Presence Of Obstructive Lung Disease Research Articles

An Australian COVID-19 respiratory care unit experience.

Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a heterogeneous presentation ranging from severe pneumonitis to asymptomatic infection. International studies have demonstrated the utility of respiratory care units (RCUs) to facilitate the delivery of non-invasive ventilation techniques to patients with COVID-19 pneumonitis. This study aims to describe the patient characteristics, flow and outcomes of admissions to the Royal Melbourne Hospital (RMH) COVID-19 RCU (CRCU) during its initial period of operation. Single-centre retrospective cohort study, all patients admitted to CRCU between 17 September and 10 December 2021 were included in this study. Patient demographics, including comorbidities and limitations of medical treatment, were analysed. Admission source and discharge destination were reviewed. Length of stay was recorded. Finally, in-hospital and CRCU mortality were analysed. Ninety-seven patients, comprising 111 admissions, occurred during the study period with median age of 65 years (48% female). Most patients were admitted from and discharged to the ward. Twenty patients died in hospital (21%), with age, 4C score, comorbidity and presence of obstructive lung disease predicting mortality (area under the curve (AUC) 0.85, P < 0.001). Mortality was significantly higher in those over 65 years of age compared to those under 65 (P < 0.001), or those deemed not for intubation compared to those for intubation (P = 0.0019). This study demonstrates the feasibility of operating a CRCU within an Australian tertiary healthcare setting.

Is bilevel PAP more effective than CPAP in treating hypercapnic obese patients with COPD and severe OSA?

Commentary on Zheng Y, Yee BJ, Wong K, Grunstein R, Piper A. A pilot randomized trial comparing CPAP versus bilevel PAP spontaneous mode in the treatment of hypoventilation disorder in patients with obesity and obstructive airway disease. J Clin Sleep Med. 20XX;XX(XX):XXX-XXX. doi:10.5664/jcsm.9506.

PRS11 - The Association Between Airflow Limitation and Early Retirement Using the Health Retirement Survey Data

Many individuals may retire early due to health issues resulting from a chronic condition. This study’s objective is to determine if there is an association between airflow limitation, measured by peak expiratory flow (PEF), and early retirement. A retrospective cohort study was conducted using data from the Health Retirement Survey (HRS) waves 2006 to 2014. Included individuals were age 55 to 64 years, working in survey years 2006-2010, with a completed PEF test and information on gender, race, height, age, education status and planned retirement age. Individuals responding “yes” to having a diagnosis of stroke were excluded. Individuals were followed for 4 years after providing planned retirement age, and individuals retiring earlier than planned were considered as “retired early”. Presence of airflow limitation was determined using an individual’s PEF measurement as a proportion of predicted lung function (PPLF). Airflow limitation was defined as a PPLF of <75%. Statistical analyses included Chi-square test, t-test, simple linear regression and multiple linear regression. A total of 1346 individuals were included, 203 (15.1%) with airflow limitation. Overall, 134 individuals retired early (9.9%). Among individuals with airflow limitation, a significantly greater proportion retired early versus those without airflow limitation (14.3% vs 9.2%, p=0.025); adjusted odds ratio 1.77 (95% CI 1.11, 2.84). Significantly greater proportions of individuals with these conditions also retired early compared to individuals without: depression (14.7% vs 9.4%, p=.04), cancer (16.4% vs 9.4%, p<0.01), arthritis (13.2% vs 7.4%, p<0.01) and hypertension (11.8% vs 8.0%, p=.02). Airflow limitation measured by PEF is significantly associated with early retirement. Airflow limitation may indicate the presence of obstructive lung disease, a chronic disabling condition. This information may be useful in designing early detection screening programs for obstructive lung disease, potentially delaying disease progression and reducing the effect of airflow limitation on early retirement.

Avaliação da função pulmonar em pacientes com câncer submetidos à quimioterapia

Justificativa e Objetivo: Alguns agentes neoplásicos usados no tratamento do câncer (CA) causam toxicidade pulmonar e outros importantes efeitos adversos, dessa forma, o presente estudo objetivou avaliar a presença de distúrbio ventilatório obstrutivo (DVO), distúrbio ventilatório restritivo (DVR) ou misto em pacientes com diagnóstico de câncer submetidos a tratamento quimioterápico. Métodos: Trata-se de estudo transversal descritivo que avaliou pacientes com diagnóstico de câncer e submetidos à quimioterapia utilizando os fármacos Doxorrubicina, Bleomicina, Vimblastina, Dacarbazina, Ciclofosfamida, Fluoruracila e Vincristina, sendo excluídos aqueles com diagnóstico de CA de pulmão. Realizado teste de função pulmonar através de análise espirométrica (EasyOne®, Switzerland) em pacientes que iniciaram tratamento quimioterápico há mais de 30 dias, tendo sido avaliadas a Capacidade Vital Forçada (CVF), o Volume Expiratório Forçado no primeiro segundo da CVF (VEF1), o Fluxo Expiratório Forçado entre 25-75% da CVF (FEF25 75%) e a Relação VEF1/CVFantes da sessão quimioterápica. Resultados: Amostra (n=18) composta por portadores de CA com média de idade de 49,28±9,90 anos e 26,49±5,67 Kg/m2 onde 44,4% apresentou padrão espirométrico normal, 27,8%apresentou DVO, 16,7% apresentou DVR e 11,1% apresentou distúrbio ventilatório misto. Conclusão: A quimioterapia resultou em distúrbio pulmonar obstrutivo, restritivo e misto nos portadores de leucemia, câncer de mama e Linfoma de Hodgkin não específico avaliados.

Hepatitis C Virus Infection Is Not An Independent Risk Factor For Obstructive Lung Disease

Several epidemiological studies have suggested that hepatitis C virus (HCV) infection is associated with the presence of obstructive lung disease (OLD). However, there is a strong link between HCV infection and tobacco abuse, a major risk factor for the development of OLD. In this study we analyzed clinical, laboratory and spirometric data from 1068 study participants to assess whether HCV infection, viremia, or HCV-associated end organ damage were associated with OLD. Demographics, risk behavior, serologic status for HCV and HIV, and spirometric measurements were collected from a cross-sectional analysis of the Acquired Immunodeficiency Syndrome (AIDS) Linked to the IntraVenous Experience (ALIVE) study, an observational cohort of IDUs followed in Baltimore, MD since 1988. Of 1,068 participants, 890 (83%) were HCV positive and 174 (16%) met spirometric criteria for OLD. Factors independently associated with OLD were age and BMI. HCV infection, viral load and HCV-associated end organ damage were similar in participants with and without OLD. In summary, there was no independent association between markers of HCV exposure, chronicity, viremia, or HCV-associated end-organ damage with OLD. Our findings support the strong correlation between HCV status, injection drug use, and smoking. These data suggest that HCV may not be a sole contributor to the increased prevalence of OLD described in previous studies of HCV-infected individuals.

Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation

BackgroundObjective measurement of airflow obstruction by spirometry is an essential part of the diagnosis of asthma or COPD. During exacerbations, the feasibility and utility of spirometry to confirm the diagnosis of asthma or chronic obstructive pulmonary disease (COPD) are unclear. Addressing these gaps in knowledge may help define the need for confirmatory testing in clinical care and quality improvement efforts. This study was designed to determine the feasibility of spirometry and to determine its utility to confirm the diagnosis in patients hospitalized with a physician diagnosis of asthma or COPD exacerbation.MethodsMulti-center study of four academic healthcare institutions. Spirometry was performed in 113 adults admitted to general medicine wards with a physician diagnosis of asthma or COPD exacerbation. Two board-certified pulmonologists evaluated the spirometry tracings to determine the proportion of patients able to produce adequate quality spirometry data. Findings were interpreted to evaluate the utility of spirometry to confirm the presence of obstructive lung disease, according to the 2005 European Respiratory Society/American Thoracic Society recommendations.ResultsThere was an almost perfect agreement for acceptability (κ = 0.92) and reproducibility (κ =0.93) of spirometry tracings. Three-quarters (73%) of the tests were interpreted by both pulmonologists as being of adequate quality. Of these adequate quality tests, 22% did not present objective evidence of obstructive lung disease. Obese patients (BMI ≥30 kg/m2) were more likely to produce spirometry tracings with no evidence of obstructive lung disease, compared to non-obese patients (33% vs. 8%, p = 0.007).ConclusionsAdequate quality spirometry can be obtained in most hospitalized adults with a physician diagnosis of asthma or COPD exacerbation. Confirmatory spirometry could be a useful tool to help reduce overdiagnosis of obstructive lung disease, especially among obese patients.

Association between obstructive lung disease and markers of HIV infection in a high-risk cohort

BackgroundEvidence suggests an association between HIV infection and the presence of obstructive lung disease (OLD). However, the associations between specific markers of HIV infection and OLD remain unclear. A study...

COPD Stage and Risk of Hospitalization for Infectious Disease*

Respiratory tract infections are a frequent complication of COPD, but little is known about the incidence, association, and risk of infectious diseases related to impaired lung function. Participants in the Copenhagen City Heart Study had lung function measured at baseline, and were followed for up to 25 years. All hospitalizations due to any infection were identified through registry linkage. Impaired lung function was defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging system. A total of 3,333 infectious disease hospitalizations (IDHs) occurred during 230,653 person-years of follow-up (PY), corresponding to an overall incidence of 145 IDHs (95% confidence interval [CI], 139 to 149) per 10,000 PY. The incidence increased with GOLD stage, from 131 (95% CI, 126 to 136) for normal COPD, to 170 (95% CI, 146 to 193) for mild COPD, to 230 (95% CI, 207 to 253) for moderate COPD, and 394 (95% CI, 330 to 459) for severe/very severe COPD. The trend in risk persisted after the control of background characteristics using Cox proportional hazards analysis (adjusted relative risks: 1.06 [95% CI, 0.92 to 1.23], 1.39 [95% CI, 1.24 to 1.56], and 2.21 [95% CI, 1.84 to 2.64], respectively; p=0.001). In subgroup analysis, the increased risk was associated with lower and upper respiratory tract infections, pyothorax, and tuberculosis, but not with influenza, sepsis, skin infections, urinary tract infections, diarrheal disease, or other infectious diseases. The presence of obstructive lung disease is a significant predictor of IDH caused by respiratory tract infections, but not of hospitalizations due to infections outside the respiratory system.

The Proportional Venn Diagram of Obstructive Lung Disease in the Italian General Population

The Venn diagram of obstructive lung disease (OLD) has been recently quantified. We aimed to quantify the proportion of the general population with OLD, and the intersections of physician-diagnosed asthma, chronic bronchitis (CB), and emphysema in two Italian general population samples, in relationship to airflow obstruction (AO) determined through spirometry. We analyzed data from two prospective studies (4,353 patients) carried out in the rural area of Po River delta from 1988 to 1991 and in the urban area of Pisa from 1991 to 1993. Prevalence rates of asthma, CB, and emphysema were 5.3%, 1.5%, and 1.2% in the Po delta, and 6.5%, 2.5%, and 3.6% in Pisa. A double Venn diagram, which was used to quantify the distribution of CB, emphysema, and asthma in relation to the presence/absence of AO, identified 15 categories. Isolated AO was the most frequent category (Po delta, 11.0%; Pisa, 6.7%), followed by asthma only without AO (Po delta, 3.3%; Pisa, 4.3%). The combination of the three OLD conditions was the only category that always showed higher prevalence rates for those with AO (Po delta, 0.20%; Pisa, 0.16%) than for those without AO (Po delta, 0.04%; Pisa, 0.05%). Of those with either OLD or AO, there were 61.4% in Po delta and 38.2% in Pisa with isolated AO, 24.8% and 41.9%, respectively, with an OLD without AO, and 13.8% and 19.9%, respectively, with simultaneous OLD and AO. For both genders, the frequency of isolated asthma decreased with age, while that of isolated AO, CB-emphysema, and the combination of asthma and CB-emphysema increased. About 18% of the Italian general population samples either reported the presence of OLD or showed spirometric signs of AO. We confirmed that the Venn diagram of OLD can be quantified in the general population by extending the mutually exclusive disease categories (including a concomitant diagnosis of asthma, CB, or emphysema) to 15.

Radiology of obstructive pulmonary disease.

Obstructive lung diseases may be associated with a variety of pathologic findings, including emphysema, large airways abnormalities, and small airways abnormalities. The usefulness of plain radiographs for showing these findings is limited, although the presence of obstructive lung disease can often be inferred in the presence of increased lung volumes, gross lung destruction (emphysema) or large airways abnormalities. Furthermore, radiographs may not provide useful information in many patients with a known disease who experience an exacerbation of their symptoms. Nonetheless, chest radiographs are commonly obtained in this setting to assess the presence or absence of disease complications. HRCT can reveal morphologic abnormalities associated with obstructive lung disease with a greater accuracy than plain radiographs. HRCT is more sensitive than radiographs in showing emphysema, large airways abnormalities such as bronchiectasis, and small airways abnormalities such as bronchiolectasis and the tree-in-bud appearance. Furthermore, findings associated with abnormal ventilation, including mosaic perfusion, can also be seen on HRCT, as can findings of air trapping on expiratory scans. These latter findings are particularly helpful in diagnosing obstructive disease in the absence of other morphologic abnormalities. Although the indications for use of HRCT vary with the specific disease, HRCT can be valuable in patients in whom the diagnosis is, on the basis of clinical and plain radiographic findings, in question or for whom specific therapy is being contemplated.

An unusual opportunity to reduce operative risk by combining cardiac and pulmonary procedures

A case is presented of a successful triple combined procedure consisting of coronary artery bypass grafting, mitral valve replacement and pulmonary resection. Previous studies have shown the increased risk of surgery for coronary occlusive disease when combined with mitral valve replacement or when undertaken in the presence of obstructive lung disease. We believe this to be the first report describing the reduction of operative risk as a result of combining pulmonary resection with mitral valvular and coronary artery surgery.

Risk of Pneumothorax Not Increased by Obstructive Lung Disease in Percutaneous Needle Biopsy

All computed tomography directed lung biopsies from 1987 to 1991 were retrospectively reviewed. Pneumothorax occurred in 33 of 93 (35 percent) patients; 16 of these patients or 17 percent overall required a chest tube. No correlation was found between the presence of obstructive lung disease and the incidence of pneumothorax. Patients with smaller lesions were more likely to incur a pneumothorax. No relation was found with central or peripheral location, patient's age, or the operator and the incidence of pneumothorax. Patients with a pneumothorax were more likely to require a chest tube if they had obstructive lung disease.

Role of inhalation challenge testing in the diagnosis of isocyanate-induced asthma.

Results of isocyanate challenge tests performed on 63 workers referred with a diagnosis of probable isocyanate asthma between 1974 and 1988 were reviewed. Thirty (48 percent) had an acute episode of asthma with a greater than 20 percent decline in FEV1 following subirritant exposure to isocyanates. No difference in the frequency or type of respiratory complaints between isocyanate reactors and nonreactors was found. No differences in lung function results were present when comparing smoking and ex-smoking reactors and nonreactors. In never-smokers with complaints consistent with isocyanate-induced asthma, the presence of obstructive lung disease increased the likelihood that isocyanate-induced asthma was present. Bronchial responsiveness to methacholine occurred in nearly all isocyanate reactors but predicted isocyanate-induced asthma in only 68 percent of the workers. In nearly all cases of challenge-confirmed toluene diisocyanate (TDI)-induced asthma, a 15-min exposure to 20 ppb of the commercial TDI mixture (80:20 2,4:2,6) provoked asthma. Conversely, in the absence of an asthmatic response following exposure to this dose for this duration, a second exposure at this concentration for a longer time would be reasonable to confirm the absence of isocyanate-induced asthma. Among workers employed in the production of polyurethane foam and confirmed to have TDI-induced asthma by inhalation challenge to the different TDI isomers, there appeared to be increased airway reactivity to the 2,6 isomer. This may have relevance to the frequency and intensity of respiratory symptoms that workers with TDI-induced asthma develop in differing industrial settings.