Perspectives on Using Race in Pulmonary Function Testing: A National Survey Fellows and Program Directors.

Background: Pulmonary function tests (PFTs) have historically used race-specific prediction equations. The recent American Thoracic Society guidelines recommend the use of a race-neutral approach in prediction equations. There are limited studies centering the opinions of practicing pulmonologists on the use of race in spirometry.

Pulmonary function testing in neuromuscular disease.

Neuromuscular disorders frequently compromize pulmonary function and effective ventilation, and a thorough respiratory evaluation often can assist in diagnosis, risk assessment, and prognostication. Since many of these disorders can be progressive, serial assessments may be necessary to best define a trajectory of impairment or improvement with therapy. Patients with neuromuscular diseases may have few respiratory symptoms and limited signs of skeletal muscle weakness, but can have significant respiratory muscle weakness.

Diagnostic Performance of the Herder Model in Veterans Undergoing PET Scans for Pulmonary Nodule Evaluation.

British Thoracic Society (BTS) guidelines recommend using the Herder model to risk-stratify lung nodules after positron emission tomography (PET). However, this approach has not been adequately evaluated, particularly among Veterans. A single-center retrospective cohort study was carried out in U.

End-expiratory lung volume decreases during REM sleep despite continuous positive airway pressure.

Purpose: Patients with obstructive sleep apnea (OSA) may experience apneas and hypopneas primarily during stage R (REM) sleep when end-expiratory lung volume (EELV) reaches its nadir. The purpose of this study was to determine if REM-related reductions in EELV persist in the presence of continuous positive airway pressure (CPAP) prescribed during non-stage REM (NREM) sleep.

Methods: We prospectively recruited 17 subjects referred to the sleep laboratory for CPAP titration.

A chest tube translocating the posterior mediastinum: A strange case of malpositioning without complication or injury.

Malpositioning of a chest tube is a recognised complication of chest tube insertion. However, cases involving the mediastinum comprise only a fraction of such occurrences, while the complete translocation of the tube through the medisastinum is only noted in three published cases. This case report describes a case of complete translocation of the mediastinum during chest tube insertion to resolve a pneumothorax.

Pulmonary Function Testing in Neuromuscular and Chest Wall Disorders.

Neuromuscular and chest wall disorders frequently compromise pulmonary function, and thorough respiratory evaluation often can assist in diagnosis, risk assessment, and prognosis. Because many of these disorders can be progressive, serial assessments are necessary to best define a trajectory of impairment (or improvement with therapy). This article covers the major respiratory testing modalities available in the evaluation of these patients, emphasizing both the benefits and shortcomings of each approach.

Change in End-Expiratory Lung Volume During Sleep in Patients at Risk for Obstructive Sleep Apnea.

Study Objectives: As lung volume decreases radial traction on the upper airway is reduced, making it more collapsible. The purpose of this study was to measure change in end-expiratory lung volume (EELV) following sleep onset and to evaluate the relationship between change in EELV and sleep-disordered breathing.

Methods: Twenty subjects underwent overnight polysomnography, of whom 14 (70%) had obstructive sleep apnea (OSA).

The Maximal Expiratory-to-Inspiratory Pressure Ratio and Supine Vital Capacity as Screening Tests for Diaphragm Dysfunction.

Purpose: The change in vital capacity from the seated to supine position (∆VC-supine) is used to screen for diaphragm dysfunction (DD), but some individuals are unable to tolerate the supine position. Since expiratory muscle function is often preserved in patients with isolated DD and inspiratory strength is reduced, the purpose of this study was to examine if the ratio of maximal expiratory pressure to maximal inspiratory pressure (MEP/MIP) may provide an alternative to ∆VC-supine when screening patients for DD.

Methods: We performed a cross-sectional analysis on 76 patients referred for evaluation of unexplained dyspnea and possible DD.

Physiology in Medicine: physiological basis of diaphragmatic dysfunction with abdominal hernias-implications for therapy.

An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea).

New developments in the assessment of COPD: early diagnosis is key.

Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease in the world, and its associated health burdens and costs are mounting. Until recently, it was generally accepted that targeting the diagnosis of COPD early in its course was a relatively fruitless effort, since treatments other than already ubiquitous smoking-cessation efforts were unlikely to alter its course. However, there is strong evidence to suggest that the majority of patients with objective COPD are not aware of their condition, and this leads to a significant delay in diagnosis, more aggressive smoking-cessation intervention, and potential treatment.

Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation.

Introduction: The purpose of this study was to evaluate if ultrasound derived measures of diaphragm thickening, rather than diaphragm motion, can be used to predict extubation success or failure.

Methods: Sixty-three mechanically ventilated patients were prospectively recruited. Diaphragm thickness (tdi) was measured in the zone of apposition of the diaphragm to the rib cage using a 7-10 MHz ultrasound transducer.

The use of thrombolytic therapy in pregnancy.

The relative hypercoagulable state of pregnancy leads to an increased risk of thrombotic complications, of which some may be life-threatening or medically devastating. In the non-pregnant patient, the current guidelines suggest thrombolysis as the primary treatment in acute ischemic stroke, myocardial infarction when percutaneous intervention is unavailable, certain cases of mechanical valve thrombosis, and pulmonary embolism with hemodynamic compromise or shock. Given that clinical trial data regarding thrombolytic use in pregnant women are absent due to exclusion, the goal of this review is to summarize the available published data regarding the use of thrombolytic agents and subsequent outcomes and complications in pregnant women.

Methacholine-induced airway hyper-reactivity phenotypes.

Objective: The incorporation of airways conductance/resistance is a rare feature in clinical methacholine challenge test (MCT) protocols, and the majority of pulmonary laboratories rely solely on the spirometric parameters. The importance and interpretation of an MCT demonstrating a significant decline in specific airway conductance specific airway conductance (sGaw), but not forced expiratory volume in one second (FEV(1)), remains undefined. This study sought to elucidate the clinical and physiologic phenotypes of individuals with a ≥40% sGaw decline but <20% FEV(1) change.

Initial risk assessment for pulmonary hypertension in patients with COPD.

Background: Pulmonary hypertension (PH) is a comorbidity associated with increased mortality in chronic obstructive pulmonary disease (COPD) patients. It is not known which clinical markers are predictive of PH in COPD. The goal of this study was to develop a clinical tool to identify patients who should be sent for initial screening with echocardiography.

Treatment options for cystic fibrosis: state of the art and future perspectives.

Cystic fibrosis (CF) is an autosomal recessive disorder characterized by chronic lung and sinus disease, impaired mucociliary clearance (leading to recurrent pulmonary infection), pancreatic insufficiency, elevated sweat chloride levels and male infertility. Cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-regulated chloride channel in the plasma membrane of epithelial cells lining the lung, pancreas, liver, intestines, sweat duct, and the epididymis. Genetic mutations in CFTR affect its synthesis, processing, and transport to the plasma membrane and/or impede its function as a chloride channel and conductance regulator.

The role of natriuretic peptides in inflammation and immunity.

The natriuretic peptides (NPs) are a family of widely distributed, but evolutionarily conserved, polypeptide mediators that exert a range of effects throughout the body. There is growing realization that NP actions go far beyond volume and blood pressure homeostasis. Their pleiotropic effects include a significant role in regulating the immune system.

Using serial severity scores to predict death in ICU patients: a validation study and review of the literature.

Purpose Of Review: The present study describes the use of serial severity scores to predict death in ICU patients and compares the results with previously published literature on this topic.

Recent Findings: Predicting mortality in critically ill patients has tremendous significance and methods to do so accurately have been studied for decades. The ability to accurately predict death impacts medical therapies, triaging, end-of-life care, and many other aspects of ICU care.

Increased risk of arrhythmic events in long-QT syndrome with mutations in the pore region of the human ether-a-go-go-related gene potassium channel.

Background: The hereditary long-QT syndrome is characterized by prolonged ventricular repolarization and a variable clinical course with arrhythmia-related syncope and sudden death. Mutations involving the human ether-a-go-go-related gene (HERG) channel are responsible for the LQT2 form of long-QT syndrome, and in cellular expression studies these mutations are associated with reduction in the rapid component of the delayed rectifier repolarizing current (I(Kr)). We investigated the clinical features and prognostic implications of mutations involving pore and nonpore regions of the HERG channel in the LQT2 form of this disorder.

The relative stress on the Achilles tendon during ambulation in an ankle immobiliser: implications for rehabilitation after Achilles tendon repair.

Background: After Achilles tendon repair, immediate weightbearing and immobilisation closer to neutral plantarflexion are thought to limit atrophy and stiffness, but may place deleterious stress on the repair.

Objectives: To estimate the relative stress on the Achilles tendon during weightbearing with immobilisation in varying degrees of plantarflexion.

Methods: Electromyographic (EMG) activity from the plantarflexors was recorded during walking in 10 subjects (six men, four women) without ankle pathology.