脉冲振荡技术在儿童支气管舒张试验中的应用

目的：探讨脉冲振荡方法(IOS)在儿童支气管舒张试验中的应用及其与常规肺量计法结果的相关关系。方法：发作期的哮喘患儿同时应用两种方法做吸入支气管扩张剂前后肺功能测定，以FEV1改善≥15％判断为阳性，应用统计学处理对两种方法各指标作相关性分析。结果：IOS各指标舒张后改善明显，△Zrs、△R5与金标准△FEV1密切相关，经多元回归得出方程△FEV1=-1．527△Zrs 0．883△R5。结论：IOS法可以作为不能配合用力呼气动作的儿童行支气管舒张试验。     

Respiratory health and fluoride exposure in different parts of the modern primary aluminum industry

Objective: The aim of this cross-sectional study was to investigate possible acute and long-term respiratory health effects of work at different working places in the primary aluminum industry. Method: A cross-sectional study was carried out on 78 potroom workers, 24 foundry workers, and 45 carbon-plant workers (n = 147, exposed group), and 56 control workers (watchmen, craftsmen, office workers, laboratory employees) of a modern German prebake aluminum plant. The survey consisted of pre- and postshift spirometric and urinary fluoride measurements. Results: Potroom workers had significantly lower preshift results with regard to forced vital capacity (FVC, 99.5% versus the 107.2% predicted; P < 0.05) and peak expiratory flow (PEF, 85.2% versus the 98.4% predicted; P < 0.01) as compared with controls. In a multiple regression model a small but significant negative correlation was found between postshift urinary fluoride concentrations and FVC, FEV₁, and PEF. Across-shift spirometric changes were observed only in FVC among carbon-plant workers (103.0 ± 13.3% predicted preshift value versus 101.2 ± 13.6% predicted postshift value; P < 0.05). Conclusions: The results suggest that lung function impairment in the modern primary aluminum industry may be only partly due to fluoride exposure and that working in aluminum carbon plants may cause acute lung function changes. Received: 8 July 1998 / Accepted: 31 October 1998     

Comparison of the Prevalence of Chronic Obstructive Pulmonary Disease Diagnosed by Lower Limit of Normal and Fixed Ratio Criteria

The Global Initiative of Chronic Obstructive Lung Disease (GOLD) guidelines define chronic obstructive pulmonary disease (COPD) in subjects with FEV₁/FVC <0.7. However, the use of this fixed ratio may result in over-diagnosis of COPD in the elderly, especially with mild degree of COPD. The lower limit of normal (LLN) can be used to minimize the potential misclassification. The aim of this study was to evaluate the impact of different definitions of airflow obstruction (LLN or fixed ratio of FEV₁/FVC) on the estimated prevalence of COPD in a population-based sample. We compared the prevalence of COPD and its difference diagnosed by different methods using either fixed ratio (FEV₁/FVC <0.7) or LLN criterion (FEV₁/FVC below LLN). Among the 4,816 subjects who had performed spirometry, 2,728 subjects met new ATS/ERS spirometry criteria for acceptability and repeatability. The prevalence of COPD was 10.9% (14.7% in men, 7.2% in women) by LLN criterion and 15.5% (21.8% in men, 9.1% in women) by fixed ratio of FEV₁/FVC among subjects older than 45 yr. The difference of prevalence between LLN and fixed ratio of FEV₁/FVC was even higher among subjects with age ≥65, 14.9% and 31.1%, respectively. In conclusion, the prevalence of COPD by LLN criterion was significantly lower in elderly compared to fixed ratio of FEV₁/FVC. Implementing LLN criterion instead of fixed ratio of FEV₁/FVC may reduce the risk of over-diagnosis of COPD in elderly people.     

The role of objective tests to support a diagnosis of asthma in children

In many healthcare settings asthma in children is a clinical diagnosis based on parental reported symptoms. These include intermittent episodes of wheezing, breathlessness and periodic nocturnal dry cough. Increased symptoms often coincide with colds. Confirming a diagnosis of asthma in children can be difficult and recent reports highlight that misdiagnosis, including over- and under-diagnosis of asthma are common. Recent UK National Institute of Health and Care Excellence guidelines recommend diagnostic algorithms for children from five years and adults to support a clinical suspicion of asthma. Spirometry, bronchodilator reversibility and fractional exhaled nitric oxide testing are the first line tests to diagnose asthma in children. The introduction of these tests across all healthcare settings has the potential to reduce misdiagnosis, improve asthma management and reduce healthcare spending for asthma.     

肺通气功能测定对矽肺肺心病的诊断价值

在分析104例矽肺及矽肺肺心病患者肺功能资料的基础上,筛选出以下六项指标作为矽肺肺心病肺功能辅助诊断指标。即:(1)Vc％<预计值的40％,(2)V1.0％<50％Vc,(3)FEF200—1200<1.20升/秒,(4)FEF25—75％<预计值的15％,(5)MTT>正常预计值的1.6倍,(6)tsD>1.527秒。符合6项中任何一项便可诊断肺心病,而且其敏感性、特异性和诊断准确率均较超声心动图等为高     

Office Spirometry: Equipment Selection and Training of Staff in the Private Practice Setting

SUMMARY

Spirometry is a basic pulmonary function test that is widely used for the detection of airflow limitation. Its use will continue to grow in the medical office setting because it is useful for both diagnostic and monitoring purposes. Additionally, the assessment of airflow reversibility is a quick, safe, and useful adjunct to baseline spirometry.

Many manufacturers offer various models and types of spirometers. Before purchasing, determine the needs and characteristics of the office and its staff, and then choose an appropriate device. There is no “holy grail” for selecting what instrument is best for a specific office. Rather, it requires time and effort to make a good choice. Carefully assess the instrument before purchase and, ideally, compare several instruments. Once an instrument is purchased and it arrives, carefully validate it before reporting results.

Proper training of the technicians who perform the testing is perhaps the most important factor in obtaining good spirometric testing. After adequate training, it is also important to have continued competency assessments, periodic inservices, and careful review of test results.

The ATS and American Association for Respiratory Care (AARC) published extensive guidelines on the performance of spirometry. These recommendations should be followed to ensure quality and reduce interlaboratory variability. Patients should be properly prepared, the instrumentation properly calibrated, and the test conducted so that there is a good start, adequate exhalation time, satisfactory end-of-test, and good reproducibility between trials.     

社区体检诊断慢性阻塞性肺疾病198例分析

目的 了解上海市各临床分级慢性阻塞性肺疾病(COPD)患者的一般情况、临床表现及诊断、治疗状况。方法 社区体检中经肺功能测定诊断为COPD的198例患者，通过问卷调查获得其生活习惯、呼吸道症状、既往呼吸道疾病的诊断及治疗等信息。结果 198例中，男性占68．2％，女性占31．8％；40～60岁占24．8％，60岁以上占75．2％。曾经或现在吸烟者占56．6％，因父母或配偶吸烟而被动吸烟者分别占67．2％和62．1％。Ⅰ、Ⅱ、Ⅲ、Ⅳ级COPD分别占19．2％、51．5％、27．8％和1．5％；Ⅰ和Ⅱ级COPD咳嗽、咳痰者分别为17．9％和17．9％；Ⅲ和Ⅳ级COPD呼吸困难、咳嗽、咳痰者分别为74．1％、56．9％和46．6％。2．5％先前诊断为COPD，11．1％曾接受肺功能测定，1．5％使用过支气管扩张剂。结论 上海地区COPD的医院诊断率低，与疾病早期症状易被忽视、患者未及时就诊、门诊医师缺乏认识及未广泛开展肺功能测定有关。     

Validación de las ecuaciones propuestas por la Iniciativa Global de Función Pulmonar (GLI) y las de Todas las Edades para espirometría forzada en preescolares sanos españoles

Introduction

Recent publication of multi-ethnic spirometry reference equations for subjects aged from 3-95 years aim to avoid age-related discontinuities and provide a worldwide standard for interpreting spirometric test results.