Spirometry in the ambulatory setting

OBJECTIVE: Home telemonitoring improves clinical outcomes but can generate large amounts of data. Automating data surveillance with clinical decision support could reduce the impact of translating these systems to clinical settings. We utilized time-motion methodology to measure the time spent on activities monitoring subjects in the two groups of a home spirometry telemonitoring randomized controlled trial: the manual nurse review (control) group and the automated review (intervention) group...

BACKGROUND: In asthma treatment, doses of inhaled corticosteroids are often adapted to symptoms and need for bronchodilators. However, in cross-sectional studies in emergency room settings, lung function and respiratory symptoms are not always concordant. Available longitudinal data are based on written peak flow diaries, which are unreliable. Using home spirometry, we studied prospectively whether mild respiratory symptoms, prompting reliever therapy are accompanied by a clinically relevant drop in lung function in children with asthma...

INTRODUCTION: We have previously published the outcome of a community-based lung cancer screening program. We now report on the 5-year follow-up of this study and include both patients with and without airflow obstruction. MATERIALS AND METHODS: One thousand two hundred fifty-six patients completed questionnaires in the office of their primary care physicians, and 430 of this group were assessed to be at high risk for lung cancer. These patients then underwent spirometry, and 88 of 126 patients with airflow obstruction consented to lung cancer screening test...

BACKGROUND: Even several days after surgery, obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications. Particularly in ambulatory surgery, rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient. In this study, we wanted to evaluate intensive short-term respiratory physical therapy treatment (incentive spirometry) in the postanesthesia care unit (PACU) and its impact on pulmonary function in the obese...

New technologies have allowed remote real-time electronic recording of symptoms and spirometry. The feasibility of utilising this technology in COPD patients has not been investigated. This is a feasibility study. The primary objective is to determine whether the use of an electronic diary with a portable spirometer can be performed by COPD patients with a moderate to severe disease. Secondary objectives are to investigate the value of this method in early detection of acute exacerbations of COPD (AECOPD). In this 6-month study, 18 patients recorded daily their symptom score and spirometry...

Established in 1978, Computerized Screening Inc. (CSI) is the manufacturer of medical kiosks that combine non-invasive & invasive preventive health-screening technology and services in the U.S. The centerpiece of CSl's health complement is the CSI Health Station, one-stop health information and screening using patented technology. The CSI Health Station (Model 6K) represents the corporation's evolution from its self-administered automated blood pressure monitors (Model 3K). CSI Health Stations also offer touch screen activated heart rate testing, patented, seated weight measurement and fitness evaluations plus other non-invasive features like BMI, resting metabolic rate, spirometry, pulse oximetry and customized health risk assessments or triage guidelines...

BACKGROUND: Cough is one of the most common symptoms of asthma. However, studies using capsaicin, citric acid, or tartaric acid to document cough threshold have repeatedly failed to show statistically significant differences between asthmatic and healthy subjects. The studies using hypertonic aerosols as the cough stimulant have suggested an enhanced sensitivity in asthmatic subjects but the induced bronchoconstriction has made the interpretation of the results difficult. OBJECTIVE: To determine the cough sensitivity to hypertonicity in healthy subjects, patients with chronic cough, and patients with asthma in a setting where the induction of bronchoconstriction is prevented...

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common and disabling condition in adults. Information about therapeutic effectiveness and adverse effects of common treatment options and how clinical and spirometric characteristics affect outcomes is not well known but is important for clinicians caring for patients with stable COPD. PURPOSE: To evaluate the effectiveness of COPD management strategies. DATA SOURCES: English-language publications in MEDLINE and the Cochrane Library through March 2007...

BACKGROUND: Asthma, the leading cause of chronic illness in children, must be managed in both the home and school environments. Identification of children who have risk factors associated with asthma is the first step toward achieving one of the Healthy People 2010 (2000) objectives, which identifies that 25 states will establish a system of surveillance to track asthma mortality, morbidity, access to care, and asthma management. PURPOSE: The purposes of this research were to: a) identify rural children who are at risk for asthma through written screening; b) assess parameters of respiratory health status of rural school-aged children as indicated by forced expiratory volume at l second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), mean mid-expiratory flow (FEF(25-75)); and c) identify the number of rural school-aged children who sought and obtained follow-up from their primary health care provider and were given a definitive diagnosis of asthma...

The follow-up of Community Acquired Pneumonias (CAP) and Acute Exacerbations of Chronic Obstructive Pulmonary Diseases (AECOPD) differs with the setting of care, but overall calls upon the same investigations as the initial evaluations. In the event of initial ambulatory care, the evaluation is carried out primarily on clinical data, at the 2 or 3rd day for the CAP, at the 2nd to 5th day for the AECOPD. In the event of unfavourable evolution, or from the start in the most severe cases, the follow-up is carried out in hospital; clinical evaluation is readily daily, and all the more frequent that the clinical condition is worrying because of the severity or risk factors...

OBJECTIVES: To test questions usable in an ambulatory clinic to identify persons likely to have chronic obstructive pulmonary disease (COPD). METHODS: Analyses were performed as part of a study to identify patients with likely COPD in the Glenfield UK primary care clinic. Patients age 40 and older were recruited based on one of the following criteria: (1) respiratory medications in previous 2 years; (2) history of smoking or (3) history of asthma with no current medications based on case notes...

Purpose The objective of this study was to develop and evaluate a computerized rule-based decision support algorithm for nursing triage of potential acute bronchopulmonary events in lung transplant recipients on the basis of home monitoring of spirometry and symptoms. Methods The algorithm automatically separates recipients into 2 groups: those who are stable or improving and those who should be "watched" further because of their potential for developing bronchopulmonary events according to their weekly home-monitoring measurements...

The objective of this study was to determine the level of adherence of pediatricians in Spain to the Spanish National Guidelines for Asthma Treatment with regard to the use of a peak flow meter (PEFR) or a spirometer in the diagnosis and management of asthma in childhood and to analyze sources of variations in these practices. A prospective survey (consisting of demographic and asthma knowledge sections) was conducted over a 2-wk time interval of 3000 pediatricians throughout the country. At least one part of the questionnaire was completed and returned by 2773 individuals (92...

Chronic obstructive pulmonary disease (COPD) causes significant morbidity in primary care. The main symptoms of COPD are cough and shortness of breath, while the main cause of the disease is smoking. It is a treatable condition, and to ensure best treatment it needs to be differentiated from asthma. Following the publication of guidelines by the British Thoracic Society in 1997, primary care has been given a framework for managing this condition. In primary care, COPD is best managed in a specific COPD clinic...

UNLABELLED: Pulmonary function testing is not usually done in the preschool child, despite the recent data showing early deterioration in airway function in asthma. METHODS: We evaluated feasibility and clinical interest of flow-volume loop by forced expiratory maneuver and measure of airway resistance by interrupter technique (interrupter resistance), before and after inhalation of salbutamol, in 75 children aged three to five years seen in the ambulatory setting for asthma...

Chronic obstructive pulmonary disease (COPD) is easily detected in its preclinical phase using spirometry, and successful smoking cessation (a cost-effective intervention) prevents further disease progression. This consensus statement recommends the widespread use of office spirometry by primary-care providers for patients > or = 45 years old who smoke cigarettes. Discussion of the spirometry results with current smokers should be accompanied by strong advice to quit smoking and referral to local smoking cessation resources...

OBJECTIVE: To evaluate induced sputum eosinophils in asthma and chronic cough. DESIGN: This was an analytical, cross-sectional study set in an ambulatory respiratory clinic. SUBJECTS: Subjects (n=75) referred for evaluation of symptomatic asthma or episodic respiratory symptoms had a clinical assessment, spirometry, hypertonic saline challenge and induced sputum. Two diagnostic groups were identified. The first group comprised subjects with symptomatic asthma and variable airway obstruction (VAO) (n=32)...

Based on the Consensus of the Chilean Respiratory Society, this article summarizes the main topics of the ambulatory management of patients with COPD. The Consensus proposes operative definitions in order to prevent the most frequent conceptual errors, specially those related to the confusion between patients with chronic bronchitis without chronic obstruction and those with COPD. Among the diagnostic criteria, the consensus emphasizes the importance of demonstrating irreversible airway obstruction through spirometry, as well as strategies to the differential diagnosis between COPD and asthma...

OBJECTIVE: This report describes ambulatory visits for asthma in the United States across three ambulatory care settings. The primary focus is on visits to office-based physicians. METHODS: The data sources include the National Ambulatory Medical Care Survey (NAMCS), a national probability survey of visits to office-based physicians in the United States, and the National Hospital Ambulatory Medical Care Survey (NHAMCS), a national probability survey of visits to hospital emergency and outpatient departments in the United States...

In this pilot study we assessed patient compliance and acceptability of data recorded in the home environment by asthmatics using a Vitalograph 2110 spirometer which measures peak expiratory flow rate (PEFR) and forced expiratory volume in 1 s (FEV1). This meter automatically time and date stamps all measurements and can also assess the technical acceptability of results. Data are uploaded to a personal computer for review and analysis. We recruited 30 patients (10 male and 20 female, age range 21-72 years) from the chest clinic at Guy's Hospital (n = 20) and from a GP clinic (n = 10)...