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Bruce Thompson - One of the best experts on this subject based on the ideXlab platform.
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factors associated with abnormal Spirometry among hiv infected individuals
AIDS, 2015Co-Authors: Bradley M Drummond, Laurence Huang, Philip T Diaz, Gregory D Kirk, Eric C Kleerup, Alison Morris, William N Rom, Michael D Weiden, Enxu Zhao, Bruce ThompsonAbstract:Author(s): Drummond, M Bradley; Huang, Laurence; Diaz, Philip T; Kirk, Gregory D; Kleerup, Eric C; Morris, Alison; Rom, William; Weiden, Michael D; Zhao, Enxu; Thompson, Bruce; Crothers, Kristina | Abstract: OBJECTIVE:HIV-infected individuals are susceptible to development of chronic lung diseases, but little is known regarding the prevalence and risk factors associated with different spirometric abnormalities in this population. We sought to determine the prevalence, risk factors and performance characteristics of risk factors for spirometric abnormalities among HIV-infected individuals. DESIGN:Cross-sectional cohort study. METHODS:We analyzed cross-sectional US data from the NHLBI-funded Lung-HIV consortium - a multicenter observational study of heterogeneous groups of HIV-infected participants in diverse geographic sites. Logistic regression analysis was performed to determine factors statistically significantly associated with Spirometry patterns. RESULTS:A total of 908 HIV-infected individuals were included. The median age of the cohort was 50 years, 78% were men and 68% current smokers. An abnormal Spirometry pattern was present in 37% of the cohort: 27% had obstructed and 10% had restricted Spirometry patterns. Overall, age, smoking status and intensity, history of Pneumocystis infection, asthma diagnosis and presence of respiratory symptoms were independently associated with an abnormal Spirometry pattern. Regardless of the presence of respiratory symptoms, five HIV-infected participants would need to be screened with Spirometry to diagnose two individuals with any abnormal Spirometry pattern. CONCLUSIONS:Nearly 40% of a diverse US cohort of HIV-infected individuals had an abnormal Spirometry pattern. Specific characteristics including age, smoking status, respiratory infection history and respiratory symptoms can identify those at risk for abnormal Spirometry. The high prevalence of abnormal Spirometry and the poor predictive capability of respiratory symptoms to identify abnormal Spirometry should prompt clinicians to consider screening Spirometry in HIV-infected populations.
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the all age Spirometry reference ranges reflect contemporary australasian Spirometry
Respirology, 2011Co-Authors: Bruce Thompson, Sanja Stanojevic, Michael J. Abramson, Richard Beasley, Andrew Coates, A. Dent, Brenton Eckert, Alan James, Sue Filsell, Arthur W. MuskAbstract:Background and objective: Advances in statistical modelling have allowed the creation of smoothly changing Spirometry reference ranges that apply across a wide age range and better define the lower limit of normal. The objective of this study was to assess the agreement of the Stanojevic 2009 all-age reference ranges to contemporary lung function data to verify the appropriateness of this reference for clinical use in Australia and New Zealand.Methods: Spirometry data from healthy Caucasians measured between 2000-2009 in Australia and New Zealand were collected. Z-scores were calculated for the standard Spirometry outcomes based on the all-age reference ranges.Results: Spirometry from 2066 subjects aged 4-80 years (55% male) from 14 centres were eligible. Statistically, the collated contemporary dataset differed from the all-age reference ranges, but these differences were relatively small and clinically irrelevant representing differences of approximately 3% predicted. Significant differences were also observed between some centres and equipment, potentially indicating varying influence of equipment or subject selection.Conclusions: Spirometry from contemporary Australasian healthy subjects fits the all-age reference ranges well. While the current study supports the use of the all-age reference ranges, the between-centre differences highlight the need for Spirometry to be used in conjunction with other clinical findings.
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The all‐age Spirometry reference ranges reflect contemporary Australasian Spirometry
Respirology (Carlton Vic.), 2011Co-Authors: Bruce Thompson, Sanja Stanojevic, Michael J. Abramson, Richard Beasley, Andrew Coates, A. Dent, Brenton Eckert, Alan James, Sue Filsell, Arthur W. MuskAbstract:Background and objective: Advances in statistical modelling have allowed the creation of smoothly changing Spirometry reference ranges that apply across a wide age range and better define the lower limit of normal. The objective of this study was to assess the agreement of the Stanojevic 2009 all-age reference ranges to contemporary lung function data to verify the appropriateness of this reference for clinical use in Australia and New Zealand.Methods: Spirometry data from healthy Caucasians measured between 2000-2009 in Australia and New Zealand were collected. Z-scores were calculated for the standard Spirometry outcomes based on the all-age reference ranges.Results: Spirometry from 2066 subjects aged 4-80 years (55% male) from 14 centres were eligible. Statistically, the collated contemporary dataset differed from the all-age reference ranges, but these differences were relatively small and clinically irrelevant representing differences of approximately 3% predicted. Significant differences were also observed between some centres and equipment, potentially indicating varying influence of equipment or subject selection.Conclusions: Spirometry from contemporary Australasian healthy subjects fits the all-age reference ranges well. While the current study supports the use of the all-age reference ranges, the between-centre differences highlight the need for Spirometry to be used in conjunction with other clinical findings.
Maureen P Swanney - One of the best experts on this subject based on the ideXlab platform.
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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
Respirology, 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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Spirometry training courses are not enough to achieve quality Spirometry in the community
European Respiratory Journal, 2012Co-Authors: Maureen P Swanney, Josh D. StantonAbstract:Community diagnostic Spirometry should be performed at the same standard as a respiratory laboratory. In 2008 our 10-year-old training course was altered to include a post-course quality review to qualify for Spirometry certification. Aim : To review the effectiveness of a quality review after Spirometry training. Methods: We audited attendees at our Spirometry courses and portfolio submissions. The portfolio required 10 tests and technical comments; Spirometry pattern; and quality control logs. We required 90% in all criteria and those who failed could resubmit. Results: 2-day and refresher Spirometry courses were reviewed including 107 practice nurses, 59 occupational health nurses and 27 regional hospital technicians. We found similar trends for the three groups. The portfolio first submission (22%, 30%) and pass rate (33%,62%) for the 2- and 1-day courses respectively were low. Discussion: The number seeking feedback on Spirometry practice was low with 24% submitting portfolios. Poor compliance was probably because Spirometry certification is not compulsory in New Zealand. This review suggests a Spirometry course alone is insufficient to achieve quality Spirometry, or there are deficiencies in our course content or delivery. A failed portfolio provided additional learning because some resubmissions were successful. The low submissions and passes for the portfolios are a concern. We need to encourage excellence in community Spirometry and maybe legislation to make Spirometry certification compulsory is the way forward.
Arthur W. Musk - One of the best experts on this subject based on the ideXlab platform.
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the all age Spirometry reference ranges reflect contemporary australasian Spirometry
Respirology, 2011Co-Authors: Bruce Thompson, Sanja Stanojevic, Michael J. Abramson, Richard Beasley, Andrew Coates, A. Dent, Brenton Eckert, Alan James, Sue Filsell, Arthur W. MuskAbstract:Background and objective: Advances in statistical modelling have allowed the creation of smoothly changing Spirometry reference ranges that apply across a wide age range and better define the lower limit of normal. The objective of this study was to assess the agreement of the Stanojevic 2009 all-age reference ranges to contemporary lung function data to verify the appropriateness of this reference for clinical use in Australia and New Zealand.Methods: Spirometry data from healthy Caucasians measured between 2000-2009 in Australia and New Zealand were collected. Z-scores were calculated for the standard Spirometry outcomes based on the all-age reference ranges.Results: Spirometry from 2066 subjects aged 4-80 years (55% male) from 14 centres were eligible. Statistically, the collated contemporary dataset differed from the all-age reference ranges, but these differences were relatively small and clinically irrelevant representing differences of approximately 3% predicted. Significant differences were also observed between some centres and equipment, potentially indicating varying influence of equipment or subject selection.Conclusions: Spirometry from contemporary Australasian healthy subjects fits the all-age reference ranges well. While the current study supports the use of the all-age reference ranges, the between-centre differences highlight the need for Spirometry to be used in conjunction with other clinical findings.
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The all‐age Spirometry reference ranges reflect contemporary Australasian Spirometry
Respirology (Carlton Vic.), 2011Co-Authors: Bruce Thompson, Sanja Stanojevic, Michael J. Abramson, Richard Beasley, Andrew Coates, A. Dent, Brenton Eckert, Alan James, Sue Filsell, Arthur W. MuskAbstract:Background and objective: Advances in statistical modelling have allowed the creation of smoothly changing Spirometry reference ranges that apply across a wide age range and better define the lower limit of normal. The objective of this study was to assess the agreement of the Stanojevic 2009 all-age reference ranges to contemporary lung function data to verify the appropriateness of this reference for clinical use in Australia and New Zealand.Methods: Spirometry data from healthy Caucasians measured between 2000-2009 in Australia and New Zealand were collected. Z-scores were calculated for the standard Spirometry outcomes based on the all-age reference ranges.Results: Spirometry from 2066 subjects aged 4-80 years (55% male) from 14 centres were eligible. Statistically, the collated contemporary dataset differed from the all-age reference ranges, but these differences were relatively small and clinically irrelevant representing differences of approximately 3% predicted. Significant differences were also observed between some centres and equipment, potentially indicating varying influence of equipment or subject selection.Conclusions: Spirometry from contemporary Australasian healthy subjects fits the all-age reference ranges well. While the current study supports the use of the all-age reference ranges, the between-centre differences highlight the need for Spirometry to be used in conjunction with other clinical findings.
Paul L. Enright - One of the best experts on this subject based on the ideXlab platform.
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Spirometry Longitudinal Data Analysis Software (SPIROLA) for Analysis of Spirometry Data in Workplace Prevention or COPD Treatment.
The Open Medical Informatics Journal, 2010Co-Authors: Eva Hnizdo, Artak Hakobyan, Paul L. Enright, Lu-ann Beeckman-wagner, John L. Hankinson, James L. Fleming, Edward L. PetsonkAbstract:: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality. Periodic Spirometry is often recommended for individuals with potential occupational exposure to respiratory hazards and in medical treatment of respiratory disease, to prevent COPD or improve treatment outcome. To achieve the full potential of Spirometry monitoring in preserving lung function, it is important to maintain acceptable precision of the longitudinal measurements, apply interpretive strategies that identify individuals with abnormal test results or excessive loss of lung function in a timely manner, and use the results for intervention on respiratory disease prevention or treatment modification. We describe novel, easy-to-use visual and analytical software, Spirometry Longitudinal Data Analysis software (SPIROLA), designed to assist healthcare providers in the above aspects of Spirometry monitoring. Software application in ongoing workplace Spirometry-based medical monitoring programs helped to identify increased Spirometry data variability due to deteriorating test quality and subsequent improvement following interventions, and helped to enhance identification of individuals with excessive decline in lung function.
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quality of Spirometry performed by 13 599 participants in the world trade center worker and volunteer medical screening program
Respiratory Care, 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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The use and abuse of office Spirometry.
Primary care respiratory journal : journal of the General Practice Airways Group, 2008Co-Authors: Paul L. EnrightAbstract:Spirometry programs (outside of primary care settings) designed to detect COPD in the general adult population are not justified, since the true positive yield (airway obstruction with an FEV1 below 60% predicted) is very low, and the false positive rate is very high. However, Spirometry is greatly under-utilised by GPs who often prescribe inhalers for patients haphazardly. Inhalers for COPD are expensive and risk serious side-effects, so they should not be prescribed for current or former smokers without confirming severe airway obstruction. A large program in Finland has shown that some GPs can perform good quality Spirometry. If good quality Spirometry is not available in the GP's office, patients should be referred to a local resource for pre- and post-bronchodilator Spirometry. More studies are needed to show that GPs use Spirometry results systematically to make decisions which truly benefit their patients with asthma or COPD.
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Spirometry can be done in family physicians offices and alters clinical decisions in management of asthma and copd
Chest, 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
Chest, 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.
Graham L. Hall - One of the best experts on this subject based on the ideXlab platform.
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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
Respirology, 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.