ARMI News - Part 5

Technical and Functional Assessment of 10 Office Spirometers: Assessment of User Friendliness

We developed a novel questionnaire to assess the user friendliness of office spirometers (to view Tables A and B in the on-line supplementary data, go to www.chestnet.org). The questionnaire completed by the three GPs covered the following: general properties and parameters of the software, quality of the patient administrative data, features of the display and automated quality control, comparison of successive tests in the same subject, use at home visits, and export facilities. The precision of the office spirometers was assessed by the Sw of FEV1 and FVC obtained from five successive maneuvers done by the nine ETs with the office spirometers and with the standard spirometers. The larger the Sw value, the lower the precision. The variance of each set of five measurements (FVC, FEV1) was computed, and the within-subject variance of the measurements was obtained by averaging the nine variances. To obtain the 95% error limits, the square root of the within-subject variance was multiplied by 1.96. We used goals for within-session repeatability for FEV1 and FVC of 200 mL, as our upper limits of precision. website
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Technical and Functional Assessment of 10 Office Spirometers: Setting

Technical and Functional Assessment of 10 Office Spirometers: SettingThe ETs were asked to perform PFTs in the two other centers to verify interchangeability of the results. There was no significant difference between centers in absolute values and reproducibility (p > 0.05, by one-way analysis of variance; Fig 1).
Precision of the Spirometers: The ETs were asked to perform on the same day five successive forced expiratory maneuvers with the standard spirometers (one by center) and with the office spirometers to compare their reproducibility. After verifying the interchangeability of the results, we pooled the values and reported the within-subjects SD (Sw). buy actos 30mg
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Technical and Functional Assessment of 10 Office Spirometers: Setting

The study was divided into an in-laboratory study and an assessment of user friendliness of the office spirometers. The in-laboratory study was performed in the pulmonary function laboratories of three academic hospitals in Belgium.
For the user-friendliness assessment, the office spirometers were also presented to three GPs working in the general practice department of the three universities. The same office spirometers were used successively in the three laboratories and by the three GPs according to their availability.
The sales representatives of the office spirometers were asked to demonstrate the devices in each center. At the moment of the study, Sibelmed (Barcelona, Spain) was not represented in Belgium and the two Sibelmed spirometers (Datospir 70 and Datospir 120) were not demonstrated. We scrupulously followed the instructions of the manufacturers, in particular concerning the handling of the devices and the need for calibration checks. According to instruction manuals, the majority of the office spirometers do not need calibration.
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Technical and Functional Assessment of 10 Office Spirometers

Technical and Functional Assessment of 10 Office SpirometersThere is a clear need for early diagnosis of COPD. This lung disease is one of the leading causes of mortality and disability in developed countries, and only smoking cessation has proven its efficacy in changing the natural evolution of COPD. One major problem with early detection of COPD is the fact that smokers rarely complain even if they have dyspnea. However, lung function changes are often detectable > 10 years before onset of dyspnea at rest. Therefore, according to a consensus statement from the National Lung Health Education Program, the screening of asymptomatic at-risk populations should start from the age of 45 years, The screening by general practitioners (GPs) using office spirometry can double the number of early diagnoses in COPD patients.

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Advanced Emphysema in African-American and White Patients: Conclusion

Advanced Emphysema in African-American and White Patients: ConclusionThe percentage difference in emphysema severity and distribution between the two groups, based on quantitative CT analysis (Table 5, Fig 4), suggests some variability in lung response to injury caused by smoking, and thus supports the notion of differences in phenotypic expression and burden of disease. To date, no studies have explored racial differences in airway response to cigarette smoking; however, it is noteworthy that African Americans have been shown to have a slower oxidative metabolism of nicotine than whites. Investi-gations pertaining to variability in inflammatory response between various racial groups started to emerge in an attempt to explain susceptibility and heterogeneity of certain inflammatory conditions.
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Advanced Emphysema in African-American and White Patients: Discussion

Socioeconomic status is another aspect that may have a significant confounding effect on the prevalence of emphysema. This aspect is difficult to control for because it entrains access to health care, level of education, environmental exposure, and possibly respiratory infections. Race and socioeconomic status are closely entwined, and patients with lower levels of income often receive substandard care due to lack of insurance, delay in seeking health care, reliance on hospital clinics and emergency departments, and less referrals to specialists. It is also possible that African Americans with emphysema are underdiagnosed because they are perceived to be “protected” and their symptoms are attributed to other illnesses, including asthma and heart disease. In a national survey, the prevalence of COPD (by history) was found to increase with age in white subjects but not in African Americans, although the age-specific percentage of African Americans having obstructive lung disease by spirometry (FEV1/FVC ratio < 70 and FEV1 < 80% of predicted) was actually similar or higher compared to whites. Although no studies are available on racial bias in diagnosing COPD, this tendency has been observed in women, a population that was thought to be less susceptible to injury from smoking. The aforementioned observations suggest that COPD/ emphysema may be underdiagnosed in African Americans. More info
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Advanced Emphysema in African-American and White Patients: Discussion

Advanced Emphysema in African-American and White Patients: DiscussionFew doubt that the answer lies in the complex genotype/environment interactions, but the extent to which each factor plays in the pathogenesis of emphysema is enigmatic. Except for a1-antitryp-sin deficiency, no studies have identified other “emphysema genes” that distinguish the remaining 99% patients with emphysema. Studies are starting to unveil some potential genetic markers and risk factors that could be implicated in the pathogenesis of emphysema. Among these are tumor necrosis factor-a and matrix metalloproteinase-1 and matrix metalloproteinase-12 polymorphisms. Currently, although genetic familial studies are underway, they include few African-American patients. in detail
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Advanced Emphysema in African-American and White Patients: Results

In white patients, the core-peel difference was significantly greater in the lung apex but not at the mid and basilar lung regions than in the African-American patients. In Figure 4, the frequency distribution of the core-peel percentage of emphysema differences are plotted for the whole lung, lung apex, and lung base. Note that the two frequency distributions for the apical lung are skewed in opposite directions for African-American vs white patients. No differences were noted for mild-to-moderate emphysema regions between the two groups when — 910 HU and — 850 HU were assumed as cutoffs. in detail

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Advanced Emphysema in African-American and White Patients: Demographic and Physiologic Racial Differences

Advanced Emphysema in African-American and White Patients: Demographic and Physiologic Racial DifferencesBetween January 1998 and July 2002, a total of 1,218 patients with severe emphysema were enrolled in the NETT. Forty-two of the patients (3.4%) were African American, and 1,156 patients (95%) were white. The baseline characteristics of these patients are shown in Table 1. African Americans were younger and less heavy. There was no difference in the severity of the emphysema based on static pulmonary function, gas exchange, exercise performance, and use of steroids. African-American patients in the study had a lower socioeconomic status and a lower level of education, and were less likely to be married (Fig 1).
Although the debut and duration of smoking was similar between the two races, African Americans smoked less both in terms of quantity of cigarettes and quality of exposure to cigarette smoke, ie, whites inhaled more deeply than African Americans (Table 2). this

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Advanced Emphysema in African-American and White Patients: Statistical Analysis

In addition to the density histogram, the a value (the negative slope) from the log-log relationship of hole size vs percentage of holes (with hole membership defined as voxels at — 950 HU, — 910 HU, or — 850 HU) was evaluated in this study because it has been shown also to represent severity of emphysema based on the concept that as emphysema progresses, there is a tendency of small holes to mechanically destabilize a lung region, such that small holes merge into larger holes rather than additional small holes accumulating. African-American patients were matched with white patients (1:1) according to gender, height (± 12 cm), age (± 3 years), number of cigarettes smoked per day (± 10 cigarettes), and age started smoking (± 3 years). When more than one match was identified, the match that was closest in age and closest in height was chosen. further

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