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.

Diagnosis and early detection of COPD using spirometry

The standard respiratory function test for case detection of chronic obstructive pulmonary disease (COPD) is spirometry. The criterion for diagnosis defined in guidelines is based on the FEV₁/FVC ratio forced expiratory ratio (FER) and its severity is based on forced expiratory volume in one second (FEV₁) from measurements obtained during maximal forced expiratory manoeuvres. Spirometry is a safe and practical procedure, and when conducted by a trained operator using a spirometer that provides quality feedback, the majority of patients can be coached to provide acceptable and repeatable results. This allows potentially wide application of testing to improve recognition and diagnosis of COPD, such as for case finding in primary care. However, COPD remains substantially under diagnosed in primary care and a major reason for this is underuse of spirometry. The presence of symptoms is not a reliable indicator of disease and diagnosis is often delayed until more severe airflow obstruction is present. Early diagnosis is worthwhile, as it allows risk factors for COPD such as smoking to be addressed promptly and treatment optimised. Paradoxically, investigation of the patho-physiology in COPD has shown that extensive small airway disease exists before it is detectable with conventional spirometric indices, and methods to detect airway disease earlier using the flow-volume curve are discussed.     

Reference values for spirometry,including vital capacity,in Japanese adults calculated with the LMS method and compared with previous values

BackgroundReference values for lung function tests should be periodically updated because of birth cohort effects and improved technology. This study updates the spirometric reference values, including vital capacity (VC), for Japanese adults and compares the new reference values with previous Japanese reference values.MethodsSpirometric data from healthy non-smokers (20,341 individuals aged 17–95 years, 67% females) were collected from 12 centers across Japan, and reference equations were derived using the LMS method. This method incorporates modeling skewness (lambda: L), mean (mu: M), and coefficient of variation (sigma: S), which are functions of sex, age, and height. In addition, the age-specific lower limits of normal (LLN) were calculated.ResultsSpirometric reference values for the 17–95-year age range and the age-dependent LLN for Japanese adults were derived. The new reference values for FEV₁ in males are smaller, while those for VC and FVC in middle age and elderly males and those for FEV₁, VC, and FVC in females are larger than the previous values. The LLN of the FEV₁/FVC for females is larger than previous values. The FVC is significantly smaller than the VC in the elderly.ConclusionsThe new reference values faithfully reflect spirometric indices and provide an age-specific LLN for the 17–95-year age range, enabling improved diagnostic accuracy. Compared with previous prediction equations, they more accurately reflect the transition in pulmonary function during young adulthood. In elderly subjects, the FVC reference values are not interchangeable with the VC values.     

What can we learn from pulmonary function testing in heart failure?

Pulmonary diseases frequently coexist in heart failure (HF), thus posing diagnostic and therapeutic challenges to cardiologists evaluating patients with overlapping symptoms and implementing recommended HF treatments. There is a growing body of evidence suggesting that pulmonary function testing might provide useful information for the best management of these patients. The availability of portable devices, allowing the measurement of spirometry and lung diffusion capacity for carbon monoxide outside of hospital‐based pulmonary lung function laboratories, provides an opportunity for a more widespread use of these measures in the cardiology community, but their interpretation can be challenging. In this work, after a brief review of the methodologies, we discuss the interpretation of pulmonary function testing in patients with HF alone or associated with pulmonary diseases, and its contribution in differentiating cardiac and pulmonary symptoms and preventing acute cardiac decompensation. In addition, we examined recent evidence suggesting how the use of pulmonary function testing may provide independent prognostic information in HF patients with and without pulmonary disorders, and help therapeutic decisions to fill the treatment gap that still exists in HF patients with concomitant pulmonary diseases.     

Small airway disease and its predictors in patients with rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is a connective tissue disease, characterized by symmetric peripheral polyarthritis. Extra-articular disease occurs in approximately 50% of the patients with lung being a common site. The presence of functional or morphological abnormalities in small airways has recently been noted in patients with RA but its exact prevalence and clinical significance is still a subject of debate. This study was aimed to determine the prevalence of small airway disease (SAD) in patients with RA and the factors influencing it.MethodsFifty consecutive patients with RA were included in this cross-sectional observational study. All patients were subjected to pulmonary function tests (PFT) including Spirometry and Forced Oscillation technique (FOT). Those with features of SAD on PFT were subjected to High-Resolution Computed Tomography (HRCT) of the chest.ResultsSpirometry was suggestive of SAD in 17 patients, with 34% prevalence and FOT was abnormal in 9 patients, with 18% prevalence in the study population. Of 17 patients with SAD on spirometry, 8 (47.05%) patients showed mosaic attenuation, a sign of SAD on the HRCT chest. On univariate analysis, age, Disease Activity Score (DAS-28), joint erosions on X-ray, RF and anti-CCP were found to be associated with SAD.ConclusionSAD was present in one-third of the patients with RA, even in those with short duration of disease, low to moderate disease activity and no respiratory symptoms. It is thus inferred that the complete workup of RA patients should include pulmonary function assessment.     

Impact of coronavirus disease 2019 on respiratory care in Japan: A nationwide survey by the Japanese Respiratory Society

BackgroundCoronavirus disease 2019 (COVID-19) has spread worldwide since 2020, placing a huge burden on medical facilities. In the field of respiratory medicine, there has been a decrease in the number of patients. While many pulmonologists have been receiving patients with COVID-19, the actual effects on respiratory care have not been elucidated. Therefore, we conducted this study to clarify the effects of COVID-19 on medical care in the field of respiratory medicine.MethodsWe conducted a questionnaire survey among 749 hospitals belonging to the Board-Certified Member system of the Japanese Respiratory Society on the effects of COVID-19 from November 2021.ResultsResponses were obtained from 170 hospitals (23%), in approximately 70% of which the respiratory medicine department was the main department involved in managing COVID-19. The number of spirometry and bronchoscopy tests decreased by 25% and 15%, respectively, and the number of both outpatients and inpatients decreased in 93% of hospitals. Among respiratory diseases, the number of patients hospitalized for usual pneumonia, bronchial asthma, and chronic obstructive pulmonary disease decreased greatly by 30%–45%. In 62% of hospitals, the biggest effect of the COVID-19 pandemic was the greater burden in terms of the clinical workload due to COVID-19.ConclusionsAlthough the number of tests and non-COVID-19 outpatients and inpatients decreased in respiratory medicine departments during the COVID-19 pandemic, the workload increased due to COVID-19, resulting in a great increase in the clinical burden.     

Importance of slow vital capacity in the detection of airway obstruction

OBJECTIVE:

To investigate the presence of airway obstruction by determining the FEV₁/FVC and FEV₁/slow vital capacity (SVC) ratios.

METHODS:

This was a quantitative, retrospective cross-sectional study. The sample comprised 1,084 individuals who underwent spirometry and plethysmography in a central hospital in Lisbon, Portugal. The study sample was stratified into six groups, by pulmonary function.

RESULTS:

The analysis of the FEV₁/FVC ratio revealed the presence of airway obstruction in 476 individuals (43.9%), compared with 566 individuals (52.2%) for the analysis of the FEV₁/SVC ratio. In the airway obstruction, airway obstruction plus lung hyperinflation, and mixed pattern groups, the difference between SVC and FVC (SVC − FVC) was statistically superior to that in the normal pulmonary function, reduced FEF, and restrictive lung disease groups. The SVC − FVC parameter showed a significant negative correlation with FEV₁ (in % of the predicted value) only in the airway obstruction plus lung hyperinflation group.

CONCLUSIONS:

The FEV₁/SVC ratio detected the presence of airway obstruction in more individuals than did the FEV₁/FVC ratio; that is, the FEV₁/SVC ratio is more reliable than is the FEV₁/FVC ratio in the detection of obstructive pulmonary disease.     

烟熏法建立的慢性阻塞性肺疾病鼠肺功能和病理的动态变化

目的 动态观察不同烟熏时间建立的慢性阻塞性肺疾病(COPD)大鼠肺功能和病理的改变,为成功建立COPD大鼠模型提供理论基础.方法 30只8周龄SD大鼠随机分为6周实验组(E1组)及6周对照组(C1组),12周实验组(E2组)及12周对照组(C2组),间隔实验组(烟熏12周后正常饲养6周,E3组).Buxco小动物肺功能仪检测肺功能、HE染色观察肺组织病理变化.结果 ①与C1组相比,E1组FRC、IC、VC和TLC增高(P＜0.05),FEV100/FVC和FEV200/FVC分别降低22％和11％(P＜0.01);②与C2组相比,E2组FRC增高,IC、VC和TLC降低(P＜0.05),FEV100/FVC和FEV200/FVC分别降低28％和21％(P＜0.01);③与C2组相比,E3组IC、VC和TLC升高(P＜0.05),FEV100/FVC和FEV200/FVC差异无统计学意义;④E1组肺泡间隔变窄,呈轻度肺气肿表现,局部可见炎症细胞浸润;E2组呈典型肺气肿表现,细支气管、血管周围有大量炎症细胞浸润;E3组肺气肿表现明显,但未见明显炎症;C1、C2组气道上皮结构完整,肺泡间隔完整.结论 烟熏时间对大鼠肺功能和病理改变的程度有显著影响,烟熏6周出现早期COPD表现,烟熏12周出现典型COPD表现.     

Review: Clinical Inertia in the Management of Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death in the United States. Despite clinical practice guidelines endorsed by national organizations, the management of COPD deviates from guideline recommendations. Patients with COPD are frequently underdiagnosed and misdiagnosed, due in large part to the lack of spirometry testing. When diagnosed, about one third of patients are not receiving any COPD-related drug therapy. Factors that contribute to suboptimal management include provider, patient, and system factors. Physician factors such as understanding and attitude toward the disease, and awareness of guidelines, may affect appropriate management of COPD. Patient factors include medication non-adherence, understanding of the disease, severity of their symptoms, and access to medications. System factors such as insurance coverage may limit aspects of COPD care. To overcome clinical inertia, a multifaceted approach is required. Provider and patient education, the use of health informatics, changes in provider work-flow and the recent development of performance measures, such as the use of spirometry in patients with COPD, can improve the delivery of recommended care for COPD patients.