Persistent Empiric COPD Diagnosis and Treatment After Pulmonary Function Test Showed No Obstruction.

Abstract:

BACKGROUND:Health-care providers often diagnose and empirically treat COPD without a confirmative pulmonary function test (PFT) or even despite a PFT that is not diagnostic of obstructive lung disease. We hypothesized that a portion of patients continue to carry a persistent empiric COPD diagnosis and receive treatment with bronchodilators and inhaled steroids after a PFT shows no obstruction. METHODS:We retrospectively reviewed single PFT sessions with both spirometry and plethysmography in 1,805 subjects. We included subjects who had a normal PFT or a restrictive ventilatory defect. Persistent empiric COPD diagnosis and treatment were defined when subjects with normal PFTs or a restrictive ventilatory defect continued to carry a health-care provider COPD diagnosis or receive treatment with bronchodilators and/or inhaled glucocorticoids, respectively, after a PFT showed no obstruction. RESULTS:One quarter of subjects with FEV1/FVC ≥ lower limit of the normal range had nonspecific PFT abnormalities. We included 473 subjects with normal PFTs and 382 with a restrictive ventilatory defect (n = 855). Persistent empiric COPD diagnosis (60 of 855, 7% prevalence) was associated with current (odds ratio [OR] = 44.7, P < .001) and former smoking (OR = 17.3, P < .001) and older age (OR = 1.03/y, P = .005). Persistent empiric treatment (208 of 855, 24%) was associated with empiric COPD diagnosis (OR = 24.6, P < .001), female sex (OR = 1.75, P = .002), current (OR = 2.04, P = 0.040) and former smoking (OR = 1.53, P = 0.029), interstitial lung disease (OR = 2.09, P = .001), other respiratory diagnosis (OR = 3.17, P < .001), and obstructive sleep apnea (OR = 1.79, P = .006). CONCLUSIONS:Persistent empiric COPD diagnosis was 7%, but persistent empiric treatment was common.

journal_name

Respir Care

journal_title

Respiratory care

authors

Fortis S,Corazalla EO,Jacobs DR Jr,Kim HJ

doi

10.4187/respcare.04647

subject

Has Abstract

pub_date

2016-09-01 00:00:00

pages

1192-200

issue

9

eissn

0020-1324

issn

1943-3654

pii

respcare.04647

journal_volume

61

pub_type

杂志文章
  • Is the content of textbooks on the evaluation of a patient in respiratory distress adequate?

    abstract:BACKGROUND:The ability to rapidly and precisely evaluate patients in respiratory distress is essential. Due to limited opportunities for formal instruction during training, textbooks are the main educational source to teach junior physicians how to interpret the signs of respiratory distress. The quality of the textbo...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.01112

    authors: Tulaimat A,Patel A,Shah B,Littleton SW

    更新日期:2012-03-01 00:00:00

  • Home treatment of infection-related acute respiratory failure in kyphoscoliotic patients on long-term mechanical ventilation.

    abstract:BACKGROUND:In patients with kyphoscoliosis, long-term mechanical ventilation improves chronic alveolar hypoventilation during spontaneous breathing, improves quality of life, decreases the need for hospitalization, and improves survival. In these patients respiratory infection can precipitate acute respiratory failure ...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Banfi P,Redolfi S,Robert D

    更新日期:2007-06-01 00:00:00

  • Aerosol delivery to ventilated infant and pediatric patients.

    abstract::Infants have low tidal volume, vital capacity, and functional residual capacity, and short respiratory cycles (low I:E ratio), which result in a low residence time for aerosol particles and, thus, low pulmonary deposition of aerosol particles (< 1% of the nominal dose), compared to adults (8-22%). Scintigraphy data su...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:

    authors: Fink JB

    更新日期:2004-06-01 00:00:00

  • Spirometry training does not guarantee valid results.

    abstract:BACKGROUND:Many healthcare professionals performing spirometry in primary care have had less than half a day's training in spirometry practice, and the validity of the test results is questionable. Longer training periods, with or without follow-up training, may improve test validity. OBJECTIVE:To determine if a 14-ho...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Borg BM,Hartley MF,Fisher MT,Thompson BR

    更新日期:2010-06-01 00:00:00

  • Spontaneous Breathing Patterns During Maximum Extracorporeal CO2 Removal in Subjects With Early Severe ARDS.

    abstract:BACKGROUND:Switching patients affected by early severe ARDS and undergoing extracorporeal membrane oxygenation (ECMO) from controlled ventilation to spontaneous breathing can be either beneficial or harmful, depending on how effectively the breathing pattern is controlled with ECMO. Identifying the factors associated w...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.07391

    authors: Spinelli E,Mauri T,Lissoni A,Crotti S,Langer T,Albanese M,Volta CA,Fornari C,Tagliabue P,Grasselli G,Pesenti A

    更新日期:2020-07-01 00:00:00

  • The evaluation and management of accidental hypothermia.

    abstract::Accidental hypothermia is defined as an unintentional decrease in core body temperature to below 35 degrees C. Hypothermia causes hundreds of deaths in the United States annually. Victims of accidental hypothermia present year-round and in all climates with a potentially confusing array of signs and symptoms, but incr...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:

    authors: Kempainen RR,Brunette DD

    更新日期:2004-02-01 00:00:00

  • Human relations skills of respriatory therapy supervisors.

    abstract::The most critical factor in effective supervision is the supervisor's skill in human relations. A standardized test, the Supervisory Inventory of Human Relations, was administered to 39 credentialed respiratory therapists who were responsible for the work performance of at least two other individuals. It was found tha...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Conine TA,Rueckl RG

    更新日期:1978-07-01 00:00:00

  • Development and Feasibility of a Home Pulmonary Rehabilitation Program With Health Coaching.

    abstract:BACKGROUND:Pulmonary rehabilitation (PR) is an effective intervention for COPD. However, traditional center-based PR programs suffer from low uptake. Home-based PR is a viable solution, but few studies have shown the effectiveness of remote PR, as there is a scarcity of systems that can be easily adopted in clinical pr...

    journal_title:Respiratory care

    pub_type: 临床试验,社论

    doi:10.4187/respcare.05690

    authors: Benzo RP,Kramer KM,Hoult JP,Anderson PM,Begue IM,Seifert SJ

    更新日期:2018-02-01 00:00:00

  • Brain Tissue Oxygen Monitoring and the Intersection of Brain and Lung: A Comprehensive Review.

    abstract::Traumatic brain injury is a problem that affects millions of Americans yearly and for which there is no definitive treatment that improves outcome. Continuous brain tissue oxygen (PbtO2 ) monitoring is a complement to traditional brain monitoring techniques, such as intracranial pressure and cerebral perfusion pressur...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.04962

    authors: Ngwenya LB,Burke JF,Manley GT

    更新日期:2016-09-01 00:00:00

  • Idiopathic pulmonary fibrosis with emphysema: evidence of synergy among emphysema and idiopathic pulmonary fibrosis in smokers.

    abstract:BACKGROUND:Emphysema and fibrosis, typically the idiopathic pulmonary fibrosis (IPF) form of usual interstitial pneumonia (UIP), can co-exist as combined pulmonary fibrosis emphysema (CPFE). It is unknown whether there is a pathobiologic basis for CPFE beyond the coexistence of fibrosis and emphysema. The aim of this s...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.03389

    authors: Mitchell PD,Das JP,Murphy DJ,Keane MP,Donnelly SC,Dodd JD,Butler MW

    更新日期:2015-02-01 00:00:00

  • High-Risk Smoking Behaviors and Barriers to Smoking Cessation Among Homeless Individuals.

    abstract:BACKGROUND:Although tobacco practices and the effects of tobacco use among the general American population are well described, minimal data exist regarding tobacco use and barriers to smoking cessation among homeless individuals. METHODS:Anonymous, voluntary surveys based on a previously implemented instrument were co...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.04439

    authors: Chen JS,Nguyen AH,Malesker MA,Morrow LE

    更新日期:2016-05-01 00:00:00

  • Dynamic Airway Driving Pressure and Outcomes in Children With Acute Hypoxemic Respiratory Failure.

    abstract:BACKGROUND:Limited adult data suggest that airway driving pressure might better reflect the potential risk for lung injury than tidal volume based on ideal body weight, and the parameter correlates with mortality in ARDS. There is a lack of data about the effect of driving pressure on mortality in pediatric ARDS. This ...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.08024

    authors: Rauf A,Sachdev A,Venkataraman ST,Dinand V

    更新日期:2020-10-06 00:00:00

  • Home unattended portable monitoring and automatic CPAP titration in patients with high risk for moderate to severe obstructive sleep apnea.

    abstract:BACKGROUND:Obstructive sleep apnea is a disorder characterized by recurrent obstruction of the upper airways during sleep. The high prevalence of this disease led to proposed new strategies based on the home evaluation and management of patients. OBJECTIVE:To compare home unattended portable monitoring and automatic C...

    journal_title:Respiratory care

    pub_type: 杂志文章,随机对照试验

    doi:10.4187/respcare.01939

    authors: Tedeschi E,Carratù P,Damiani MF,Ventura VA,Drigo R,Enzo E,Ferraresso A,Sasso G,Zambotto FM,Resta O

    更新日期:2013-07-01 00:00:00

  • Effect of Heated Humidification on CPAP Therapy Adherence in Subjects With Obstructive Sleep Apnea With Nasopharyngeal Symptoms.

    abstract:BACKGROUND:The addition of heated humidification to CPAP has been shown to improve nasal adverse effects in subjects with obstructive sleep apnea (OSA). However, current data regarding improvement in CPAP adherence is conflicting. Furthermore, there are no data from a tropical climate area with a high humidity level. ...

    journal_title:Respiratory care

    pub_type: 杂志文章,随机对照试验

    doi:10.4187/respcare.04536

    authors: Soudorn C,Muntham D,Reutrakul S,Chirakalwasan N

    更新日期:2016-09-01 00:00:00

  • Gradual versus sudden weaning from nasal CPAP in preterm infants: a pilot randomized controlled trial.

    abstract:BACKGROUND:There is paucity of information on the weaning of nasal CPAP (NCPAP) in preterm infants. As the weaning from NCPAP can be gradual or sudden, we wanted to determine which of the 2 methods was better. METHODS:A prospective randomized trial was conducted to compare the success of weaning from NCPAP when using ...

    journal_title:Respiratory care

    pub_type: 杂志文章,随机对照试验

    doi:10.4187/respcare.01999

    authors: Rastogi S,Wong W,Gupta A,Bhutada A,Deepa Rastogi.,Maimonides Neonatal Group

    更新日期:2013-03-01 00:00:00

  • Bacterial colonization of ultrasonic nebulizers: implications for frequency of circuit changing.

    abstract:UNLABELLED:We conducted a prospective study of 50 consecutive postoperative patients over a 5-month period to characterize the bacterial contamination of ultrasonic nebulizers (USNs) after 24, 48, and 72 hours (h) of use. METHODS:Samples of the USN effluent mist and reservoir fluid were cultured and the results were c...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Witek TJ Jr,York R,Noonan R Jr,Topf BM,Hebb H,Kowalczyk J,Dean NL,Doubler K

    更新日期:1986-12-01 00:00:00

  • Conservative treatment of severe tracheal laceration after endotracheal intubation.

    abstract::Endotracheal intubation can lead to iatrogenic trauma to the upper airways. Superficial mucosal tears in the mouth, pharynx, or larynx are common and can cause secondary infection and acute respiratory distress due to massive air leak. We report a patient who sustained a severe 5-cm tracheal laceration and subcutaneou...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.00891

    authors: Chang CY,Cheng SL,Chang SC

    更新日期:2011-06-01 00:00:00

  • Ventilator-integrated jet nebulization systems: tidal volume control and efficiency of synchronization.

    abstract:BACKGROUND:Jet nebulizers constitute the aerosolization devices most frequently used during mechanical ventilation. Continuous nebulization can influence the delivered tidal volume (V(T)) and lead to significant medication loss during expiration. Ventilators thus provide integrated jet nebulization systems that are syn...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02637

    authors: Ehrmann S,Lyazidi A,Louis B,Isabey D,Le Pennec D,Brochard L,Apiou-Sbirlea G

    更新日期:2014-10-01 00:00:00

  • Management of acute lung injury: sharing data between adults and children.

    abstract::As the basis for this paper, it must be acknowledged that children are not simply small adults. But this acknowledgment must go further: infants are not simply small adolescents. As data for pediatric mechanical ventilation, in general, and the management for pediatric acute lung injury, more specifically, are very l...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.01413

    authors: Cheifetz IM

    更新日期:2011-09-01 00:00:00

  • Comparison of Flow Resistance Characteristics and Placement of Two Endotracheal Tubes.

    abstract:BACKGROUND:In a traditional endotracheal tube (ETT), there is a linear outward pull through its attachment to the ventilator tubing that leads to risk of accidental dislodgement. This study was conducted to assess the ETT flow characteristics and to evaluate providers' intubation experience using two ETT's in a simulat...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.05813

    authors: Deshpande GG,Sanford JE,Tripathi S

    更新日期:2018-09-01 00:00:00

  • Esophageal Manometry.

    abstract::The estimation of pleural pressure with esophageal manometry has been used for decades, and it has been a fertile area of physiology research in healthy subject as well as during mechanical ventilation in patients with lung injury. However, its scarce adoption in clinical practice takes its roots from the (false) idea...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:10.4187/respcare.07425

    authors: Pham T,Telias I,Beitler JR

    更新日期:2020-06-01 00:00:00

  • In vitro comparison of the circulaire and AeroTee to a traditional nebulizer T-piece with corrugated tubing.

    abstract:BACKGROUND:Nebulizers are a popular means of delivering aerosolized medication, primarily albuterol, to the bronchial airways of patients, and there has been extensive research done on numerous nebulizers used with nebulizer T-pieces and corrugated tubing. Very little research has been performed on other types of nebul...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Piper SD

    更新日期:2000-03-01 00:00:00

  • Usefulness of Oscillations Added to Mechanical In-Exsufflation in Amyotrophic Lateral Sclerosis.

    abstract:BACKGROUND:Assisted coughing via mechanical in-exsufflation (MI-E) is a first-line treatment for secretion management in patients with amyotrophic lateral sclerosis (ALS) with unassisted CPF < 4.25 L/s. Some devices enable oscillations to be added to MI-E (MI-E+O). We sought to determine whether adding oscillations to ...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.07202

    authors: Sancho J,Burés E,Ferrer S,Bondía E,Servera E

    更新日期:2020-05-01 00:00:00

  • A model for the evaluation of respiratory therapy program admissions criteria.

    abstract:UNLABELLED:Attrition in respiratory therapy programs is a waste of both human and economic resources and may be one cause of the current shortage of qualified personnel. Poor academic performance has been shown to be the leading cause of program attrition. The purposes of this study were to establish the predictive abi...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Flanigan KS

    更新日期:1985-05-01 00:00:00

  • A Comparison of Carbon Dioxide Elimination Measurements Between a Portable Indirect Calorimeter and Volumetric Capnography Monitor: An In Vitro Simulation.

    abstract:BACKGROUND:Gas exchange measurements for carbon dioxide elimination (V̇CO2 ) and oxygen consumption (V̇O2 ) have been used to derive resting energy expenditure and guide energy prescription. Volumetric capnography is used in intensive care units and provides V̇CO2 measurements that could be used for titrating respirato...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.04282

    authors: Smallwood CD,Martinez EE,Mehta NM

    更新日期:2016-03-01 00:00:00

  • AARC Clinical Practice Guidelines. Endotracheal suctioning of mechanically ventilated patients with artificial airways 2010.

    abstract::An electronic literature search for articles published between January 1990 and October 2009 was conducted by using MEDLINE, CINAHL, and Cochrane Library databases. The update of this clinical practice guideline is the result of reviewing a total of 114 clinical trials, 62 reviews and 6 meta-analyses on endotracheal s...

    journal_title:Respiratory care

    pub_type: 杂志文章,实务指引

    doi:

    authors: American Association for Respiratory Care.

    更新日期:2010-06-01 00:00:00

  • The physiologic effects of noninvasive ventilation.

    abstract::The physiologic effects of noninvasive ventilation (NIV) on work of breathing (WOB) and breathing pattern, respiratory-system mechanics, and hemodynamic function were examined via a literature review of clinical studies done between 1990 and 2008. Forty-one relevant studies were found; the majority examined patients w...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:

    authors: Kallet RH,Diaz JV

    更新日期:2009-01-01 00:00:00

  • Impulse oscillometry for leukotriene D4 inhalation challenge in asthma.

    abstract:BACKGROUND:The value of impulse oscillometry (IOS) for bronchial provocation testing is poorly defined. We investigated the positive threshold derived from the parameters and diagnostic power of IOS for asthma with the leukotriene D(4) bronchial provocation test. METHODS:We enrolled 62 subjects with asthma and 21 heal...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02417

    authors: Guan WJ,Zheng JP,Gao Y,Jiang CY,Shi X,Xie YQ,Liu QX,Jiang M,An JY,Yu XX,Liu WT,Zhong LP,Wu ZP,Zhong NS

    更新日期:2013-12-01 00:00:00

  • Growth of nasal and laryngeal airways in children: implications in breathing and inhaled aerosol dynamics.

    abstract:BACKGROUND:The human respiratory airway undergoes dramatic growth during infancy and childhood, which induces substantial variability in air flow pattern and particle deposition. However, deposition studies have typically focused on adult subjects, the results of which cannot be readily extrapolated to children. We dev...

    journal_title:Respiratory care

    pub_type: 杂志文章

    doi:10.4187/respcare.02568

    authors: Xi J,Si X,Zhou Y,Kim J,Berlinski A

    更新日期:2014-02-01 00:00:00

  • A new system for understanding modes of mechanical ventilation.

    abstract::Numerous ventilation modes and ventilation options have become available as new mechanical ventilators have reached the market. Ventilator manufacturers have no standardized terminology for ventilator modes and ventilation options, and ventilator operator's manuals do not help the clinician compare the modes of ventil...

    journal_title:Respiratory care

    pub_type: 杂志文章,评审

    doi:

    authors: Chatburn RL,Primiano FP Jr

    更新日期:2001-06-01 00:00:00