruction enables greater accuracy and specificity in the diagnosis of obstructive airway disease compared to traditional measures on axial imaging. Use of sagittal reconstructions can help identify up to 70% more patients with COPD than traditional imaging findings alone. • HRCT sagittal reconstruction is useful in the evaluation of obstructive lung disease. • Findings on sagittal reconstructions allow physicians to more accurately diagnose COPD. • Routine use of sagittal reconstructions increases the sensitivity for diagnosing COPD.

Airways resistance and specific conductance for the diagnosis of obstructive airways diseases.

BackgroundAirway resistance (RAW) and specific airway conductance (sGAW) are measures that reflect the patency of airways. Little is known of the variability of these measures between different lung diseases. This study investigated the contribution of RAW and sGAW to a diagnosis of obstructive airways disease and their role in differentiating asthma from COPD.Methods976 subjects admitted for the first time to a pulmonary practice in Belgium were included. Clinical diagnoses were based on complete pulmonary function tests and supported by investigations of physicians’ discretion. 651 subjects had a final diagnosis of obstructive diseases, 168 had another respiratory disease and 157 subjects had no respiratory disease (healthy controls).ResultsRAW and sGAW were significantly different (p < 0.0001) between obstructive and other groups. Abnormal RAW and sGAW were found in 39 % and 18 % of the population, respectively, in which 81 % and 90 % had diagnosed airway obstruction. Multiple regression revealed sGAW to be a significant and independent predictor of an obstructive disorder. To differentiate asthma from COPD, RAW was found to be more relevant and statistically significant. In asthma patients with normal FEV1/FVC ratio, both RAW and sGAW were more specific than sensitive diagnostic tests in differentiating asthma from healthy subjects.ConclusionsRAW and sGAW are significant factors that contribute to the diagnosis and differentiation of obstructive airways diseases.

Emotional Impact of Long Term Chronic Obstructive Pulmonary Disease

Background: Although it has been repeatedly suggested from western studies that chronic obstructive pulmonary disease (COPD) is associated with lot of emotional impact. A study was undertaken to investigate whether depression occurs more often in patients with COPD than in controls. The demographic and clinical variables associated with depression were also determined. Methods: Patients with a registered diagnosis of obstructive airway disease in general practice, aged ≥40 years, forced expiratory volume in 1 second (FEV1) <80% predicted, FEV1reversibility ≤12%, FEV1/VC ≤ predicted – 1.64 × SD, and a history of smoking were selected. A random sample of subjects without a registered diagnosis of asthma or COPD aged 40 years or older acted as controls. Depression was assessed using the Centers for Epidemiologic Studies Depression (CES-D) scale. Results: In patients with severe COPD (FEV1 <50% predicted), the prevalence of depression was 25.0% compared with 17.5% in controls and 19.6% in patients with mild to moderate COPD. When the results were adjusted for demographic variables and comorbidity, the risk for depression was 2.5 times greater for patients with severe COPD than for controls (OR 2.5, 95% CI 1.2 to 5.4). In patients with mild to moderate COPD this increased risk of depression was not seen. Living alone, reversibility of FEV1 % predicted, respiratory symptoms and physical impairment were significantly associated with the scores on the CES-D scale. Conclusion: Patients with severe COPD are at increased risk of developing depression. The results of this study underscore the importance of reducing symptoms and improving physical functioning in patients with COPD.

COPD in Helsinki, Finland: socioeconomic status based on occupation has an important impact on prevalence

Chronic obstructive pulmonary disease (COPD) is globally a major, but often undiagnosed, cause of morbidity and mortality. The aims of this study were to assess the prevalence of COPD in Helsinki, Finland, with international diagnostic criteria and to analyse risk factors including socioeconomic status, and disease severity. A general population sample of 628 adults (368 women) completed flow-volume spirometry with bronchodilation test and a structured interview. Post-bronchodilation spirometry was assessed both using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria and relative to the fifth percentile of the reference value (lower limit of normal, LLN). According to GOLD criteria, 37 (5.9%), and by using the LLN criteria, 43 subjects (6.8%) had airway obstruction consistent with COPD. Using the GOLD criteria, four subjects or 0.6% of the population had severe, 3.0% moderate, and 2.2% mild COPD. Of those with post-bronchodilator obstruction, 49% had no previous diagnosis of obstructive airways disease and did not use medication for any respiratory disease. The prevalence of undiagnosed COPD defined by GOLD was 2.9% (LLN 3.3%). In addition to age, smoking history, and prior history of asthma, socioeconomic status based on occupation was significantly related to COPD in the population. Manual workers in industry (GOLD 10.0%, LLN 11.7%) and non-manual assistant employees (10.2%, 10.2%) had a significantly higher prevalence of COPD than professionals (2.8%, 2.3%). Although smoking is the main modifiable risk factor for COPD, the disease was significantly related to manual workers and non-manual assistant employees, i.e. socioeconomic groups reflecting occupation.