Cold Dry Air Test Found Effective for Asthma Diagnosis in Young Patients
In a recent study, researchers found that asthma diagnosis in young children may be obtained from a cold dry air respiratory challenge test. Hans Bisgaard, MD, of the Department of Pediatrics, Copenhagen University Hospital, Denmark, and an associate conducted the research, which was published in the June issue of the American Journal of Respiratory and Critical Care Medicine.
The study demonstrated a more effective diagnosis method than a pharmacological challenge test—a more complicated process that may cause side effects. Bisgaard studied the effects of the cold air test on lung function response and bronchial responsiveness in 38 young asthmatics who were matched with 29 control subjects.
Researchers detected pulmonary hyperresponsiveness through specific airway resistance in 26 of 38 asthmatic children. Only two of 29 control subjects were hyperresponsive after the cold air challenge.
“We demonstrated that it is possible to cause bronchial hyperresponsiveness in awake young children and to separate asthmatics and healthy young children using the cold air challenge as a provocative stimulus,” Bisgaard says. “Hyperventilation of cold dry air can be a potent stimulus to bronchoconstriction in asthma.”
According to researchers, most of the children had fun during the procedure, and there were no reports of discomfort or other complications. The children breathed cold dry air mixed with 5% carbon dioxide through a face mask, which prevented nose breathing. The children hyperventilated by trying to keep a balloon on the computer screen flying just above a preset dashed line until a sun had crossed the screen. Maximal response occurred within 3 to 5 minutes.
New Technologies Boost Blood Gas Monitoring Market
Recent research by Frost & Sullivan, San Jose, Calif, concludes that innovations in blood gas monitoring technology have boosted that market. Products ensuring speedy, reliable results are in demand because physicians require immediate assessment of oxygen, carbon dioxide, and pH levels for critical patients.
“Easy-to-use disposable cartridges avoid contamination and decrease handling of biohazardous material,” say Frost & Sullivan analysts Minal Vasanawala and Mahpara Qureshi. “Turnaround times of less than 2 minutes have made these point-of-care blood gas analyzers a standard in the care of the critically ill.”
Noninvasive monitors include pulse oximetry and transcutaneous devices, which now give more reliable data thanks to improved technology. More than $120 million in revenues was made in this segment last year. Technology is also improving for portable, handheld invasive analyzers, which are conducive to thorough blood analysis at point of care. Both invasive and noninvasive monitors provide blood gas information without performing a more thorough test.
According to the report, the US blood gas monitoring markets reported revenues exceeding $156 million in 1999. By 2006, the market is estimated to reach $176.8 million with a modest compound annual growth rate.
National Jewish and PDHI Introduce “MyAsthma” Online Self-Care
National Jewish Medical and Research Center (NJMRC), Denver, has collaborated with self-care Web site manager Protocol Driven Healthcare Inc (PDHI), Bernardsville, NJ, to bring MyAsthma online to the NJMRC Web page. The 2-year alliance will provide care and management tips as well as recent research over the Internet for asthmatics.
“This program helps consumers better understand their disease and take steps to stay healthy,” says David Tinkelman, MD, vice president, Health Initiatives, NJMRC.
Features of the program include a full menu of self-care services, a diary feature to track asthma’s effect on daily living, the latest research on asthma treatment, and unlimited online access to NJMRC registered nurses through Lung Line®. For the more than 5,000 asthma cases already monitored by NJMRC, MyAsthma will help disease management caregivers recognize symptom changes and advise patients about preventative treatment before an attack occurs.
In addition, MyAsthma’s secure server will maintain the confidentiality of all information submitted by the patient. www.nationaljewish.org.
AARC Celebrates National Respiratory Care Week
The American Association for Respiratory Care (AARC) will promote early detection of chronic obstructive pulmonary disease (COPD) through routine lung function testing during National Respiratory Care Week. From September 10 to 16, AARC’s 50 state affiliate organizations and 32,000 members will offer spirometry screenings in malls and shopping centers as well as in hospitals and other health care facilities. RTs will host walk-a-thons, “respiratory health” fairs, tree-planting ceremonies, and open houses.
COPD, which claimed 110,000 American lives last year, is the fourth leading cause of death in the United States. Early detection can help slow the progress of the disease and increase the quality of life for the patient. www.aarc.org.
Researchers Publish New Study On Early Detection of Lung Cancer
In a recent study, researchers found that early detection of lung cancer when the lesion is small has impact on survival. The article was published in the June issue of Chest.
Along with four colleagues, Edward F. Patz, Jr, MD, Department of Radiology, Duke University Medical Center, Durham, NC, studied 285 men and 225 women who were diagnosed with stage IA non-small cell lung cancer from 1981 to 1999. Their tumor size was less than 3 cm.
Although the results suggest that there is no statistical relationship between tumor size and survival, Patz says that it remains to be seen whether detecting smaller nodules with newer technologies, such as computed tomography (CT) scans, will alter the natural history of the disease.
Preliminary CT scanning trials showed that upon initial examination, up to 30% of the small primary lung cancers of the patients had metastasized to regional lymph nodes or distant sites.
The Duke researchers believe that by the time a lesion has grown to 5 mm, or close to the detectable range of CT scanning, the cancer is late in the biology of the disease. The exact time at which metastases or genetic change causes the disease to take an aggressive turn has not been well established, according to the investigative team. Research findings suggest that small nodule detection by imaging techniques does not necessarily correspond to the biological behavior of the disease. Detection with screening CT, therefore, may not significantly improve lung cancer mortality.
“Despite continued advances in diagnostic techniques, treatment protocols, and tumor biology,” Patz says, “the survival rate for lung cancer has shown only minimal improvement over the past several decades. Most patients still present with advanced disease, at which time therapeutic options are less than optimal.”
For more information, contact the American College of Chest Physicians at (847) 498-1400; www. chestnet.org.
Budesonide Recommended for Pregnant Women with Asthma
According to a recent joint statement released by the American College of Allergy, Asthma and Immunology (ACAAII) and the American College of Obstetricians and Gynecologists (ACOG), inhaled corticosteroids, such as budesonide, can prove effective for women with persistent asthma who are pregnant or who are likely to become pregnant. Published in the Annals of Allergy, Asthma and Immunology, the statement entitled “The Use of Newer Asthma and Allergy Medications During Pregnancy” was based on safety and efficacy information from gestational use of inhaled corticosteroids published since 1993.
Complications may occur during pregnancy if asthma is not properly controlled, says the ACAAI. The expectant mother may experience high blood pressure and preeclampsia, while risks for the baby include premature birth, low birth weight, and stillbirth.
The US National Institutes of Health asthma guidelines also state the importance of treating persistent asthma with inhaled cortico-steroids and emphasize that sufficient lung function and blood oxygenation during pregnancy are essential to ensure that the fetus receives an adequate oxygen supply.
Respiratory Therapy Protocols Prove Effective
Unnecessary medical treatments may be avoided by non-ICU patients under respiratory therapy protocols, according to a recent study. Respiratory treatments were also significantly lower among patients receiving respiratory therapy-directed care.
Lead researcher Marin Kollef found that both operational costs and personal risks were reduced by minimizing the misallocation of patient services. Respiratory therapists, according to Kollef, possess the critical thinking skills and knowledge to assess a patient’s condition and make adjustments in the intensity of services, which can reduce the likelihood of unnecessary medical risks.
The research showed that 24.3% of patients under respiratory therapist-directed treatments had a lower rate of discordant respiratory care orders as compared with 56.8% to 58.5% of patients receiving physician-directed treatments. The study was funded by the American Association for Respiratory Care and published in the February issue of Chest.
There were three errors in the facility profile of King Faisal Specialist Hospital and Research Centre that ran in the last issue of RT Magazine. In the first full paragraph on page 95, the last sentence should have read, “Clinical strategies and techniques are under development for the most effective treatment of ARDS.” In the seventh full paragraph on page 95, the second sentence should have been, “In June 1999 the department changed from a supervisory structure (six supervisors/65 RRTs) to a charge RRT structure in which charge RRTs are selected by their peers.” Lastly, HCA International, mentioned on page 96, recruits in both the United States and Canada.