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Skloot GS, Guasconi A, Lavon BR, Georges G, De Backer W, Galkin D, Cortellini M, Panni I, Bates JHT. The effect of inhaled extrafine beclometasone dipropionate/formoterol fumarate/glycopyrronium bromide on distal and central airway indices, assessed using Functional Respiratory Imaging in COPD (DARWiIN). Respir Res 2023; 24:244. [PMID: 37803368 PMCID: PMC10559640 DOI: 10.1186/s12931-023-02549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND This study, in patients with symptomatic chronic obstructive pulmonary disease (COPD), explored switching therapy from non-extrafine high-dose inhaled corticosteroid/long-acting β2-agonist (ICS/LABA; fluticasone propionate/salmeterol [FP/SLM]) to extrafine medium-dose beclometasone dipropionate/formoterol fumarate dihydrate/glycopyrronium (BDP/FF/G), both via dry-powder inhaler. Functional Respiratory Imaging, a quantitative computed tomography method with 3D reconstructions of pulmonary anatomy, was used to assess airway geometry and lung function. METHODS Patients receiving a stable ICS/LABA regimen for ≥ 8 weeks were switched to FP/SLM 500/50 µg, one inhalation twice-daily (high-dose ICS) for 6 weeks. After baseline assessments (Visit 2 [V2]), therapy was switched to BDP/FF/G 100/6/10 µg, two inhalations twice-daily (medium-dose ICS) for 6 weeks, followed by V3. The primary endpoints were percentage changes in specific image-based airway volume (siVaw) and resistance (siRaw) from baseline to predose at V3 (i.e., chronic effects), assessed at total lung capacity (TLC) in central and distal lung regions. Secondary endpoints included siVaw and siRaw changes from pre-dose to post-dose at V2, and from pre-dose to post-dose at V3 at TLC (i.e., acute effects), and chronic and acute changes in siVaw and siRaw at functional residual capacity (FRC). Pre-dose forced expiratory volume in 1 s (FEV1) and COPD Assessment Test (CAT) were also assessed. RESULTS There were no significant changes in pre-dose siVaw or siRaw at TLC from baseline to V3, although at FRC there was a significant decrease in mean siRaw in the distal airways (- 63.6%; p = 0.0261). In addition, in the distal airways there were significant acute effects at TLC on mean siVaw and siRaw (siVaw: 39.8% and 62.6%; siRaw: - 51.1% and - 57.2%, V2 and V3, respectively; all p < 0.001) and at FRC at V2 (siVaw: 77.9%; siRaw: - 67.0%; both p < 0.001). At V3, the mean change in pre-dose FEV1 was 62.2 mL (p = 0.0690), and in CAT total score was - 3.30 (p < 0.0001). CONCLUSIONS In patients with symptomatic COPD receiving high-dose ICS/LABA, adding a long-acting muscarinic antagonist while decreasing the ICS dose by switching to medium-dose extrafine BDP/FF/G was associated with improved airway indices, especially in the distal airways, together with improvements in respiratory health status. Trial registration ClinicalTrials.gov (NCT04876677), first posted 6th May 2021.
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Affiliation(s)
- Gwen S. Skloot
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
- Chiesi USA, Inc., Cary, NC USA
| | | | | | - George Georges
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Wilfried De Backer
- Department of Respiratory Medicine, University of Antwerp, Antwerp, Belgium
| | - Dmitry Galkin
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Mauro Cortellini
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Ilaria Panni
- Global Clinical Development, Chiesi Farmaceutici SpA, Parma, Italy
| | - Jason H. T. Bates
- Departments of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT USA
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Skloot GS, O'Connor-Chapman KL, Schechter CB, Markley DJ, Bates JHT. Forced expiratory time: a composite of airway narrowing and airway closure. J Appl Physiol (1985) 2020; 130:80-86. [PMID: 33090909 DOI: 10.1152/japplphysiol.00556.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Forced expiratory time (FET) is a spirometrically derived variable thought to reflect lung function, but its physiological basis remains poorly understood. We developed a mathematical theory of FET assuming a linear forced expiratory flow-volume profile that terminates when expiratory flow falls below a defined detection threshold. FET is predicted to correlate negatively with both FEV1 and FVC if variations in the rate of lung emptying (relative to normal) among individuals in a population exceed variations in the amount of lung emptying. We retrospectively determined FET pre- and postmethacholine challenge in 1,241 patients (818 had normal lung function, 137 were obstructed, and 229 were restricted) and examined its relationships to spirometric and demographic variables in both hyperresponsive and normoresponsive individuals. Mean FET was 9.6 ± 2.2 s in the normal group, 12.3 ± 3.0 s in those with obstruction, and 8.8 ± 1.9 s in those with restriction. FET was inversely related to FEV1/FVC in all groups, negatively related to FEV1 in the obstructed patients, and positively related to FVC in both the normal and restricted patients. There was no relationship with methacholine responsiveness. Overall, our theory of the relationship between FET to the spirometric indices is supported by these findings and potentially explains how FET is affected by sex, age, smoking status, and possibly body mass index.NEW & NOTEWORTHY Forced expiratory time (FET) has long been felt to reflect important physiological information about lung function but exactly how has never been clear. Here, we use a model analysis to assess the contributions of airway narrowing versus airway closure to FET in a population of individuals and find support for the theory that FET correlates positively with FEV1 if the amounts of lung emptying over a forced expiration vary from predicted values more than variations in the rates of lung emptying, whereas the correlation is negative in the opposite case.
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Affiliation(s)
- Gwen S Skloot
- The Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kieley L O'Connor-Chapman
- The Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel J Markley
- The Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jason H T Bates
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Peters U, Subramanian M, Chapman DG, Kaminsky DA, Irvin CG, Wise RA, Skloot GS, Bates JHT, Dixon AE. BMI but not central obesity predisposes to airway closure during bronchoconstriction. Respirology 2019; 24:543-550. [PMID: 30694011 DOI: 10.1111/resp.13478] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Obesity produces restrictive effects on lung function. We previously reported that obese patients with asthma exhibit a propensity towards small airway closure during methacholine challenge which improved with weight loss. We hypothesized that increased abdominal adiposity, a key contributor to the restrictive effects of obesity on the lung, mediates this response. This study investigates the effect of body mass index (BMI) versus waist circumference (WC) on spirometric lung function, sensitivity to airway narrowing and closure, and airway closure during bronchoconstriction in patients with asthma. METHODS Participants underwent spirometry and methacholine challenge. Sensitivity to airway closure and narrowing was assessed from the dose-response slopes of the forced vital capacity (FVC) and the ratio of forced expiratory volume in 1 s (FEV1 ) to FVC, respectively. Airway closure during bronchoconstriction (closing index) was computed as the percent reduction in FVC divided by the percent reduction in FEV1 at maximal bronchoconstriction. RESULTS A total of 116 asthmatic patients (56 obese) underwent methacholine challenge. Spirometric lung function was inversely related to WC (P < 0.05), rather than BMI. Closing index increased significantly during bronchoconstriction in obese patients and was related to increasing BMI (P = 0.01), but not to WC. Sensitivity to airway closure and narrowing was not associated with BMI or WC. CONCLUSION Although WC is associated with restrictive effects on baseline lung function, increased BMI, rather than WC, predisposes to airway closure during bronchoconstriction. These findings suggest that obesity predisposes to airway closure during bronchoconstriction through mechanisms other than simple mass loading.
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Affiliation(s)
- Ubong Peters
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Meenakumari Subramanian
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - David G Chapman
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.,Translational Airways Group, University of Technology, Sydney, NSW, Australia.,Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - David A Kaminsky
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Charles G Irvin
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Robert A Wise
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gwen S Skloot
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jason H T Bates
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Anne E Dixon
- Division of Pulmonary and Critical Care Medicine, Vermont Lung Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Abstract
The aging population is growing at an unparalleled rate. Asthma is common in the elderly (age over 65 years) and can be more severe with little chance for remission. Asthma in older individuals is often under-diagnosed, misdiagnosed and frequently under-treated. Concomitant medical and psychosocial conditions are more prevalent in the elderly and can obfuscate the presentation of asthma and make it more difficult to assess and manage. While these comorbidities are important in understanding elderly asthma, aging itself can be considered a "comorbidity" since it impacts structural and functional changes in the lung. Structural changes of the aging lung may worsen physiologic function in asthma. The immune system also changes with age, with increased vulnerability to pathogens and differences in airway inflammation, leading to variability in how asthma manifests and responds to treatment. The fact that aging can influence the severity and presentation of asthma along with its diagnosis and management is important for the treating physician to understand. This article will discuss the multitude of factors that justify considering aging as a comorbidity of asthma.
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Affiliation(s)
- Julia Budde
- Division of Pulmonary, Critical Care, & Sleep Medicine Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building 5th Floor, Room 5-20, New York, NY, 10029, USA.
| | - Gwen S Skloot
- Division of Pulmonary, Critical Care, & Sleep Medicine Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building 5th Floor, Room 5-20, New York, NY, 10029, USA.
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Abstract
Growth of the segment of the population older than 65 years has led to intensified interest in understanding the biology of aging. This article is focused on age-related alterations in lung structure that produce predictable changes in physiologic function, both at rest and during exercise. Increased insight into the physiology of the healthy aging lung should ultimately lead to improved methods of lung function assessment in the elderly (defined as those older than 65 years) as well as better understanding of the manifestations and possibly even the treatment of geriatric lung disease.
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Affiliation(s)
- Gwen S Skloot
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box #1232, New York, NY, USA.
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Glassberg J, Minnitti C, Cromwell C, Cytryn L, Kraus T, Skloot GS, Connor JT, Rahman AH, Meurer WJ. Inhaled steroids reduce pain and sVCAM levels in individuals with sickle cell disease: A triple-blind, randomized trial. Am J Hematol 2017; 92:622-631. [PMID: 28370266 DOI: 10.1002/ajh.24742] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 12/31/2022]
Abstract
Clinical and preclinical data demonstrate that altered pulmonary physiology (including increased inflammation, increased blood flow, airway resistance, and hyper-reactivity) is an intrinsic component of Sickle Cell Disease (SCD) and may contribute to excess SCD morbidity and mortality. Inhaled corticosteroids (ICS), a safe and effective therapy for pulmonary inflammation in asthma, may ameliorate the altered pulmonary physiologic milieu in SCD. With this single-center, longitudinal, randomized, triple-blind, placebo controlled trial we studied the efficacy and feasibility of ICS in 54 nonasthmatic individuals with SCD. Participants received once daily mometasone furoate 220 mcg dry powder inhalation or placebo for 16 weeks. The primary outcome was feasibility (the number who complete the trial divided by the total number enrolled) with prespecified efficacy outcomes including daily pain score over time (patient reported) and change in soluble vascular cell adhesion molecule (sVCAM) levels between entry and 8-weeks. For the primary outcome of feasibility, the result was 96% (52 of 54, 95% CI 87%-99%) for the intent-to-treat analysis and 83% (45 of 54, 95% CI 71%-91%) for the per-protocol analysis. The adjusted treatment effect of mometasone was a reduction in daily pain score of 1.42 points (95%CI 0.61-2.21, P = 0.001). Mometasone was associated with a reduction in sVCAM levels of 526.94 ng/mL more than placebo (95% CI 50.66-1003.23, P = 0.03). These results support further study of ICS in SCD including multicenter trials and longer durations of treatment. www.clinicaltrials.gov (NCT02061202).
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Affiliation(s)
- Jeffrey Glassberg
- Department of Emergency Medicine; Icahn School of Medicine at Mount Sinai; New York
| | | | - Caroline Cromwell
- Department of Hematology and Oncology; Icahn School of Medicine at Mount Sinai Beth Israel; New York
| | - Lawrence Cytryn
- Department of Hematology and Oncology; Icahn School of Medicine at Mount Sinai Beth Israel; New York
| | - Thomas Kraus
- Center for Therapeutic Antibody Development, Icahn School of Medicine at Mount Sinai; New York
| | - Gwen S. Skloot
- Department of Pulmonary, Critical Care and Sleep Medicine; Icahn School of Medicine at Mount Sinai; New York
| | | | - Adeeb H. Rahman
- Department of Genetics and Genomic Sciences; Icahn School of Medicine at Mount Sinai; New York
| | - William J. Meurer
- Departments of Emergency Medicine and Neurology; University of Michigan; Ann Arbor Michigan
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Diep RT, Busani S, Simon J, Punzalan A, Skloot GS, Glassberg JA. Cough and wheeze events are temporally associated with increased pain in individuals with sickle cell disease without asthma. Br J Haematol 2015; 170:732-4. [PMID: 25753135 DOI: 10.1111/bjh.13325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Robert T Diep
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jena Simon
- Department of Nursing, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexa Punzalan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gwen S Skloot
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Crowley LE, Herbert R, Moline JM, Wallenstein S, Shukla G, Schechter C, Skloot GS, Udasin I, Luft BJ, Harrison D, Shapiro M, Wong K, Sacks HS, Teirstein AS, Landrigan PJ. Response to Dr. Reich's letter: "'Sarcoid-like' granulomatous pulmonary disease in world trade center disaster responders: influence of incidence computation methodology in inferring airborne dust causation": "Sarcoid-like" granulomatous pulmonary disease in World Trade Center disaster responders. Am J Ind Med 2011; 54:894-5. [PMID: 22006593 DOI: 10.1002/ajim.20995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Crowley LE, Herbert R, Moline JM, Wallenstein S, Shukla G, Schechter C, Skloot GS, Udasin I, Luft BJ, Harrison D, Shapiro M, Wong K, Sacks HS, Landrigan PJ, Teirstein AS. "Sarcoid like" granulomatous pulmonary disease in World Trade Center disaster responders. Am J Ind Med 2011; 54:175-84. [PMID: 21298693 DOI: 10.1002/ajim.20924] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND More than 20,000 responders have been examined through the World Trade Center (WTC) Medical Monitoring and Treatment Program since September 11, 2001. Studies on WTC firefighters have shown elevated rates of sarcoidosis. The main objective of this study was to report the incidence of "sarcoid like" granulomatous pulmonary disease in other WTC responders. METHODS Cases of sarcoid like granulomatous pulmonary disease were identified by: patient self-report, physician report and ICD-9 codes. Each case was evaluated by three pulmonologists using the ACCESS criteria and only "definite" cases are reported. RESULTS Thirty-eight patients were classified as "definite" cases. Six-year incidence was 192/100,000. The peak annual incidence of 54 per 100,000 person-years occurred between 9/11/2003 and 9/11/2004. Incidence in black responders was nearly double that of white responders. Low FVC was the most common spirometric abnormality. CONCLUSIONS Sarcoid like granulomatous pulmonary disease is present among the WTC responders. While the incidence is lower than that reported among firefighters, it is higher than expected.
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Affiliation(s)
- Laura E Crowley
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
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Skloot GS, Edwards NT, Enright PL. Four-year calibration stability of the EasyOne portable spirometer. Respir Care 2010; 55:873-877. [PMID: 20587099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Clinical practice guidelines recommend daily spirometer calibration checks and weekly linearity checks. The long-term stability of the volume and flow accuracy of a specific model of spirometer should be carefully characterized before modification of the frequency of calibration checks is considered for that model of spirometer. METHODS The EasyOne ultrasonic flow-sensing spirometer was chosen for use by the clinical centers at the 2002 inception of the World Trade Center Worker and Volunteer Medical Screening Program. The screening program quality-control procedure required that the expiratory and inspiratory volume accuracy of each spirometer be checked every day of testing, and the flow accuracy (linearity) checked every week. The calibration check results were transferred to a central database for summary. RESULTS Over 5,000 calibration-check results (4,109 single-speed and 1,189 three-speed) were accumulated from a total of 34 spirometers during the period February 2003 through March 2007. The mean single-speed calibration errors (and 5th-95th percentiles) were -2 mL (-80 to 70 mL) for exhalation and -10 mL (-80 to 60 mL) for inhalation. 98% of the exhalation and 97% of the inhalation calibration checks were accurate within 3.0%. There was no evidence of significant non-linearity according to the results of the 3-speed calibration checks (mean errors of -3, -5, and -6 mL at each speed). CONCLUSIONS The EasyOne retained inhalation and exhalation volume accuracy of better than 3% for at least 4 years. Routine multiple-speed volume calibration checks may not be necessary with the EasyOne. The acceptability and repeatability of patient efforts should be the primary focus of quality-assurance programs with spirometers that have been demonstrated to remain accurate for long periods.
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Affiliation(s)
- Gwen S Skloot
- Mount Sinai School of Medicine, New York, New York, USA
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Enright PL, Skloot GS, Cox-Ganser JM, Udasin IG, Herbert R. Quality of spirometry performed by 13,599 participants in the World Trade Center Worker and Volunteer Medical Screening Program. Respir Care 2010; 55:303-309. [PMID: 20196879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine the ability of spirometry technicians in the World Trade Center Worker and Volunteer Medical Screening Program to meet American Thoracic Society spirometry quality goals. METHODS Spirometry technicians were trained centrally and performed spirometry sessions at 6 sites in the greater New York City area. We reviewed and graded the spirometry results for quality every month. RESULTS About 80% (range 70-88%) of the spirometry sessions met the American Thoracic Society spirometry goals. In general, the spirometry technicians with the most experience were more successful in meeting the quality goals. Participant characteristics explained very little of the quality variability. CONCLUSIONS The overall spirometry quality in this multicenter program was very good. Efforts to improve spirometry quality should focus on the performance of individual spirometry technicians.
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Affiliation(s)
- Paul L Enright
- Division of Respiratory Disease Studies, National Institute of Occupational Safety and Health, Morgantown, West Virginia, USA.
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Skloot GS, Enright PL. Longitudinal Assessment of Spirometry in World Trade Center Responders: Response. Chest 2009. [DOI: 10.1378/chest.09-1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Skloot GS, Schechter CB, Herbert R, Moline JM, Levin SM, Crowley LE, Luft BJ, Udasin IG, Enright PL. Longitudinal Assessment of Spirometry in the World Trade Center Medical Monitoring Program. Chest 2009; 135:492-498. [DOI: 10.1378/chest.08-1391] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Skloot GS, Chandy D, Schachter N, Togias A. The bronchoprotective effect of deep inspiration is flow rate dependent. Respir Med 2007; 101:1376-82. [PMID: 17379494 DOI: 10.1016/j.rmed.2007.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Revised: 02/02/2007] [Accepted: 02/07/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND STUDY OBJECTIVE Deep inspiration (DI) protects against methacholine-induced bronchoconstriction in healthy subjects. We hypothesized that this bronchoprotective effect of DI depends upon the inspiratory flow rate. DESIGN Prospective, controlled study. SETTING Pulmonary function laboratory within a large tertiary medical center. PARTICIPANTS Ten healthy nonsmokers without asthma or rhinitis. MEASUREMENTS First, we performed a methacholine challenge in the absence of DI to determine the concentration sufficient to reduce FEV(1) by 20%. On two subsequent days, the challenge was repeated with the addition of either a fast or slow DI immediately before the threshold concentration of methacholine. We calculated the % reduction in FEV(1) and FVC from baseline. RESULTS Mean % reduction in FEV(1) and FVC was significantly less with a fast DI than with no DI (20+/-3% vs. 34+/-4% for FEV(1), p=0.02; 12+/-3% vs. 23+/-3% for FVC, p=0.03); slow DIs did not significantly affect the methacholine-induced reduction in lung function. CONCLUSION A fast DI is bronchoprotective while a slow DI is not. Elucidating the conditions that maximize or alternatively, eliminate bronchoprotection in healthy subjects may ultimately provide insight into the pathophysiology of asthma.
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Affiliation(s)
- Gwen S Skloot
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA.
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Dixon AE, Shade DM, Cohen RI, Skloot GS, Holbrook JT, Smith LJ, Lima JJ, Allayee H, Irvin CG, Wise RA. Effect of obesity on clinical presentation and response to treatment in asthma. J Asthma 2006; 43:553-8. [PMID: 16939998 DOI: 10.1080/02770900600859123] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Obesity is a risk factor for being diagnosed with asthma, but there is conflicting evidence on whether obesity is a risk factor for lung function abnormalities characteristic of asthma. We studied a cohort of 488 subjects, 47% of whom were obese. Obese and non-obese subjects with asthma had similar airflow limitation and bronchodilator responsiveness, but obese participants had increased sleep disturbance and gastroesophageal reflux disease, higher cytokine levels, and a trend towards increased exacerbations when treated with theophylline. Obese and non-obese asthmatics have similar lung function abnormalities, but comorbidities and altered responses to medications may significantly affect asthma control in obese people.
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Affiliation(s)
- Anne E Dixon
- University of Vermont, Burlington, VT 05401, USA.
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Skloot GS. Nocturnal asthma: mechanisms and management. Mt Sinai J Med 2002; 69:140-7. [PMID: 12035073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Nocturnal asthma, defined as an exacerbation of asthma at night, is associated with increases in symptoms and need for medication, increased airway responsiveness and worsening of lung function. Nighttime worsening of asthma has been recognized since the 5th century A.D. and is believed to be quite common, affecting a majority of asthmatics. The mechanisms of nocturnal asthma are intimately related to circadian rhythms, which influence inflammatory cells and mediators, hormone levels and cholinergic tone. Patients with nocturnal asthma symptoms may have greater nighttime activation of inflammatory cells and mediators, lower levels of epinephrine and increased vagal tone. In addition, underlying differences in the glucocorticoid receptor and b- receptors in these patients may diminish their ability to respond to therapy. While sleep appears to play a role in the pathophysiology of nocturnal asthma, it is not essential to it. Selective timing of medication can increase its efficacy and reduce its toxicity. Available therapy includes inhaled and oral corticosteroids, sustained-release theophylline, long-acting b-agonists, leukotriene- modifying agents and anticholinergic medication. The definition, epidemiology, potential mechanisms and management of nocturnal asthma are discussed in this review.
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Affiliation(s)
- Gwen S Skloot
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA
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