Usefulness of the Piko-6 Portable Device for Early COPD Detection in Primary Care

Introduction

COPD is a highly prevalent but underdiagnosed disease, due to the limited availability of forced spirometry (FS) in primary care (PC). Microspirometers are inexpensive, easy-to-use devices that can measure FEV₆ and FEV₁/FEV₆, and may help reduce underdiagnosis. The aim of this study was to validate the Piko-6 COPD screening device by demonstrating a good correlation with standard FS.

Continuous monitoring of ventilatory mechanics during one-lung ventilation

Objective. The Ultima SV respiratory monitor can be used to monitor the intraoperative effects of the lateral decubitus position and one-lung ventilation on ventilatory mechanics.Methods. Eight patients with esophageal cancer who required one-lung ventilation for esophagectomy and reconstruction were enrolled in the study. We monitored pressure-volume or flow-rate-volume loops continuously throughout the operation. Respiratory parameters were evaluated closely during five conditions of ventilation: two-lung ventilation in the supine position, two-lung ventilation in the lateral decubitus position, dependent one-lung ventilation in the lateral decubitus position, nondependent one-lung ventilation in the lateral decubitus position, and dependent one-lung ventilation in the lateral decubitus position with the chest opened. Respiratory rate was controlled at 10 breaths/min, and tidal volume was kept constant (10 ml/kg) during surgery.Results. Peak inspiratory pressure increased to 29.0 ± 9.0 (mean ± SD) cm H₂O in the dependent one-lung in the lateral decubitus position with the chest opened (p < 0.01). Dynamic compliance decreased to 29.4 ± 4.9 ml/cm H₂O in the dependent one-lung in the lateral decubitus position with the chest opened (p < 0.01). The changing configuration of the loops also offered additional and instantaneous information during one-lung ventilation.Conclusions. One-lung ventilation caused several changes in the whole respiratory system (lung, thorax, and endotracheal tube). Continuous monitoring of flow-rate-volume or pressure-volume loops with in-line spirometry provided comprehensive information regarding parameters in one-lung ventilation.     

中国大型综合性医院肺量计检查报告质量的多中心调查

目的 了解我国肺量计检查报告质最控制现状.方法 收集2008年1-10月我国36家大型综合性医院肺功能室的肺量计检查报告单,参照ATS和ERS的肺活量测试标准进行质量分析,肺量计检查各质量控制标准的符合情况以百分率来描述.结果 共收集345例报告单,82.5%(282/342)的报告单符合测试起始质量的标准;65.8%(219/333)的报告单达到分析呼气流畅质量的标准,其余114例不符合标准的报告单中,咳嗽占8.7%(29/333),声门早闭占2.4%(8/333),口嘴漏气占8.7%(29/333),提前中止占7.8%(26/333),阻塞口器占1.8%(6/333),未尽最大努力占14.7%(49/333);50.6%(119/235)的报告单达到分析测试结束质量的标准;测试次数≥3次的占22.6%(78/345),其中65例有各次测试数据报告,可分析其重复性,符合标准的占95.4%(62/65),占总数的18.0%(62/345),AFVC＜150 ml的占95.4%(62/65),△FVC＜100 ml的占92.3%(60/65),△FEV_1＜150 ml的占100.0%(65/65),△FEV_1＜100 ml的占87.7%(57/65);在345例报告单中,同时符合上述4项标准的仅占总数的7.2%(25/345).结论 我国医院的用力肺功能检查质量有待提高.     

Diaphragm Paralysis Definitively Diagnosed by Ultrasonography and Postural Dependence of Dynamic Lung Volumes after Seven Decades of Dysfunction

Unilateral diaphragm paralysis is an important and often unrecognized cause of dyspnea. In patients with appropriate risk factors, such as prior head and neck surgery and presentation of positional dyspnea or dyspnea on submersion, unilateral diaphragmatic paralysis should be considered. We present our approach to the diagnosis of diaphragm paralysis and demonstrate the utility of upright/supine spirometry and M-mode ultrasonography in these patients’ evaluation.     

Serum Uric Acid to Creatinine Ratio in Patients with Chronic Obstructive Pulmonary Disease

Serum uric acid (UA), the final product of purine degradation, has been shown to be increased in the hypoxic state. We assessed whether the presence of higher values of serum UA and serum UA to creatinine ratio is associated with clinical or functional characteristics in patients with chronic obstructive pulmonary disease (COPD). Fifty-nine consecutive stable patients with COPD, without comorbid conditions, were included. Clinical and functional characteristics were compared between patients with levels below and above the median values of serum UA and serum UA to creatinine ratio. Patients with serum UA levels above the median value differed significantly from the group with levels below this value only in FVC (p = 0.04), and serum UA did not correlate significantly with the parameters analyzed. Patients with the serum UA to creatinine ratio above the median value had lower FVC (63 ± 18 vs. 73 ± 15 percentage of predicted, p = 0.028), lower FEV₁ (43 ± 19 vs. 55 ± 18 percentage of predicted, p = 0.019), and a higher level of dyspnea (MRC scale, 1.5 ± 1.1 vs. 0.8 ± 1.0, p = 0.011). The serum UA to creatinine ratio correlated with FVC (r = −0.27), with FEV₁ (r = −0.31), and with dyspnea (r = 0.29). In view of these results, we consider that the serum UA to creatinine ratio warrants evaluation as an additional parameter for predicting outcome in COPD.     

Components of the COPD Assessment Test (CAT) associated with a diagnosis of COPD in a random population sample

Abstract

The aim of this study was to determine if components of the COPD Assessment Test (CAT), a validated health status impairment instrument, had additional utility in identifying patients at risk for COPD in whom spirometry testing is appropriate. This study was part of the Canadian Obstructive Lung Disease prevalence study. Consenting participants ≥ 40 years of age were identified by random digit dialing. Smoking history, 8-item CAT scores, and post-bronchodilator spirometry were recorded for each. Stepwise logistic regression analysis was used to identify variables related to the presence of airway obstruction and a final logistic model was developed which best predicted COPD in this sample. Of the 801 individuals approached, 532 were included: 51 (9.6%) had COPD, the majority (92%) of whom fit GOLD I or II severity criteria. Items that correlated significantly with a COPD diagnosis included the CAT total score (p = 0.01) and its breathlessness (p < 0.0001) and phlegm (p = 0.001) components. The final logistic model included: age (<55 or ≥55 years), smoking status (current, former, never) and the CAT breathlessness score (ordinal scale 0–5). The area under the receiver-operating characteristic curve for this model was 0.77, sensitivity was 77.6%, specificity was 64.9% and the positive likelihood ratio was 2.21. In summary, the triad of smoking history, age at least 55 years and the presence of exertional breathlessness were key elements of a simple model which had reliable measurement properties when tested in a random population. This may help identify patients at risk for COPD for whom spirometry testing is recommended.