Update in Pulmonary Medicine

Update in Pulmonary Medicine

John H. Hansen-Flaschen, MD

From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

2002-2003 Series: Update Sessions from ACP-ASIM's 2002 Annual Session

David A. Cramer, MD, and Paul T. Kefalides, MD, Co-Editors

Pulmonary diseases, including chronic lung disease and pneumonia, are the third leading cause of death in the United States. Because of the worldwide popularity of cigarette smoking, these illnesses are increasing in frequency, and trends suggest that a greater proportion of disability and death will result from lung illnesses compared with heart disease as cardiovascular risk preventions take full effect.

This Update focuses on recent advances in the diagnosis and treatment of lung diseases. Each study used high-quality research methods. The articles are divided into six areas: chronic obstructive pulmonary disease, the acute respiratory distress syndrome, tuberculosis, thoracic imaging, sleep apnea, and end-of-life care.

Chronic Obstructive Pulmonary Disease

Undiagnosed Airflow Obstruction Produces Symptoms and Impairs Quality of Life

Coultas DB, Mapel D, Gagnon R, Lydick E. The health impact of undiagnosed airflow obstruction in a national sample of United States adults. Am J Respir Crit Care Med. 2001; 164:372-7. [PMID: 11500335]

This article was derived from data collected for the Third National Health and Nutrition Examination Survey of 20 000 U.S. adults. From the survey respondents, Coultas and colleagues selected 5745 white persons 45 years of age and older. The authors evaluated the respondents' questionnaires, physical examination findings, and spirometry results, with attention to respiratory symptoms and clinical signs of obstructive lung disease. Airflow obstruction was defined as an FEV₁–FVC ratio below the lower limits of normal for age rather than a fixed 70% cutoff value.

Overall, 12% of the sample selected had undiagnosed airflow obstruction, but only 3.1% had chronic obstructive pulmonary disease (COPD) diagnosed by their physician; 2.7% had known asthma. For 90% of those with undiagnosed disease, the condition was mild, with an FEV₁–FVC ratio just below the lower limits of normal and stage 1 or 1a disease. However, 5% of the respondents with undiagnosed airflow obstruction had an FEV₁ less than 75% of the predicted value, a level at which symptoms might be expected. This analysis suggests that physicians …

[Full Text of this Article]