Spirometry is fundamental to making a diagnosis of COPD and a confident diagnosis of COPD can only be made with spirometry. However, there is no single diagnostic test for COPD. Making a diagnosis relies on clinical judgement based on a combination of history, physical examination and confirmation of the presence of airflow obstruction using spirometry.
Spirometry is the only accurate method of measuring the airflow obstruction in patients with COPD. Peak expiratory flow rate (PEFR) measurement may significantly underestimate the severity of the airflow limitation.
A diagnosis of airflow obstruction can be made if the FEV1/FVC <0.7 (ie 70%) and FEV1 <80% predicted.
National Institute for Health and Clinical Excellence (NICE) classification of the severity of COPD:
  • Stage 1 - mild: 80% or above (symptoms should be present to diagnose COPD in people with mild airflow obstruction).
  • Stage 2 - moderate: 50-79%.
  • Stage 3 - severe: 30-49%.
  • Stage 4 - very severe: below 30% (or FEV1 less than 50% but with respiratory failure).
The presence of airflow obstruction should be confirmed by performing post-bronchodilator spirometry.
Changes in the flow volume loop may give additional information about mild airflow obstruction.
For more on Spirometry in Primary Care, read more here.
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Screening smokers with spirometry for chronic obstructive pulmonary disease (COPD) picks up more cases than symptom-based detection, research suggests.
The authors say the findings highlight the need for more screening in primary care, which is seldom used at present.
"Despite current and updated GOLD [Global Initiative for Chronic Obstructive Lung Disease] guidelines that recommend case-finding studies for early diagnosis of COPD, the present study showed that a screening program aimed at all smokers may also be a positive strategy if economic resources are available," say Raul Sansores (Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico) and colleagues.
The study included 1999 participants who underwent spirometry after reporting symptoms of cough, phlegm, wheezing, and shortness of breath, and 782 participants recruited from a smoking cessation program. All participants were current or former smokers with a cumulative past consumption of at least 10 pack-years.
A significantly greater proportion of participants in the screening group were classified as having COPD according to the GOLD classification compared with the symptom-based group (13.3 vs 10.1%).
Dyspnea was the most common symptom in the two groups, occurring in 56% in the symptom-based group and 55% in the screening group. Regression analyses showed that it was the only risk factor that predicted COPD in both strategies, being associated with a two-fold increase in the odds of diagnosis compared with patients without it. Meanwhile, patients in the symptom-based group had a significantly higher incidence of cough, phlegm, wheezing, and history of bronchitis and emphysema than the screening group.
The authors say that previous studies have shown that spirometry is often not performed on smokers or patients presenting with symptoms. This has led to an underestimation of the worldwide prevalence of COPD, as well as missed opportunities for early treatment.
"All lines of evidence overwhelmingly demonstrate that the identification of smokers (with or without symptoms) may also be useful, not only to detect an important number of smokers with COPD but also to increase awareness about COPD, to prevent its development, to encourage smoking cessation and to decrease the potential risk of death," they conclude in Respiratory Medicine.
Licensed from medwireNews with permission from Springer...
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What causes asthma?
The exact cause of asthma isn't known. It's possible that a combination of genetics and environmental exposures interact to cause asthma to develop, most often early in life. Risk factors for developing asthma include:
  • Atopy, an inherited tendency to develop allergies
  • Certain respiratory infections during childhood
  • Contact with airborne allergens
  • Exposure to viral infections
  • Parents who have asthma
  • An asthma attack occurs when asthma symptoms become worse than usual.

For more on the causes of asthma, read here.

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What is asthma?
Asthma is a serious, sometimes life-threatening respiratory disease that affects the lungs and the quality of life for millions of Americans.  Asthma affects people of all ages, but frequently begins in childhood. More than 22 million Americans are known to have asthma; 6 million people diagnosed with asthma are children.
Asthma is a chronic respiratory disease that affects the airways, or tubes, that carry air in and out of your lungs.  Particularly, asthma affects the inside walls of your airways and they become sore and swollen. As the airways swell, they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrow and your lungs get less air causing repeated episodes of wheezing, breathlessness, chest tightness, and night or early morning coughing.
For more about asthma, read here.
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Fruits and Vegetables may Help Asthma Sufferers

Eating lots of fruits and vegetables may help reduce asthma symptoms, according to a recent study. But if you're one of the 25 million Americans with the breathing disorder, the take-away message is not that you should rely solely on dietary improvements.

"One of the dangers here is that people pick up this headline and say, well, I don't need to take my medicine anymore, I can just eat fruits and vegetables," cautions Dr. Marc Riedl, UCLA associate clinical professor of immunology and allergy. "It may help; I'm not saying there's no effect. There probably is, based on this paper, but it's not a substitute for many people who need to take some sort of anti-inflammatory medication for their asthma."

Published in the American Journal of Clinical Nutrition, the Australian study divided adults into two groups. One ate a low-antioxidant diet, while the other ate a high-antioxidant diet, including five servings of vegetables and two fruit portions each day for two weeks. At the end of the testing period, people in the high-antioxidant group had better lung function and less breathing problems than those in the other group.

The researchers concluded: "Improvements were evident only after increased fruit and vegetable intake, which suggests that whole-food interventions are most effective."

For more information and to view the rest of the article, visit here.

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Hormone may play a role in asthma-obesity link

Based on studies of mice, experts at Columbia University Medical Center in New York City are suggesting that leptin, a hormone involved in energy metabolism, appetite, fertility, and building bone mass, may play a key role in the link between asthma and obesity — and possibly lead to development of a leptin-based treatment for weight-related asthma.

The researchers observed that some patients who are anorexic or obese also have asthma, which makes sense because both abnormally low or high body weight and fat mass can result in narrowing of the airways and diminished lung function.

For the complete article, view here.

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Asthma linked to pulmonary embolism risk


Patients with asthma have an increased risk for pulmonary embolism, show Dutch findings.

In particular, patients with a severe case of the disease are most at risk.

"This is the first time a link has been found between asthma and pulmonary embolism and we believe these results have important clinical implications," said Christof Majoor (Academic Medical Center, Amsterdam, the Netherlands) in a press statement.

The authors compared 365 patients with mild-moderate asthma and 283 patients with severe asthma against age-matched controls from a previously published Norwegian population study.

During 31,889 person-years of follow up, 16 patients with asthma developed deep vein thrombosis, and 19 patients had a pulmonary embolism.

The rate of pulmonary embolism among patients with severe asthma was nine times greater than in the general population (0.93 vs 0.18 per 1000 person-years). The rate among patients with mild-moderate asthma was four times greater than in the general population, although this did not reach statistical significance (0.33 vs 0.18 per 1000 person-years).

Multivariate analyses showed that severe asthma was associated with a 3.33-fold increased risk for pulmonary embolism versus no asthma, and also showed that oral corticosteroid use was associated with a 2.82-fold increased risk .

By contrast, the risk for deep vein thrombosis was not associated with the presence of asthma.

Asthma has been associated with procoagulant and antifibrinolytic activity in the airways, but this is the first study to examine an association with pulmonary embolism, explain the authors in the European Respiratory Journal.

Inactivity due to severe symptoms and the use of corticosteroids may also play a role, they say.

For more information and for the complete article, visit here.

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Late pregnancy pollen exposure increases risk of early asthma


A woman's exposure to high pollen levels in late pregnancy increases the risk of earlyasthma in the child, according to a group of researchers at Sweden's Ume- University in a recent study.

A number of studies have previously shown that there is an association with being born during a pollen season and an increased risk of allergies. Although the pollen season is a regular annual event, there are large variations between years in pollen levels. Few studies have closely examined the significance of actual pollen content in different time periods before and after birth, but now, researchers at the Division of Occupational and Environmental Medicine at Ume- University have conducted such a study involving 110,000 pregnancies in the Stockholm area.

For the entire article, you can read here.

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