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Maureen P Swanney - One of the best experts on this subject based on the ideXlab platform.
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spirometry training courses content delivery and assessment a position statement from the australian and new zealand society of respiratory science
2017Co-Authors: Maureen P Swanney, Christopher Odea, Emily R Ingram, Leanne T Rodwell, Brigitte M BorgAbstract:Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement.
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reference values for spirometry and their use in test interpretation a position statement from the australian and new zealand society of respiratory science
2016Co-Authors: Danny J Brazzale, Graham L. Hall, Maureen P SwanneyAbstract:Traditionally, spirometry testing tended to be confined to the realm of hospital-based laboratories but is now performed in a variety of health care settings. Regardless of the setting in which the test is conducted, the fundamental basis of spirometry is that the test is both performed and interpreted according to the international standards. The purpose of this Australian and New Zealand Society of Respiratory Science (ANZSRS) statement is to provide the background and recommendations for the interpretation of spirometry results in clinical practice. This includes the benchmarking of an individual's results to population reference data, as well as providing the platform for a statistically and conceptually based approach to the interpretation of spirometry results. Given the many limitations of older reference equations, it is imperative that the most up-to-date and relevant reference equations are used for test interpretation. Given this, the ANZSRS recommends the adoption of the Global Lung Function Initiative (GLI) 2012 spirometry reference values throughout Australia and New Zealand. The ANZSRS also recommends that interpretation of spirometry results is based on the lower limit of normal from the reference values and the use of Z-scores where available.
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validity of the american thoracic society and other spirometric algorithms using fvc and forced expiratory volume at 6 s for predicting a reduced total lung capacity
2004Co-Authors: Maureen P Swanney, Lutz Beckert, Chris Frampton, Lauren Wallace, Robert L Jensen, Robert O CrapoAbstract:Objectives: (1) To compare the performance of three spirometric algorithms developed to predict whether the total lung capacity (TLC) is reduced vs normal or increased, (2) to determine if forced expiratory volume at 6 s (FEV 6 ) can be substituted for FVC in these algorithms, and (3) to determine if ascertainment bias was present in patients referred for the measurement of spirometry and TLC compared to patients referred for spirometry only. Methods: We analyzed the results of 219 consenting consecutive patients referred to a New Zealand tertiary hospital respiratory laboratory for spirometry and TLC measurements. Spirometry results from 370 patients referred for spirometry but not lung volumes were used to test for potential ascertainment bias. Spirometry results were analyzed using the lower limit of normal (LLN) values from the third National Health and Nutrition Examination Study reference equations. The equations of Goldman and Becklake, and Crapo were used to classify TLC as normal or abnormal. Receiver operator characteristic curves were used to produce an algorithm using the LLN for FVC and FEV 6 . The performances of previous algorithms and our own algorithms were analyzed for predicting a reduced lung volume against the “gold standard,” plethysmographic TLC. Results: All three algorithms predicted a reduced TLC with an accuracy of approximately 50%. In contrast, all algorithms predicted TLC was either normal or increased with an accuracy of ≥ 99% regardless of the reference set used. The algorithms based on FEV 6 performed equally as well as the FVC algorithms. No ascertainment bias was found. Conclusions: This study provides evidence that spirometry-based algorithms can accurately predict when TLC is either normal or increased, and can also increase the a priori probability that TLC is reduced to approximately 50%. FEV 6 is equivalent to FVC in these predictions.
Paul L. Enright - One of the best experts on this subject based on the ideXlab platform.
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case finding options for copd results from the burden of obstructive lung disease study
2013Co-Authors: Anamika Jithoo, Paul L. Enright, Sonia A Buist, Peter Burney, Eric D Bateman, Wan C Tan, Michael Studnicka, Filip Mejza, Suzanne Gillespie, William M VollmerAbstract:This study aimed to compare strategies for chronic obstructive pulmonary disease (COPD) case finding using data from the Burden of Obstructive Lung Disease study. Population-based samples of adults aged ≥40 yrs (n = 9,390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of differently staged algorithms that used questionnaire data and/or peak expiratory flow (PEF) data to identify persons at risk for COPD and, hence, needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1,000 people. For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%) but required confirmatory spirometry in 80% of participants. Use of PEF necessitated confirmatory spirometry in only 19-22% of subjects, with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in <9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case-finding strategy. Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults aged ≥40 yrs. These findings should be validated in real-world settings such as the primary care environment.
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quality of spirometry performed by 13 599 participants in the world trade center worker and volunteer medical screening program
2010Co-Authors: Paul L. Enright, Gwen Skloot, Jean M Coxganser, Iris Udasin, Robin HerbertAbstract:OBJECTIVE: To determine the ability of spirometry technicians in the World Trade Center Worker and Volunteer Medical Screening Program to meet American Thoracic Society spirometry quality goals. METHODS: Spirometry technicians were trained centrally and performed spirometry sessions at 6 sites in the greater New York City area. We reviewed and graded the spirometry results for quality every month. RESULTS: About 80% (range 70–88%) of the spirometry sessions met the American Thoracic Society spirometry goals. In general, the spirometry technicians with the most experience were more successful in meeting the quality goals. Participant characteristics explained very little of the quality variability. CONCLUSIONS: The overall spirometry quality in this multicenter program was very good. Efforts to improve spirometry quality should focus on the performance of individual spirometry technicians. Key words: spirometry; quality control; World Trade Center. [Respir Care 2010;55(3):303–309. © 2010 Daedalus Enterprises]
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can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease
2009Co-Authors: Rogelio Perezpadilla, Paul L. Enright, Juan Carlos Vazquezgarcia, Ana M B Menezes, William M Vollmer, A S BuistAbstract:Although chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide,1 it is greatly underdiagnosed.2 International guidelines now recommend documenting i rreversible airflow obstruction, assessed via post-bronchodilator (post-BD) spirometry, as the primary diagnostic test for COPD, before an inhaler prescription is considered.1 Despite the increasing availability of relatively low-cost, easy to use office spirometers,3,4 spirometry is not often available in the primary care setting and economic factors may limit specialty referrals for spirometry testing. This problem is further exacerbated in resource-poor countries for which even the least expensive spirometers may be a luxury for many primary care practitioners and an unaffordable test for many patients. In this context, access to a simple, inexpensive, easy to interpret test to screen patients and identify those most likely to benefit from spirometry is a highly desirable goal. Measurement of the peak expiratory flow (PEF) requires only a short maximal expiration, and the demands required of the patient and technician to achieve reliable data are fewer than for spirometry. Although previous studies have concluded that PEF is not an adequate substitute for spirometry for the diagnosis of COPD,5,6 these studies did not evaluate the possible value of PEF as a screening tool to reduce the need for spirometry in adults with COPD risk factors. The data used for this report are from the Latin American Project for the Investigation of Obstructive Lung Diseases (PLATINO) study7 and the ongoing Burden of Obstructive Lung Disease (BOLD) study.8 These population-based COPD prevalence studies shared a common protocol and have been carried out to date in over 17 countries around the world. We tested whether PEF, assessed before bronchodilator use and using a diagnostic-quality spirometer with trained technicians, identified spirometrically confirmed post-BD airflow obstruction.
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spirometry can be done in family physicians offices and alters clinical decisions in management of asthma and copd
2007Co-Authors: Barbara P Yawn, Paul L. Enright, Robert F Lemanske, Elliot Israel, Wilson D Pace, Peter C Wollan, Homer A BousheyAbstract:Background Spirometry is recommended for diagnosis and management of obstructive lung disease. While many patients with asthma and COPD are cared for by primary care practices, limited data are available on the use and results associated with spirometry in primary care. Object To assess the technical adequacy, accuracy of interpretation, and impact of office spirometry. Design A before-and-after quasiexperimental design. Setting Three hundred eighty-two patients from 12 family medicine practices across the United States. Participants Patients with asthma and COPD, and staff from the 12 practices. Measurements Technical adequacy of spirometry results, concordance between family physician and pulmonary expert interpretations of spirometry test results, and changes in asthma and COPD management following spirometry testing. Results Of the 368 tests completed over the 6 months, 71% were technically adequate for interpretation. Family physician and pulmonary expert interpretations were concordant in 76% of completed tests. Spirometry was followed by changes in management in 48% of subjects with completed tests, including 107 medication changes (>85% concordant with guideline recommendations) and 102 nonpharmacologic changes. Concordance between family physician and expert interpretations of spirometry results was higher in those patients with asthma compared to those with COPD. Discussion and conclusions US family physicians can perform and interpret spirometry for asthma and COPD patients at rates comparable to those published in the literature for international primary care studies, and the spirometry results modify care.
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office spirometry for lung health assessment in adults a consensus statement from the national lung health education program
2000Co-Authors: Gary T Ferguson, Paul L. Enright, Sonia A Buist, Millicent HigginsAbstract:COPD is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients ≥ 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources. Spirometry also is recommended for patients with respiratory symptoms such as chronic cough, episodic wheezing, and exertional dyspnea in order to detect airways obstruction due to asthma or COPD. Although diagnostic-quality spirometry may be used to detect COPD, we recommend the development, validation, and implementation of a new type of spirometry—office spirometry—for this purpose in the primary-care setting. In order to encourage the widespread use of office spirometers, their specifications differ somewhat from those for diagnostic spirometers, allowing lower instrument cost, smaller size, less effort to perform the test, improved ease of calibration checks, and an improved quality-assurance program.
Keeseon S. Eom - One of the best experts on this subject based on the ideXlab platform.
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mitochondrial genome of Spirometra theileri compared with other Spirometra species
2021Co-Authors: Barakaeli Abdieli Ndosi, Hansol Park, Dongmin Lee, Seongjun Choe, Yeseul Kang, Mohammed Mebarek Bia, Tilak Chandra Nath, Chatanun Eamudomkarn, Hyeong-kyu Jeon, Keeseon S. EomAbstract:This study was carried out to provide information on the taxonomic classification and analysis of mitochondrial genomes of Spirometra theileri. One strobila of S. theileri was collected from the intestine of an African leopard (Panthera pardus) in the Maswa Game Reserve, Tanzania. The complete mtDNA sequence of S. theileri was 13,685 bp encoding 36 genes including 12 protein genes, 22 tRNAs and 2 rRNAs with absence of atp8. Divergences of 12 protein-coding genes were as follow: 14.9% between S. theileri and S. erinaceieuropaei, 14.7% between S. theileri and S. decipiens, and 14.5% between S. theileri with S. ranarum. Divergences of 12 proteins of S. theileri and S. erinaceieuropaei ranged from 2.3% in cox1 to 15.7% in nad5, while S. theileri varied from S. decipiens and S. ranarum by 1.3% in cox1 to 15.7% in nad3. Phylogenetic relationship of S. theileri with eucestodes inferred using the maximum likelihood and Bayesian inferences exhibited identical tree topologies. A clade composed of S. decipiens and S. ranarum formed a sister species to S. erinaceieuropaei, and S. theileri formed a sister species to all species in this clade. Within the diphyllobothridean clade, Dibothriocephalus, Diphyllobothrium and Spirometra formed a monophyletic group, and sister genera were well supported.
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Morphological and Molecular Identification of Spirometra Tapeworms (Cestoda: Diphyllobothriidae) from Carnivorous Mammals in the Serengeti and Selous Ecosystems of Tanzania.
2020Co-Authors: Barakaeli Abdieli Ndosi, Hansol Park, Dongmin Lee, Seongjun Choe, Yeseul Kang, Mohammed Mebarek Bia, Tilak Chandra Nath, Chatanun Eamudomkarn, Hyeong-kyu Jeon, Keeseon S. EomAbstract:Spirometra tapeworms (Cestoda: Diphyllobothriidae) collected from carnivorous mammals in Tanzania were identified by the DNA sequence analysis of the mitochondrial cytochrome c oxidase subunit 1 (cox1) and internal transcribed spacer 1 (ITS1), and by morphological characteristics. A total of 15 adult worms were collected from stool samples and carcasses of Panthera leo, Panthera pardus, and Crocuta crocuta in the Serengeti and Selous ecosystems of Tanzania. Three Spirometra species: S. theileri, S. ranarum and S. erinaceieuropaei were identified based on morphological features. Partial cox1 sequences (400 bp) of 10 specimens were revealed. Eight specimens showed 99.5% similarity with Spirometra theileri (MK955901), 1 specimen showed 99.5% similarity with the Korean S. erinaceieuropaei and 1 specimen had 99.5% similarity with Myanmar S. ranarum. Sequence homology estimates for the ITS1 region of S. theileri were 89.8% with S. erinaceieuropaei, 82.5% with S. decipiens, and 78.3% with S. ranarum; and 94.4% homology was observed between S. decipiens and S. ranarum. Phylogenetic analyses were performed with 4 species of Spirometra and 2 species of Dibothriocephalus (=Diphyllobothrium). By both ML and BI methods, cox1 and ITS1 gave well supported, congruent trees topology of S. erinaceieuropaei and S. theileri with S. decipiens and S. ranarum forming a clade. The Dibothriocephalus species were sisters of each other and collectively forming successive outgroups. Our findings confirmed that 3 Spirometra species (S. theileri, S. ranarum, and S. erinaceieuropaei) are distributed in the Serengeti and Selous ecosystems of Tanzania.
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Identity of Spirometra theileri from a Leopard (Panthera pardus) and Spotted Hyena (Crocuta crocuta) in Tanzania.
2019Co-Authors: Keeseon S. Eom, Hansol Park, Dongmin Lee, Seongjun Choe, Yeseul Kang, Mohammed Mebarek Bia, Barakaeli Abdieli Ndosi, Tilak Chandra Nath, Chatanun Eamudomkarn, Julius KeyyuAbstract:In the present study, a Spirometra species of Tanzania origin obtained from an African leopard (Panthera pardus) and spotted hyena (Crocuta crocuta) was identified based on molecular analysis of cytochrome c oxidase I (cox1) and NADH dehydrogenase subunit I (nad1) as well as by morphological observations of an adult tapeworm. One strobila and several segments of a Spirometra species were obtained from the intestine of an African male leopard (Panthera pardus) and spotted hyena (Crocuta crocuta) in the Maswa Game Reserve of Tanzania. The morphological characteristics of S. theileri observed comprised 3 uterine loops on one side and 4 on the other side of the mid-line, a uterine pore situated posterior to the vagina and alternating irregularly either to the right or left of the latter, and vesicular seminis that were much smaller than other Spirometra species. Sequence differences in the cox1 and nad1 genes between S. theileri (Tanzania origin) and S. erinaceieuropaei were 10.1% (cox1) and 12.0% (nad1), while those of S. decipiens and S. ranarum were 9.6%, 9.8% (cox1) and 13.0%, 12.6% (nad1), respectively. The morphological features of the Tanzania-origin Spirometra specimens coincided with those of S. theileri, and the molecular data was also consistent with that of S. theileri, thereby demonstrating the distribution of S. theileri in Tanzania. This places the leopard (Panthera pardus) and spotted hyena (Crocuta crocuta) as new definitive hosts of this spirometrid tapeworm.
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mitochondrial dna sequence variability of Spirometra species in asian countries
2019Co-Authors: Hyeong-kyu Jeon, Keeseon S. EomAbstract:Mitochondrial DNA sequence variability of Spirometra erinaceieuropaei in GenBank was observed by reinvestigation of mitochondrial cox1 and cytb sequences. The DNA sequences were analyzed in this study, comprising complete DNA sequences of cox1 (n=239) and cytb (n=213) genes. The 10 complete mitochondrial DNA sequences of Spirometra species were compared with those of Korea, China and Japan. The sequences were analyzed for nucleotide composition, conserved sites, variable sites, singleton sites and parsimony-informative sites. Phylogenetic analyses was done using neighbor joining, maximum parsimony, Bayesian inference and maximum-likelihood on cox1 and cytb sequences of Spirometra species. These polymorphic sites identified 148 (cox1) and 83 (cytb) haplotypes within 239 and 213 isolates from 3 Asian countries. Phylogenetic tree topologies were presented high-level confidence values for the 2 major branches of 2 Spirometra species containing S. erinaceieuropaei and S. decipiens, and S. decipiens sub-clades including all sequences registered as S. erinaceieuropaei in cox1 and cytb genes. These results indicated that mitochondrial haplotypes of S. erinaceieuropaei and S. decipiens were found in the 3 Asian countries.
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molecular genetic findings of Spirometra decipiens and s ranarum in korea
2018Co-Authors: Hyeong-kyu Jeon, Woon Mok Sohn, Sun Huh, Jongyil Chai, Keeseon S. EomAbstract:The taxonomy of Spirometra species has been controversial despite the medical and veterinary importance. Currently, only a few Spirometra species are considered valid species in the genus Spirometra. In the present study, the distribution of Spirometra species obtained from animals in Korea were identified by molecular analysis of the mitochondrial cytochrome c oxidase I (cox1) gene. A total of 28 Spirometra species specimens were analyzed. These were all collected between 1973 and 2008 in the Republic of Korea. Mitochondrial cox1 sequences were examined for a total of 28 specimens comprising 14 S. decipiens and 14 S. ranarum. The difference in partial cox1 sequences (316 bp) between S. erinaceieuropaei (KJ599680) and S. ranarum (this study) was 9.3%, while that between S. decipiens (KJ599679) and S. ranarum (this study) was 2.2%. Genetic analyses identified 2 Spirometra species in animals such as cat, leopard cat, dog, duck and snake in Korea as S. decipiens and S. ranarum. S. decipiens and S. ranarum were present in Gyeongnam Province (P), Jeonnam P, Gangwon P, Chungbuk P, and Seoul. S. decipiens was found in tadpoles, snakes, ducks, cats, leopard cats and dogs, while S. ranarum was found in cats and dogs. The ratio of S. decipiens:S. ranarum calculated from the molecular data was 14:14 (or 1:1). These results indicate that S. decipiens and S. ranarum are sympatrically distributed in Korea.
A S Buist - One of the best experts on this subject based on the ideXlab platform.
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restricted spirometry in the burden of lung disease study
2012Co-Authors: David M Mannino, William M Vollmer, Mary Ann Mcburnie, Wancheng Tan, Ali Kocabas, Josep M Anto, A S BuistAbstract:BACKGROUND The presence of restrictive lung disease has classically required the measure of total lung capacity to document 'true' restriction, which has limited its detection in large population-based studies. METHODS We used spirometric data to classify people with restricted spirometry (forced expiratory volume in 1 second [FEV(1)]/forced vital capacity ≥ 0.70 and FEV(1) < 80% predicted) in the Burden of Lung Disease (BOLD) Study and determined the relation between this finding and demographic factors and the presence of chronic diseases, including diabetes mellitus, hypertension and cardiovascular disease. RESULTS Overall, we found that 11.7% of men (546/4664) and 16.4% of women (836/5098) had restricted spirometry. Prevalence varied widely by site, from a low of 4.2% among males in Sydney, Australia, to a high of 48.7% among females in Manila, The Philippines. Compared to people with normal lung function, those with restricted spirometry had a higher prevalence of diabetes (12.2% vs. 4.6%), heart disease (15.0% vs. 7.7%) and hypertension (38.8% vs. 22.8%). CONCLUSIONS Restricted spirometry is a common finding in population studies. Additional research is needed to better define and describe the mechanisms that lead to restricted spirometry and potential interventions.
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can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease
2009Co-Authors: Rogelio Perezpadilla, Paul L. Enright, Juan Carlos Vazquezgarcia, Ana M B Menezes, William M Vollmer, A S BuistAbstract:Although chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide,1 it is greatly underdiagnosed.2 International guidelines now recommend documenting i rreversible airflow obstruction, assessed via post-bronchodilator (post-BD) spirometry, as the primary diagnostic test for COPD, before an inhaler prescription is considered.1 Despite the increasing availability of relatively low-cost, easy to use office spirometers,3,4 spirometry is not often available in the primary care setting and economic factors may limit specialty referrals for spirometry testing. This problem is further exacerbated in resource-poor countries for which even the least expensive spirometers may be a luxury for many primary care practitioners and an unaffordable test for many patients. In this context, access to a simple, inexpensive, easy to interpret test to screen patients and identify those most likely to benefit from spirometry is a highly desirable goal. Measurement of the peak expiratory flow (PEF) requires only a short maximal expiration, and the demands required of the patient and technician to achieve reliable data are fewer than for spirometry. Although previous studies have concluded that PEF is not an adequate substitute for spirometry for the diagnosis of COPD,5,6 these studies did not evaluate the possible value of PEF as a screening tool to reduce the need for spirometry in adults with COPD risk factors. The data used for this report are from the Latin American Project for the Investigation of Obstructive Lung Diseases (PLATINO) study7 and the ongoing Burden of Obstructive Lung Disease (BOLD) study.8 These population-based COPD prevalence studies shared a common protocol and have been carried out to date in over 17 countries around the world. We tested whether PEF, assessed before bronchodilator use and using a diagnostic-quality spirometer with trained technicians, identified spirometrically confirmed post-BD airflow obstruction.
William M Vollmer - One of the best experts on this subject based on the ideXlab platform.
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case finding options for copd results from the burden of obstructive lung disease study
2013Co-Authors: Anamika Jithoo, Paul L. Enright, Sonia A Buist, Peter Burney, Eric D Bateman, Wan C Tan, Michael Studnicka, Filip Mejza, Suzanne Gillespie, William M VollmerAbstract:This study aimed to compare strategies for chronic obstructive pulmonary disease (COPD) case finding using data from the Burden of Obstructive Lung Disease study. Population-based samples of adults aged ≥40 yrs (n = 9,390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of differently staged algorithms that used questionnaire data and/or peak expiratory flow (PEF) data to identify persons at risk for COPD and, hence, needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1,000 people. For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%) but required confirmatory spirometry in 80% of participants. Use of PEF necessitated confirmatory spirometry in only 19-22% of subjects, with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in <9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case-finding strategy. Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults aged ≥40 yrs. These findings should be validated in real-world settings such as the primary care environment.
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restricted spirometry in the burden of lung disease study
2012Co-Authors: David M Mannino, William M Vollmer, Mary Ann Mcburnie, Wancheng Tan, Ali Kocabas, Josep M Anto, A S BuistAbstract:BACKGROUND The presence of restrictive lung disease has classically required the measure of total lung capacity to document 'true' restriction, which has limited its detection in large population-based studies. METHODS We used spirometric data to classify people with restricted spirometry (forced expiratory volume in 1 second [FEV(1)]/forced vital capacity ≥ 0.70 and FEV(1) < 80% predicted) in the Burden of Lung Disease (BOLD) Study and determined the relation between this finding and demographic factors and the presence of chronic diseases, including diabetes mellitus, hypertension and cardiovascular disease. RESULTS Overall, we found that 11.7% of men (546/4664) and 16.4% of women (836/5098) had restricted spirometry. Prevalence varied widely by site, from a low of 4.2% among males in Sydney, Australia, to a high of 48.7% among females in Manila, The Philippines. Compared to people with normal lung function, those with restricted spirometry had a higher prevalence of diabetes (12.2% vs. 4.6%), heart disease (15.0% vs. 7.7%) and hypertension (38.8% vs. 22.8%). CONCLUSIONS Restricted spirometry is a common finding in population studies. Additional research is needed to better define and describe the mechanisms that lead to restricted spirometry and potential interventions.
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can a normal peak expiratory flow exclude severe chronic obstructive pulmonary disease
2009Co-Authors: Rogelio Perezpadilla, Paul L. Enright, Juan Carlos Vazquezgarcia, Ana M B Menezes, William M Vollmer, A S BuistAbstract:Although chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide,1 it is greatly underdiagnosed.2 International guidelines now recommend documenting i rreversible airflow obstruction, assessed via post-bronchodilator (post-BD) spirometry, as the primary diagnostic test for COPD, before an inhaler prescription is considered.1 Despite the increasing availability of relatively low-cost, easy to use office spirometers,3,4 spirometry is not often available in the primary care setting and economic factors may limit specialty referrals for spirometry testing. This problem is further exacerbated in resource-poor countries for which even the least expensive spirometers may be a luxury for many primary care practitioners and an unaffordable test for many patients. In this context, access to a simple, inexpensive, easy to interpret test to screen patients and identify those most likely to benefit from spirometry is a highly desirable goal. Measurement of the peak expiratory flow (PEF) requires only a short maximal expiration, and the demands required of the patient and technician to achieve reliable data are fewer than for spirometry. Although previous studies have concluded that PEF is not an adequate substitute for spirometry for the diagnosis of COPD,5,6 these studies did not evaluate the possible value of PEF as a screening tool to reduce the need for spirometry in adults with COPD risk factors. The data used for this report are from the Latin American Project for the Investigation of Obstructive Lung Diseases (PLATINO) study7 and the ongoing Burden of Obstructive Lung Disease (BOLD) study.8 These population-based COPD prevalence studies shared a common protocol and have been carried out to date in over 17 countries around the world. We tested whether PEF, assessed before bronchodilator use and using a diagnostic-quality spirometer with trained technicians, identified spirometrically confirmed post-BD airflow obstruction.