The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction.

In order to raise public awareness of the importance of early detection of airway obstruction and to enable many people who had not been tested previously to have their lung function measured, the European Lung Foundation and the European Respiratory Society (ERS) organised a spirometry testing tent during the annual ERS Congresses in 2004-2009. Spirometry was performed during the ERS Congresses in volunteers; all participants answered a simple, brief questionnaire on their descriptive characteristics, smoking and asthma. Portable spirometers were freely provided by the manufacturer. Nurses and doctors from pulmonary departments of local hospitals/universities gave their service for free. Lower limit of normal (LLN) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for diagnosing and grading airway obstruction were used. Of 12,448 participants in six congress cities, 10,395 (83.5%) performed acceptable spirometry (mean age 51.0 ± 18.4 yrs; 25.5% smokers; 5.5% asthmatic). Airway obstruction was present in 12.4% of investigated subjects according to LLN criteria and 20.3% according to GOLD criteria. Through multinomial logistic regression analysis, age, smoking habits and asthma were significant risk factors for airway obstruction. Relative risk ratio and 95% confidence interval for LLN stage I, for example, was 2.9 (2.0-4.1) for the youngest age (≤ 19 yrs), 1.9 (1.2-3.0) for the oldest age (≥ 80 yrs), 2.4 (2.0-2.9) for current smokers and 2.8 (2.2-3.6) for reported asthma diagnosis. In addition to being a useful advocacy tool, the spirometry tent represents an unusual occasion for early detection of airway obstruction in large numbers of city residents with an important public health perspective.

Effects of formoterol on exercise tolerance in severely disabled patients with COPD.

OBJECTIVE: We wished to evaluate the effects of inhaled formoterol, a long-acting beta(2)-adrenergic agonist, on exercise tolerance and dynamic hyperinflation (DH) in severely disabled chronic obstructive pulmonary disease (COPD) patients. DESIGN: In a two-period, crossover study, 21 patients with advanced COPD (FEV(1)=38.8+/-11.7% predicted, 16 patients GOLD stages III-IV) were randomly allocated to receive inhaled formoterol fumarate 12 microg twice daily for 14 days followed by placebo for 14 days, or vice versa. Patients performed constant work-rate cardiopulmonary exercise tests to the limit of tolerance (Tlim) on a cycle ergometer: inspiratory capacity (IC) was obtained at rest and each minute during exercise. Baseline and transitional dyspnoea indices (BDI and TDI) were also recorded. RESULTS: Eighteen patients completed both treatment periods. Formoterol treatment was associated with an estimated increase of 130 s in Tlim compared with placebo (P=0.052): this corresponded to a 37.8% improvement over placebo (P=0.012). Enhanced exercise tolerance after bronchodilator was associated with diminished DH marked by higher inspiratory reserve and tidal volumes at isotime and exercise cessation (P<0.05). There was no significant difference between formoterol and placebo on exercise dyspnoea ratings; however, all domains of the TDI improved (P

Proceedings of second Indian GAME conference, Mumbai, February, 2016.

The second Indian Global Alliance for Medical Education (GAME) conference on continuing medical education-continuing professional development (CME-CPD) was held in Mumbai in February 2016. The main aim of the meeting was to create a blueprint for further development of CME in India based on best practices from around the world. To that end, delegates had been invited from the USA, the UK and Australasia, who engaged in productive discussions with the major stakeholders of the CME community in India. The latter included clinicians, medical communications representatives and delegates from the pharmaceutical industry. The mandatory CME system already established in Maharashtra was described as an example, which could be exported to other states. The various types of accreditation were discussed, including provider and activity accreditation along with hybrid systems. Recommendations for future development were proposed from workshops comprising clinicians, industry representatives and medical communications agencies.

A longitudinal study of lung function in nonsmoking patients with rheumatoid arthritis.

STUDY OBJECTIVE: s: Patients with rheumatoid arthritis (RA) have a high prevalence of pulmonary function test (PFT) abnormality, but the long-term significance of this is unknown. We performed a longitudinal study of pulmonary function in asymptomatic, nonsmoking patients with active RA requiring disease-modifying drugs. We looked for temporal change in lung function and characteristics that would predict subsequent development of PFT abnormality or respiratory symptoms. METHODS: In 1990, 52 patients (44 women; age range, 29 to 78 years; median, 56 years) underwent clinical assessment (drug history, RA severity, immunologic, and inflammatory markers) and PFTs (spirometry, body plethysmography, gas transfer). PFT results were expressed as standardized residuals (SRs). Thirty-eight patients were reassessed in 2000. A self-administered questionnaire was used to identify respiratory symptoms. RESULTS: The prevalence of pulmonary function abnormality was higher than expected compared with a reference population, but there was no significant increase in number over 10 years (8.7% in 1990 and 8.8% in 2000). When assessed by group means and compared with reference values, reduced diffusing capacity of the lung for carbon monoxide (DLCO) and increased ratio of residual volume (RV) to total lung capacity (TLC) [RV/TLC] were the only abnormalities to develop over the study period (mean DLCO in 2000, - 0.47 SR; 95% confidence interval [CI], - 0.91 to - 0.01; RV/TLC, 0.49 SR; 95% CI, 0.13 to 0.84). However, rates of change of pulmonary function variables were not significantly different from zero. Logistic regression did not identify any meaningful relationship between disease characteristics and PFT abnormality. CONCLUSIONS: Asymptomatic patients with RA have a higher prevalence of PFT abnormality than expected, but these do not increase in number over time. We did not identify any patient or disease-specific characteristic that could predict the development of respiratory disease in patients with RA. Analysis using percentage of predicted values, rather than SRs, is misleading as it exaggerates the extent of abnormality present. Abnormal lung function is a common and probably benign finding in nonsmoking, asymptomatic patients with RA.

Measurement of physiological recovery from exacerbation of chronic obstructive pulmonary disease using within-breath forced oscillometry.

BACKGROUND: Within-breath reactance from forced oscillometry estimates resistance via its inspiratory component (X(rs,insp)) and flow limitation via its expiratory component (X(rs,exp)). AIM: To assess whether reactance can detect recovery from an exacerbation of chronic obstructive pulmonary disease (COPD). METHOD: 39 subjects with a COPD exacerbation were assessed on three occasions over 6 weeks using post-bronchodilator forced oscillometry, arterial blood gases, spirometry including inspiratory capacity, symptoms and health-related quality of life (HRQOL). RESULTS: Significant improvements were seen in all spirometric variables except the ratio of forced expiratory volume in 1 s (FEV(1)) to vital capacity, ranging in mean (SEM) size from 11.0 (2.2)% predicted for peak expiratory flow to 12.1 (2.3)% predicted for vital capacity at 6 weeks. There was an associated increase in arterial partial pressure of oxygen (PaO(2)). There were significant mean (SEM) increases in both X(rs,insp) and X(rs,exp) (27.4 (6.7)% and 37.1 (10.0)%, respectively) but no change in oscillometry resistance (R(rs)) values. Symptom scales and HRQOL scores improved. For most variables, the largest improvement occurred within the first week with spirometry having the best signal-to-noise ratio. Changes in symptoms and HRQOL correlated best with changes in FEV(1), PaO(2) and X(rs,insp). CONCLUSIONS: The physiological changes seen following an exacerbation of COPD comprised both an improvement in operating lung volumes and a reduction in airway resistance. Given the ease with which forced oscillometry can be performed in these subjects, measurements of X(rs,insp) and X(rs,exp) could be useful for tracking recovery.

Clinical relevance of inter-method differences in fat-free mass estimation in chronic obstructive pulmonary disease.

BACKGROUND: Evaluation of fat-free mass (FFM) is becoming recognised as an important component in the assessment of clinical status and formulation of prognosis in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to determine whether potential differences in FFM estimation performed by air displacement plethysmography (ADP), bioelectrical impedance (BIE) and anthropometry (ANTHRO) would assume clinical significance. METHODS: Twenty-eight patients with moderate-to-severe COPD were submitted to FFM estimation by ADP, BIE and ANTHRO. FFM was then allometrically related to peak oxygen uptake (peak VO2) as determined by symptom-limited incremental cycle ergometry. RESULTS: We found that ANTHRO classified fewer patients as 'FFM-depleted' than the other two techniques (p < 0.05). Although mean biases of the BIE-ADP differences were close to zero, their 95% confidence limits extended as high as 5.9 kg (16%). The ANTHRO-based allometric exponents for peak VO2 correction of FFM, therefore, were typically higher than those obtained by the other two methods in both depleted and non-depleted patients (ANTHRO: 1.45-1.41, BIE: 0.97-1.18, ADP: 1.08-1.14, respectively). CONCLUSION: We conclude that between-method differences in FFM estimation can be sufficiently large to have practical implications in patients with moderate-to-severe COPD. A single method of body composition assessment, therefore, should be used for FFM estimation in these patients.