Introduction
In pulmonary vascular disease exercise, abnormalities can include reduced exercise capacity, reduced oxygen pulse and elevated VE/VCO2. The association of clinical measures such as ...six-minute walk work, haemodynamics, lung function and echocardiogram to peak VO2, O2 pulse and VE/VCO2 has not been fully investigated in pulmonary vascular disease.
Aims
To determine the relationship of six-minute walk work and other clinical measures to peak VO2, peak O2 pulse and VE/VCO2. Additionally, to investigate the ability to predict peak VO2 from six-minute walk work and other clinical parameters.
Methods
Clinical data was retrospectively analysed from 63 chronic thromboembolic pulmonary hypertension (CTEPH) and 54 chronic thromboembolic disease (CTED) patients. Six-minute walk test measures, haemodynamics, lung function and echocardiographic measures were correlated with peak VO2, peak O2 pulse and VE/VCO2. Predictive equations were developed to predict peak V̇O2 in both CTEPH and CTED cohorts and subsequently validated.
Results
A number of clinical parameters correlated to peak VO2, peak O2 pulse and VE/VCO2. Six-minute walk work and transfer factor for carbon monoxide demonstrated the strongest correlation to peak VO2 and peak O2 pulse. The validation of the predictive equations showed a variable level of agreement between measured peak VO2 and calculated peak VO2 from the predictive equations.
Conclusion
Six-minute walk work and additionally a number of clinical test parameters were associated to peak VO2, peak O2 pulse and VE/VCO2. Six-minute walk work and transfer factor for carbon monoxide were particularly highly correlated to peak VO2 and similarly to peak oxygen pulse. The validation of the predictive equations showed a variable level of agreement and therefore may have limited clinical applicability.
Environmental air pollution presents a considerable risk to global respiratory health. If critical levels are exceeded, inhaled pollutants can lead to the development of respiratory dysfunction and ...provoke exacerbation in those with pre‐existing chronic respiratory disease. Over 90% of the global population currently reside in areas where environmental air pollution is considered excessive—with adverse effects ranging from acute airway irritation to complex immunomodulatory alterations. This narrative review provides an up‐to‐date perspective concerning the impact of environmental air pollution on respiratory health and function and describes the underpinning mechanisms that contribute to the development and progression of chronic respiratory disease.
IntroductionSpirometry is a point-of-care lung function test that helps support the diagnosis and monitoring of chronic lung disease. The quality and interpretation accuracy of spirometry is variable ...in primary care. This study aims to evaluate whether artificial intelligence (AI) decision support software improves the performance of primary care clinicians in the interpretation of spirometry, against reference standard (expert interpretation).Methods and analysisA parallel, two-group, statistician-blinded, randomised controlled trial of primary care clinicians in the UK, who refer for, or interpret, spirometry. People with specialist training in respiratory medicine to consultant level were excluded. A minimum target of 228 primary care clinician participants will be randomised with a 1:1 allocation to assess fifty de-identified, real-world patient spirometry sessions through an online platform either with (intervention group) or without (control group) AI decision support software report. Outcomes will cover primary care clinicians’ spirometry interpretation performance including measures of technical quality assessment, spirometry pattern recognition and diagnostic prediction, compared with reference standard. Clinicians’ self-rated confidence in spirometry interpretation will also be evaluated. The primary outcome is the proportion of the 50 spirometry sessions where the participant’s preferred diagnosis matches the reference diagnosis. Unpaired t-tests and analysis of covariance will be used to estimate the difference in primary outcome between intervention and control groups.Ethics and disseminationThis study has been reviewed and given favourable opinion by Health Research Authority Wales (reference: 22/HRA/5023). Results will be submitted for publication in peer-reviewed journals, presented at relevant national and international conferences, disseminated through social media, patient and public routes and directly shared with stakeholders.Trial registration number NCT05933694.
IntroductionThe National Health Service for England Long Term Plan identifies respiratory disease as one of its priority workstreams. To assist with earlier and more accurate diagnosis of lung ...disease they recommend improvement in delivery of quality-assured spirometry. However, there is a likelihood that patients will present with abnormal gas exchange when spirometry results are normal and therefore there will be a proportion of patients whose time to diagnosis is still protracted. We wished to determine the incidence rate of this occurring within our Trust.MethodsA retrospective review of all patients attending the lung function laboratory for their first pulmonary function assessment from June 2006 to December 2020 was undertaken. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) >−1.64 standardised residual (SR) was used to confirm no obstructive lung function abnormality and FVC >−1.64 SR to confirm no suggestion of a restrictive lung function abnormality. Lung gas transfer for carbon monoxide (TLCO) and transfer coefficient of the lung for carbon monoxide (KCO) <−1.64 SR confirmed the presence of a gas exchange abnormality. Spirometry and gas transfer reference values generated by the Global Lung Initiative were used to determine normality.ResultsOf 12 835 eligible first visits with normal FEV1/FVC and FVC, 4856 (37.8%) were identified as having an abnormally low TLCO and 3302 (25.7%) presenting with an abnormally low KCO. Of 3494 with FEV1/FVC SR <−1.64, 3316 also had a ratio of <0.70, meaning 178 (5%) of patients in this cohort would have been misclassified as having obstructive lung disease using the 0.70 cut-off recommended by the Global Initiative for Chronic Obstructive Lung Disease for diagnosing obstructive lung disease.DiscussionIn conclusion, to assist with ensuring more accurate and timely diagnosis of lung disease and enhance patients’ diagnostic pathway, we recommend the performance of lung gas transfer measurements alongside spirometry in all healthcare settings. To assess and monitor gas transfer at the earliest opportunity we recommend this is implemented into new models being developed within community hubs. This will increase the identification of lung function abnormalities and provide patients with a definitive diagnosis earlier.
This paper provides an overview of some of the most memorable sessions that were (co)organised by the Allied Respiratory Professionals Assembly during the 2021 European Respiratory Society ...International Congress, which was held online for the second consecutive year due to the COVID-19 pandemic. Early Career Members from Assembly 9 summarised the content of the sessions (three oral communication sessions, two symposia and one Expert View) with the support of the chairs from the four Assembly groups: Respiratory Function Technologists and Scientists (Group 9.01); Physiotherapists (Group 9.02); Nurses (Group 9.03); and Psychologists and Behavioural Scientists (Group 9.04). The sessions covered the following topics: impact of COVID-19 on lung function and healthcare services, and the importance of quality assurance and technology in lung function assessment; diagnosis and management of sarcopenia in patients with chronic respiratory disease; maintenance of the effects of pulmonary rehabilitation; solutions outside the hospital for the management of patients with COVID-19 in need of health care; the nursing perspective during the COVID-19 pandemic; and psychological and behavioural issues in respiratory care. This highlights article provides valuable insight into the latest scientific data and emerging areas affecting clinical practice of allied respiratory professionals.
Study question In large multinational patient surveys, spirometry (which requires repeated, reproducible maximal efforts) can be associated with cough, breathlessness and tiredness, particularly in ...those with idiopathic pulmonary fibrosis (IPF). Oscillometry is an effort-independent test of airways resistance and reactance. We hypothesised that oscillometry would take less time to perform and would be associated with reduced symptom burden than spirometry. Patients and methods Spirometry and oscillometry were performed in 66 participants with IPF and repeated 2 weeks later. We compared time taken to perform tests, symptom burden and test–retest reliability with Bland–Altman plots and intraclass correlation coefficients (ICCs). Results Oscillometry took significantly less time to perform than spirometry (mean −4.5 (99% CI −6.0 to −3.0) min) and was associated with lower symptom burden scores for cough (−1.3, 99% CI −1.7 to −0.8), breathlessness (−1.0, 99% CI −1.4 to −0.5), and tiredness (−0.5, 99% CI −0.9 to −0.2). On Bland–Altman analysis, all measures showed good agreement, with narrow limits of agreement and the mean bias lying close to 0 in all cases. The ICCs for forced expiratory volume in 1 s and forced vital capacity were 0.94 and 0.89, respectively, and ranged between 0.70 and 0.90 for oscillometry measures. Conclusion Oscillometry is quicker to perform and provokes less symptoms than spirometry in patients with IPF.
Correspondence to Dr Oliver J Price; o.price@leedsbeckett.ac.uk Respiratory disease effects one in five people and is a leading cause of morbidity and mortality in the UK.1 In response to increasing ...prevalence and rising associated costs2—the Taskforce for Lung Health was established to deliver a 5-year plan or roadmap to improve respiratory health in England,3 as a priority as part of the National Health Service (NHS) England long-term plan.4 The Taskforce report, published in late 2018, provides a framework focusing on the importance of prevention, early and accurate diagnosis, high-quality treatments and support, and the recruitment of a highly knowledgeable and skilled workforce.3 The latter objective is perhaps most significant given staff shortages remain apparent across all levels of respiratory healthcare.5 In this context, it is alarming that the UK professional body for respiratory physiology practitioners—the Association for Respiratory Technology and Physiology (ARTP) recently published findings from a nationwide survey confirming that a substantial shortfall exists in the quantity of trained respiratory physiologists across the NHS.6 Indeed, respiratory physiology has been registered on the UK shortage occupations list for over a decade7—suggesting either a lack of awareness or interest when compared with other areas of healthcare science. ...there remains an immediate shortfall to support clinical assessment provision and to provide suitable training and education to the upcoming future workforce. The British Association of Sport and Exercise Sciences (BASES) (UK professional body) has previously highlighted a growing need to recognise and incorporate exercise scientists into the NHS and public health settings.9 However, despite clear transferability between disciplines (particularly for students electing clinical physiology modules and/or completing postgraduate study), assured voluntary registers such as the Registration Council for Clinical Physiologists (RCCP) do not currently accept exercise science via the ‘accreditation of prior learning’ pathway.10 Specific to respiratory medicine, the majority of advertised entry-level clinical physiologist posts in the NHS (ie, at band 4–5 level) currently stipulate that a degree in healthcare or physiological sciences (often with advanced ARTP practitioner competency qualifications and RCCP registration) is an essential entry criteria, and more often than not, fail to acknowledge related or equivalent degrees.
BACKGROUND:Chronic respiratory morbidity has been reported in prematurely born infants after respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) lower respiratory tract infections ...(LRTIs). The aim of this study was to determine the impact of viral LRTI on lung function at follow-up of prematurely born infants.
METHODS:Fifty-nine infants born before 32 weeks of gestational age were prospectively followed after neonatal unit discharge. Nasopharyngeal aspirates were obtained when the infants developed LRTIs in hospital or the community. RSV was identified by immunofluorescence and/or culture. In addition, RSV and other viral infections were identified by real time reverse transcription polymerase chain reaction. At a corrected age of 1 year, measurements of lung volume functional residual capacity (FRC)pleth and airway resistance (Raw) were made by plethysmography, and lung volume was also assessed by helium gas dilution (FRCHe). Before the measurements, parents completed diary cards for 1 month documenting on a daily basis whether their infant wheezed, coughed, or required bronchodilator therapy.
RESULTS:Twenty-five infants had at least 1 proven RSV LRTI (RSV-positive group). The RSV-positive group compared with the rest of the cohort had similar lung volumes, but significantly higher Raw (P = 0.002), more days of wheeze (P < 0.001), and bronchodilator requirement (P = 0.027). Regression analysis also identified that hMPV LRTI was associated with elevated airways resistance at follow-up.
CONCLUSION:RSV and hMPV LRTIs in prematurely born infants are associated with abnormal lung function at follow-up.
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