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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To characterize asthma in the elderly, 25 consecutive nonsmoking pulmonary clinic patients over the age of 70 who met the American Thoracic Society criteria for asthma were identified. Of these, 12 patients (48%) had developed asthma at an advanced age (greater than 65 yr). This group with late-onset asthma had a mean duration of disease of 5.1 +/- 2.5 yr. The remaining group with early-onset asthma had a mean duration of illness of 31.4 +/- 14.6 yr. On the day of evaluation each patient underwent pulmonary function testing off all medication for at least 12 h. These two groups were indistinguishable by symptoms and medication requirements. Immediate hypersensitivity skin testing to 43 aeroallergens was uniformly negative in all 25 patients but the histamine control was always positive. IgE levels in both groups were not different from those in elderly control subjects. Those with early-onset asthma had a greater likelihood of previous allergic disease (p less than 0.001) and a significantly greater degree of airflow obstruction in pre- and postbronchodilator pulmonary function testing (p less than 0.05). This study suggests that long-standing asthma may lead to chronic persistent airflow obstruction and thereby mimic chronic bronchitis and emphysema (COPD).
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PMID:Asthma in the elderly. A comparison between patients with recently acquired and long-standing disease. 199 Sep 49

This study reports on the relationship of airway hyperresponsiveness (AH) with respiratory symptoms and diurnal peak flow expiratory (PEF) variation in 221 hyperresponsive patients with moderately severe airways obstruction. The disease was in a stable phase in all patients. Closely adhering to the American Thoracic Society criteria, patients were divided into three syndrome diagnoses based on a standardized history: asthma (n = 81), asthmatic bronchitis (AB, n = 69), and chronic obstructive pulmonary disease [( COPD] n = 44); 27 subjects could not be placed in any group. Mean (+/- SEM) log2 PC20 histamine values were significantly lower in the asthmatic group (-2.77 +/- 0.20 mg/ml) than in the COPD (-0.89 +/- 0.29 mg/ml) and AB groups (-1.37 +/- 0.25 mg/ml; one-way ANOVA, p less than 0.001). However, considerable overlap of individual responses existed. Differences between the groups could not be attributed to differences in prechallenge FEV1 levels. For every level of FEV1, asthmatic subjects were more hyperresponsive than patients with COPD. The dependence of PC20 on prechallenge FEV1 was comparable in all groups. There was a significant correlation between the degree of AH and diurnal PEF variation (rho = -0.401, p less than 0.001), which was stronger in asthma (rho = -0.409) than in COPD (rho = -0.325). Despite this obvious association, a wide range of diurnal PEF variation values existed for every level of PC20, indicating that PEF variability and AH are not interchangeable. The relationships between symptoms and both AH levels and PEF variation were weak. No significant differences were found between syndrome diagnosis groups with respect to diurnal PEF variation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Relationship of airway hyperresponsiveness to respiratory symptoms and diurnal peak flow variation in patients with obstructive lung disease. The Dutch CNSLD Study Group. 202 43

Recently, the validity of the American Thoracic Society (ATS) standards for selection of spirometric test results has been questioned based on the finding of inverse dependence of FEV1 on effort. I carried out a study to determine how the test results of FEV1 and FEF25-75 are affected by use of effort-based criteria (highest PEFR) as compared with the volume-based criteria (largest FVC, largest sum of FVC and FEV1-ATS criteria). Randomly sampled routine pulmonary function test results obtained from 10 normal subjects and 12 patients with COPD were analyzed. Although selection based on the largest FVC yielded test results identical to that obtained by the ATS criteria, selection based on the highest PEFR resulted in a decline of mean FEV1. The latter, however, was accompanied by an even more significant decrease of FVC, suggesting bias of this criterion toward selecting the maneuvers with lower FVC. Furthermore, the individual values of FEV1 were often found to decrease with effort only when the accompanying FVC were also lower. In contrast, FEF25-75 were more prominently affected by the negative effect of effort regardless of the values of accompanying FVC. It appears that fully inflated lungs (the largest FVC) favorably shift the balance of two opposing influences of effort, one of which positively acts on the effort-dependent portion of the flow-volume curve. FEV1 thus is little affected by effort once the lungs are fully inflated. Accordingly, the volume-based selection criteria remain valid. This argument does not apply to FEF25-75, which is prominently affected by the negative effect of effort.
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PMID:Effect of effort versus volume on forced expiratory flow measurement. 320 27

In view of the ubiquitous practice of using bronchodilator responsiveness to determine suitable patients for clinical trials, we wanted to know whether changes in FEV1 or forced vital capacity (FVC) really were useful in differentiating COPD from asthma. Pulmonary function test results from 450 patients were documented by two technicians who had been asked to select consecutive studies in which flow-volume loops showed an obstructive pattern. The respirologist responsible for the care of each patient was asked to record the clinical diagnosis from the existing outpatient chart using clinical judgment based on American Thoracic Society criteria. In 395 cases, a single, unambiguous diagnosis of asthma or COPD was recorded; this diagnosis then formed the database for subsequent analysis. While the mean change in FEV1 in patients judged to have asthma was different from that found in COPD patients (16.4 vs 10.6 percent, p < 0.01), the change in FVC was similar (9.8 vs 10.3 percent, p > 0.06). However the sensitivities and specificities of postbronchodilator changes in FEV1 (dFEV1) for the diagnosis of asthma were not generally sufficient to diagnose or exclude asthma reliably. The FEV1 correlated better with residual volume (RV) in COPD (r = -0.55 vs r = -0.31), but with total lung capacity (TLC) in asthma (r = 0.51 vs r = -0.09). However, FEV1 correlated better with the RV-TLC ratio than RV or TLC alone in both groups, the correlation in each being similar (asthma, r = -0.72; COPD, r = -0.78). We conclude that acute responses of FEV1 and FVC following a standard dose of inhaled bronchodilator are neither sufficiently sensitive nor sufficiently specific to differentiate asthma from COPD purely on spirometric grounds. Furthermore, neither RV nor TLC reflected degrees of airflow limitation as well as did the RV-TLC ratio.
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PMID:Is the short-term response to inhaled beta-adrenergic agonist sensitive or specific for distinguishing between asthma and COPD? 816 22

A variety of studies exist as to methods of assessing quality of life in chronic obstructive pulmonary disease. Neither the American Thoracic Society nor the European Consensus Statement for COPD recommend any specific quality-of-life or functional assessment measure as a gold standard. The present study identifies measures of COPD quality of life and functional status reported in selected literature in 1994-1997. A total of 37 measures were identified; of these eight were measures of general health, 10 were COPD/disease-specific questionnaires, and 19 were functional status indices. These measures provide valuable data, and further study is necessary to determine which measures should be integrated into standards of care.
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PMID:Measures of functional status and quality of life in chronic obstructive pulmonary disease. 1039 37

Three sets of guidelines for the management of COPD that are widely recognized (from the European Respiratory Society [ERS], American Thoracic Society [ATS], and British Thoracic Society [BTS]) are reviewed and compared. None of the documents uses classic evidence-based documentation, and, in many instances, the recommendations are empiric because of a lack of scientific evidence. Overall, there is strong agreement between the documents. All three guidelines recommend inhaled bronchodilators as first-line therapy. Anticholinergics are noted to be well tolerated, although potential problems with beta(2)-agonists are mentioned. The ERS and BTS suggest that inhaled corticosteroids may be of value in patients documented to be steroid responders, whereas the ATS does not recommend their use at all. All three guidelines support the use of oxygen and pulmonary rehabilitation. There are varying levels of disagreement between the guidelines related to the role of spirometry, stratification of disease severity, and the use of theophylline and systemic corticosteroids. Other differences include the role for nebulizers and metered-dose inhalers, secretion clearance methodologies, and the treatment of acute COPD exacerbations and acute respiratory failure. All three guidelines agree that more research is needed to improve our understanding and management of COPD.
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PMID:Recommendations for the management of COPD. 1067 70

Guidelines for a variety of diseases have now been produced. However, implementation of guidelines requires that the medical profession is willing to conform to patterns of diagnostic and treatment behavior set down by others. This may not happen in practice. Early experience in the United Kingdom was gained with the introduction of guidelines for the management of asthma. For a number of years, there have been improvements in practice, but deficiencies still exist. When the introduction of guidelines for the management of COPD was planned, a new approach was taken with a consortium of the British Thoracic Society, pharmaceutical companies, and medical equipment companies being formed to promote their use. Early studies show that COPD care starts from an even lower baseline than asthma; there is poor understanding of objective diagnosis of COPD in both primary and secondary care.
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PMID:How can the implementation of guidelines be improved? 1067 73

Detection of latent tuberculosis infection is an important step in the control of tuberculosis. The tuberculin skin test is the only proven method for identifying tuberculosis infection in patients who do not have tuberculosis disease. The prevalence of tuberculosis infection among hospitalized patients in a pneumological department of an inner-city hospital was evaluated, using the intradermal tuberculin skin test (Mantoux technique). Interpretation of the Mantoux test was based on the size of induration in millimeters and the individual risk profile of the patients, according to the guidelines of the American Thoracic Society and the Centers for Disease Control, revised in 1989. Of 697 tested patients, 252 showed test results consistent with tuberculosis infection (36.2%). 55 of these 697 patients had active tuberculosis disease or a prior history of tuberculosis (7.9%). A positive tuberculin skin test was found in 197 of 642 patients (30.7%) with a diagnosis different from tuberculosis (COPD, pneumonia, cancer and others). In our study, the sensitivity of the tuberculin skin test for active tuberculosis infection was 95%. The present study revealed a high prevalence of tuberculosis infection among hospitalized patients in a pneumological department. Further studies are needed to assess the usefulness of routine tuberculin skin testing in hospitalized populations.
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PMID:[Intracutaneous tuberculin test using the Mendel-Mantoux technique. Tuberculin reactivity among inpatients in a pneumology department]. 1108 93

An audit was undertaken to assess the compliance to British Thoracic Society guidelines (1997) in the prescription of long-term oxygen treatment (LTOT) in Bassetlaw District General Hospital. A total of 34 patients were prescribed LTOT in our hospital between March 1993 and October 1998. The average age of patients was 71 years, 31 patients had COPD and three had chronic asthma. Only ten patients were clinically stable at the time of assessment. None of the measurements were repeated after a period of three weeks before prescribing LTOT. Adherence to guidelines in the prescription of LTOT was poor in our audit.
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PMID:Audit on prescription of long-term oxygen treatment. 1118 27

Despite publication of several management guidelines for COPD, relatively little is known about standards of care in clinical practice. Data were collected on the management of 1400 cases of acute admission with Chronic Obstructive Pulmonary Disease in 38 UK hospitals to compare clinical practice against the recommended British Thoracic Society standards. Variation in the process of care between the different centres was analysed and a comparison of the management by respiratory specialists and nonrespiratory specialists made. There were large variations between centres for many of the variables studied. A forced expiratory volume in one second measurement was found in only 53% of cases. Of the investigations recommended in the acute management arterial blood gases were performed in 79% (interhospital range 40-100%) of admissions and oxygen was formally prescribed in only 64% (range 9-94%). Of those cases with acidosis and hypercapnia 35% had no further blood gas analysis and only 13% received ventilatory support. Long-term management was also deficient with 246 cases known to be severely hypoxic on admission yet two-thirds had no confirmation that oxygen levels had returned to levels above the requirements for long-term oxygen therapy. Only 30% of current smokers had cessation advice documented. To conclude, the median standards of care observed fell below those recommended by the guidelines. The lowest levels of performance were for patients not under the respiratory specialists, but specialists also have room for improvement. The substantial variation in the process of care between hospitals is strong evidence that it is possible for other centres with poorer performance to improve their levels of care.
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PMID:Audit of acute admissions of COPD: standards of care and management in the hospital setting. 1140 9


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