Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung ...health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities.
This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients' experiences.
Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices.
Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement.
Indoor Air Pollution and Respiratory Health Raju, Sarath; Siddharthan, Trishul; McCormack, Meredith C
Clinics in chest medicine,
12/2020, Letnik:
41, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Worldwide, more than 4 million deaths annually are attributed to indoor air pollution. This largely preventable exposure represents a key target for reducing morbidity and mortality worldwide. ...Significant respiratory health effects are observed, ranging from attenuated lung growth and development in childhood to accelerated lung function decline and is determined by chronic obstructive pulmonary disease later in life. Personal exposure to household air pollutants include household characteristics, combustion of solid fuels, cooking practices, and household pest allergens. This review outlines important sources of indoor air pollution, their respiratory health effects, and strategies to reduce household pollution and improve lung health across the globe.
The American Thoracic Society committee on Proficiency Standards for Pulmonary Function Laboratories has recognized the need for a standardized reporting format for pulmonary function tests. Although ...prior documents have offered guidance on the reporting of test data, there is considerable variability in how these results are presented to end users, leading to potential confusion and miscommunication.
A project task force, consisting of the committee as a whole, was approved to develop a new Technical Standard on reporting pulmonary function test results. Three working groups addressed the presentation format, the reference data supporting interpretation of results, and a system for grading quality of test efforts. Each group reviewed relevant literature and wrote drafts that were merged into the final document.
This document presents a reporting format in test-specific units for spirometry, lung volumes, and diffusing capacity that can be assembled into a report appropriate for a laboratory's practice. Recommended reference sources are updated with data for spirometry and diffusing capacity published since prior documents. A grading system is presented to encourage uniformity in the important function of test quality assessment.
The committee believes that wide adoption of these formats and their underlying principles by equipment manufacturers and pulmonary function laboratories can improve the interpretation, communication, and understanding of test results.
Field walking tests are commonly employed to evaluate exercise capacity, assess prognosis and evaluate treatment response in chronic respiratory diseases. In recent years, there has been a wealth of ...new literature pertinent to the conduct of the 6-min walk test (6MWT), and a growing evidence base describing the incremental and endurance shuttle walk tests (ISWT and ESWT, respectively). The aim of this document is to describe the standard operating procedures for the 6MWT, ISWT and ESWT, which can be consistently employed by clinicians and researchers. The Technical Standard was developed by a multidisciplinary and international group of clinicians and researchers with expertise in the application of field walking tests. The procedures are underpinned by a concurrent systematic review of literature relevant to measurement properties and test conduct in adults with chronic respiratory disease. Current data confirm that the 6MWT, ISWT and ESWT are valid, reliable and responsive to change with some interventions. However, results are sensitive to small changes in methodology. It is important that two tests are conducted for the 6MWT and ISWT. This Technical Standard for field walking tests reflects current evidence regarding procedures that should be used to achieve robust results.
Abstract Background Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner-cities do not have higher prevalent pediatric asthma. ...Whether asthma morbidity is higher in inner-city areas across the U.S. not known. Objective To examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma enrolled in Medicaid. Methods Children aged 5-19 enrolled in Medicaid in 2009-2010 were included. Asthma was defined by at least one outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2 year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty and race/ethnicity on rates of asthma outpatient visits, ED visits and hospitalizations. Results 16,860,716 children were included (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but was associated with significantly more asthma-related emergency room visits and hospitalizations among those with asthma in crude analyses (RR 1.48, 95%CI:1.24-1.36 and 1.97, 95%CI:1.50-1.72, respectively) and when adjusted for race/ethnicity, age and gender (aRR 1.23, 95%CI:1.08-1.15 and 1.62, 95%CI:1.26-1.43). Residence in urban or poor areas, and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma related emergency room visits and hospitalizations. Conclusions Residence in poor and urban areas is an important risk factor for asthma morbidity, but not prevalence, among low-income U.S. children.
This systematic review examined the measurement properties of the 6-min walk test (6MWT), incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT) in adults with chronic ...respiratory disease. Studies that report the evaluation or use of the 6MWT, ISWT or ESWT were included. We searched electronic databases for studies published between January 2000 and September 2013. The 6-min walking distance (6MWD) is a reliable measure (intra-class correlation coefficients ranged from 0.82 to 0.99 in seven studies). There is a learning effect, with greater distance walked on the second test (pooled mean improvement of 26 m in 13 studies). Reliability was similar for ISWT and ESWT, with a learning effect also evident for ISWT (pooled mean improvement of 20 m in six studies). The 6MWD correlates more strongly with peak work capacity (r=0.59-0.93) and physical activity (r=0.40-0.85) than with respiratory function (r=0.10-0.59). Methodological factors affecting 6MWD include track length, encouragement, supplemental oxygen and walking aids. Supplemental oxygen also affects ISWT and ESWT performance. Responsiveness was moderate to high for all tests, with greater responsiveness to interventions that included exercise training. The findings of this review demonstrate that the 6MWT, ISWT and ESWT are robust tests of functional exercise capacity in adults with chronic respiratory disease.
Chronic Obstructive Pulmonary Disease (COPD) affects 12-16 million people in the United States and is the third-leading cause of death. In developed countries, smoking is the greatest risk factor for ...the development of COPD, but other exposures also contribute to the development and progression of the disease. Several studies suggest, though are not definitive, that outdoor air pollution exposure is linked to the prevalence and incidence of COPD. Among individuals with COPD, outdoor air pollutants are associated with loss of lung function and increased respiratory symptoms. In addition, outdoor air pollutants are also associated with COPD exacerbations and mortality. There is much less evidence for the impact of indoor air on COPD, especially in developed countries in residences without biomass exposure. The limited existing data suggests that indoor particulate matter and nitrogen dioxide concentrations are linked to increased respiratory symptoms among patients with COPD. In addition, with the projected increases in temperature and extreme weather events in the context of climate change there has been increased attention to the effects of heat exposure. Extremes of temperature-both heat and cold-have been associated with increased respiratory morbidity in COPD. Some studies also suggest that temperature may modify the effect of pollution exposure and though results are not conclusive, understanding factors that may modify susceptibility to air pollution in patients with COPD is of utmost importance.
Parabens are synthetic preservatives present in many consumer products. Their antimicrobial and endocrine-disrupting properties have raised concerns that they might play a role in respiratory and ...allergic diseases; however, studies exploring these associations are scarce.
We examined the cross-sectional association between parabens and asthma morbidity among 450 children with asthma and with asthma prevalence among 4023 children in the US general population participating in the National Health and Nutrition Examination Survey (2005-2014).
We conducted multivariable logistic regression to examine associations between urinary paraben biomarker concentrations (butyl paraben, ethyl paraben, methyl paraben MP, and propyl paraben PP) and asthma attacks and emergency department visits among children with asthma and with a current asthma diagnosis among all children. We also examined heterogeneity of associations by sex.
We observed an increased prevalence odds of reporting emergency department visits for every 10-fold increase in MP and PP concentrations among boys with asthma (adjusted prevalence odds ratio, 2.61 95% CI, 1.40-4.85 and 2.18 95% CI, 1.22-3.89, respectively; Pinteraction-MP = .002 and Pinteraction-PP = .003); associations remained after adjusting for other phenolic compounds previously linked to respiratory outcomes. No other dimorphic effects of exposure by sex were observed. Among children in the general population, no overall associations with current asthma were observed, although there was a positive trend with PP and a current asthma diagnosis.
We identified differential effects of exposure to select parabens by sex on asthma morbidity. Further studies are needed to replicate these findings and elucidate mechanisms by which parabens could affect respiratory health and elicit dimorphic effects by sex.
PDF
