BACKGROUND: In the context that accurate measurement of FVC is important in diagnosing airflow obstruction and in assessing restriction, strategies to achieve reliable and accurate FVC measurement have drawn much attention. OBJECTIVES: Because the rate of achieving end-of-test criteria during spirometry has been shown to be low, with resultant under-recording of the FVC, the current study proposes a regression equation for estimating FVC from measured values of the forced expiratory volume in 2 s (FEV2) and forced expiratory volume in 3 s (FEV3). METHODS: The predictive equation for the estimated FVC from volume measurements within the first 3 s of exhalation (estimated FVC3) was generated based on 330 consecutive acceptable spirograms performed in the Cleveland Clinic Foundation Pulmonary Function Laboratory. The equation was applied to an independent validation set comprised of spirometry measurements on 370 different consecutive patients. RESULTS: In the validation spirometry sample, in which the prevalence of obstruction was 34% (based on values of the measured FEV1/FVC compared to National Health and Nutrition Examination Survey III values), the sensitivity, specificity, and positive and negative predictive values of FEV1/estimated FVC3 for obstruction were 93.8%, 89.1%, 81.2%, and 96.9%, respectively. The misclassification rate was 9.2%. In the same cohort, the mean difference (+/- SD) between estimated FVC3 and measured FVC was 24.7 +/- 237 mL. CONCLUSIONS: Given that FVC is frequently under-recorded, with resultant overestimation of FEV1/FVC and underdiagnosis of airflow obstruction, we believe that estimating FVC from FEV2 and FEV3 can offer practical diagnostic advantages.

Aged↗

PubMed2005

A review of alpha-1 antitrypsin deficiency.

Alpha-1 antitrypsin (AAT) deficiency is a common but under-recognized disease. This hereditary disorder is characterized by low levels of AAT, and increased risks of panacinar emphysema at an early age, liver disease, vasculitis and panniculitis. Destruction of lung parenchyma and consequent emphysema result from an imbalance between different inflammatory proteases (in particular, leukocyte elastase), and the major natural antiprotease, AAT. To offer a review of key aspects of this important condition, we present the epidemiology, natural history, and pathogenesis of AAT deficiency and, in the context of recent data and the publication of an international standards document regarding the diagnosis and management of individuals with AAT deficiency, review current therapy of AAT deficiency.

Humans↗

PubMed2004

Severity scoring in community-acquired pneumonia caused by Streptococcus pneumoniae: a 5-year experience.

Multiple severity scoring systems have been devised and evaluated in community-acquired pneumonia (CAP), but a simplified set of prognostic indicators has not yet been developed. Streptococcus pneumoniae is the most frequent aetiological agent of CAP. Our aim was to characterise the outcome in the light of different severity scoring systems and to compare the predictive values of different sets of clinical parameters, using available clinical data for pneumococcal CAP patients. This is a case series retrospective analysis that included consecutive adult pneumococcal CAP patients admitted to Danbury Hospital between 1 January 1996 and 31 December 2000. The aetiology was confirmed by positive sputum and/or blood cultures. The severity assessment included the Pneumonia Outcome Research Trial (PORT) and British Thoracic Society (BTS) scoring systems and other additional parameters. Primary end-points were in-hospital CAP-attributable deaths and length of hospitalisation. N = 151 patients with S. pneumoniae CAP were identified. The mean (+/- standard deviation) age at the time of diagnosis was 68 (+/-15) years. Thirty-three patients (22%) were admitted to the medical intensive care unit. The mean (median) hospitalisation duration was 7.5 (+/-5) days. Door-to-antibiotic mean (median) administration time was 3.7 (2) hours. Most frequent antibiotics used initially were cephalosporins plus/minus macrolides or fluoroquinolones. The mean (+/- standard deviation) PORT score was 105 (+/-37). The observed CAP-related mortality was 9/151 (5.9%, 95% confidence interval: 3-9%). The mortality rate in ICU was 18% (6/33). Sixty-nine patients (45%) had S. pneumoniae bacteraemia an admission. The bacteraemic and non-bacteraemic patients had similar PORT scores (107 vs. 104, P = 0.66), length of hospitalisation (8 vs. 7 days, P = 0.41) and mortality rates (9% vs. 4%, P = 0.30). In conclusion, patients admitted with pneumococcal CAP, although severe and with multiple co-morbidities had low in-hospital mortality rates and lengths of hospitalisation. Neither prior antimicrobial use (or failure) nor antimicrobial resistance contributed to an adverse outcome. S. pneumoniae bacteraemia failed to correlate with need for ICU, length of stay, higher morbidity index or fatal outcome. Low rates of empirical antibiotic use for non-bacterial infections in the local community, implementation of an emergency department protocol for CAP therapy, early recognition of higher risk patients and placement in ICU, use of broad spectrum antibiotics, infectious disease approval or critical pathway restriction for admission orders, could all have combined to effect a good outcome for these patients.

Aged↗

PubMed2002

A 35-year-old woman with asthma and polycystic lung disease.

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Adult↗