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Biomedical subjects

David A Kaminsky

Publications and source records attributed to David A Kaminsky.

13 recordsLinked to original sources
PubMed2006

DLCO versus DLCO/VA as predictors of pulmonary gas exchange.

BACKGROUND: The diffusing capacity of the lung is usually reported as both the diffusing capacity (DLCO) and the diffusing capacity divided by the alveolar volume (DLCO/VA). However, it is unclear which measure to use when interpreting pulmonary gas exchange. We therefore conducted this study to determine whether the DLCO or the DLCO/VA is a better predictor of oxygen desaturation with exercise. METHODS: We retrospectively analyzed the pulmonary function records of all patients who had measurement of their diffusing capacity and 6-min walk oximetry in our university pulmonary function laboratory over a 2-year period. RESULTS: There were data available on 97 patients, most of who had interstitial lung disease and/or lung volume restriction. The median DLCO was 51% predicted and the median DLCO/VA was 64% predicted. The prevalence of exercise desaturation was 43%. The overall sensitivity and specificity as determined by the area under the receiver operator characteristic (ROC) curve was higher for DLCO than DLCO/VA, with an optimal cut-off of normal of 55% predicted. The positive predictive values were equally low for both measures, ranging from 50% to 70%. After adjustment for VA, there were no differences between the ROC curves or predictive values for DLCO and DLCO/VA. CONCLUSION: After adjusting for VA, neither the DLCO nor the DLCO/VA was better at predicting oxygen desaturation with exercise. The optimal cut-off of normal was 55% predicted.

Aged↗
PubMed2006

Allergic rhinitis and sinusitis in asthma: differential effects on symptoms and pulmonary function.

BACKGROUND: Allergic rhinitis and sinusitis are frequently associated with asthma. The purpose of this study was to determine the impact of self-reported allergic rhinitis and sinusitis on lower airway disease in a large cohort of participants with well-characterized asthma. METHODS: A cohort study of participants in two trials of the American Lung Association-Asthma Clinical Research Centers: 2,031 asthmatics in the Safety of Inactivated Influenza Vaccine in Asthma in Adults and Children (SIIVA) trial and 488 asthmatics in the Effectiveness of Low Dose Theophylline as Add-on Treatment in Asthma (LODO) trial. At baseline, participants reported the presence of allergic rhinitis and sinusitis, and then lung function and asthma control were measured. During the trials, participants were monitored for asthma exacerbations. RESULTS: More than 70% of participants reported either allergic rhinitis or sinusitis. Sinusitis was more common in female patients (odds ratio, 1.46 [SIIVA]), those with gastroesophageal reflux disease (odds ratio, 2.21 [SIIVA]), and those of white race (odds ratio, 1.53 [SIIVA]). Similar associations were seen for allergic rhinitis. LODO participants with allergic rhinitis and sinusitis had increased asthma symptoms and a trend toward more sleep disturbance. Participants with allergic rhinitis had higher baseline lung function than those without allergic rhinitis measured by peak flow (91.2% vs 95.8% in the SIIVA trial). Participants with sinusitis had similar lung function to those without sinusitis. Participants with and without allergic rhinitis had similar exacerbation rates. In the LODO trial only, participants with sinusitis had increased asthma exacerbations (5.68 per patient per year vs 3.72 per patient per year). CONCLUSION: Allergic rhinitis and sinusitis are associated with more severe asthmatic symptoms and, in patients with poorly controlled asthma, more exacerbations but are not associated with low lung function.

Adolescent↗
PubMed2005

Knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease by primary care physicians.

BACKGROUND: The importance of office spirometry has been strongly advocated in the pulmonary community, but whether its importance is recognized and accepted by primary care physicians is less well established. METHODS: To assess primary care physicians' knowledge and use of office spirometry for the detection of chronic obstructive pulmonary disease, we conducted a brief mail survey on the local practice of office spirometry, barriers to performing office spirometry, and general knowledge about spirometry. We also provided 60-min educational workshops to assess whether such an approach would increase spirometry testing or perceptions about spirometry. RESULTS: Twenty-nine of 57 (51%) primary care offices responded to the survey. Of these, 66% owned their own spirometer. The most common reasons for not performing spirometry were uncertainty about the impact of the test (41%), physician and staff unfamiliarity (38%), and lack of training (34%). Twenty-one respondents participated in the workshops. In the 3 months following the workshops, the number of spirometry tests increased by 59% (p = 0.004). After the workshops, the proportion of clinics that reported reasons for not performing the test decreased by 13% (p = 0.01), but important barriers to performing office spirometry were still present, including physician and staff unfamiliarity (22%), uncertain interpretation of results (22%), time (22%), and reimbursement (22%). CONCLUSIONS: The general knowledge and use of office spirometry in the primary care community is poor, but can be improved, at least in the short-term, by a simple educational workshop.

Clinical Competence↗
PubMed2004

Oscillation mechanics of the human lung periphery in asthma.

To more precisely measure the mechanical properties of the lung periphery in asthma, we have developed a forced oscillation technique that applies a broad-band flow signal through a wedged bronchoscope. We interpreted the data from four healthy and eight mildly asthmatic subjects in terms of an anatomically accurate computer model of the wedged segment. There was substantial overlap in impedance between the two groups, with resistance (R) showing minimal frequency dependence and elastance (E) showing positive and negative frequency dependence across subjects. After direct instillation of methacholine, R rose in both groups, but compared with healthy subjects, the asthmatic subjects displayed upward, parallel shifts in their dose-response curves. The baseline frequency-response patterns of E were enhanced after methacholine. Frequency dependencies of R and E were well reproduced in two normal subjects by a computational model that employed rigid airways connected to constant-phase tissue units but were better reproduced in the other two normal and three asthmatic subjects when the model employed heterogeneous, peripheral airway narrowing and compliant airways. To capture the frequency dependencies of R and E in the remaining five asthmatic subjects, the model was modified by increasing airway wall stiffness. These results indicate that the lung periphery of mildly asthmatic subjects is not well distinguished from that of healthy subjects by measurement of mechanical impedance at baseline, but group differences are seen after challenge with methacholine. Modeling of the response suggests that variable contributions of airway narrowing and wall compliance are operative in determining overall mechanical impedance of the lung periphery in humans with asthma, likely reflecting the functional consequences of airway inflammation and remodeling.

Adult↗
PubMed2004

False-positive sputum cytology in a case of pulmonary infarction.

Sputum cytology is an important diagnostic tool in pulmonary medicine, but it can yield a false-positive diagnosis of malignancy. We describe such a case, which involved a 70-year-old man who presented with chest pain, hemoptysis, and bilateral pulmonary infiltrates. In the initial evaluation of hemoptysis, multiple sputum samples demonstrated cytological abnormalities consistent with adenocarcinoma, but bronchoscopy found no evidence of malignancy. He was ultimately found to have pulmonary thromboembolic disease with infarction. Follow-up radiographs showed resolution of the pulmonary infarcts, and the absence of malignancy was proven during postmortem examination. Pulmonary infarction is one of many diseases that can produce sputum cytological findings falsely indicative of malignancy.

Adenocarcinoma↗
PubMed2003

Strategies for screening for chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease is easily detected in its preclinical phase, using office spirometry. Successful smoking cessation prevents further disease progression in most patients. Spirometry measures the ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV(1)/FVC), which is the most sensitive and specific test for detecting airflow limitation. Primary care practitioners see the majority of adult smokers, but few primary care practitioners currently have spirometers or regularly order spirometry for their smoker patients. Improvements in spirometry software have made it much easier to obtain good quality spirometry test sessions, thereby reducing the misclassification rate. Respiratory therapists and pulmonary function technologists can help primary care practitioners select good office spirometers for identifying chronic obstructive pulmonary disease and teach staff how to use spirometers correctly.

Adult↗