What defines airflow obstruction in asthma?

Asthma guidelines from the Global Initiative for Asthma (GINA) and from the National Heart, Lung, and Blood Institute provide conflicting definitions of airflow obstruction, suggesting a fixed forced expiratory volume in 1 s (FEV(1))/forced vital capacity (FVC) cut-off point and the lower limit of normality (LLN), respectively. The LLN was recommended by the recent American Thoracic Society/European Respiratory Society guidelines on lung function testing. The problem in using fixed cut-off points is that they are set regardless of age and sex in an attempt to simplify diagnosis at the expense of misclassification. The sensitivity and specificity of fixed FEV(1)/FVC ratios of 0.70, 0.75 and 0.80 versus the LLN were evaluated in 815 subjects (aged 20-44 yrs) with a diagnosis of asthma within the framework of the European Community Respiratory Health Survey. In males, the 0.70 ratio showed 76.5% sensitivity and 100.0% specificity, the 0.75 ratio 100.0% sensitivity and 92.4% specificity, and the 0.80 ratio 100.0% sensitivity but 58.1% specificity. In females, the 0.70 ratio showed 57.3% sensitivity and 100.0% specificity, the 0.75 ratio 91.5% sensitivity and 95.9% specificity, and the 0.80 ratio 100.0% sensitivity but 72.9% specificity. The fixed cut-off points cause a lot of misidentification of airflow obstruction in young adults, with overestimation with the 0.80 ratio and underestimation with the 0.70 ratio. In conclusion, the GINA guidelines should change their criteria for defining airflow obstruction.

Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes.

BACKGROUND: Early detection of airflow obstruction is particularly important among young adults because they are more likely to benefit from intervention. Using the forced expiratory volume in 1 s (FEV(1)) to forced vital capacity (FVC) (FEV(1)/FVC) <70% fixed ratio, airflow obstruction may be underdiagnosed. The lower limit of normal (LLN), which is statistically defined by the lower fifth percentile of a reference population, is physiologically appropriate but it still needs a clinical validation. METHODS: To evaluate the characteristics and longitudinal outcomes of subjects misidentified as normal by the fixed ratio with respect to the LLN, 6249 participants (aged 20-44 years) in the European Community Respiratory Health Survey were examined and divided into three groups (absence of airflow obstruction by the LLN and the fixed ratio; presence of airflow obstruction only by the LLN; presence of airflow obstruction by the two criteria) for 1991-1993. LLN equations were obtained from normal non-smoking participants. A set of clinical and functional outcomes was evaluated in 1999-2002. RESULTS: The misidentified subjects were 318 (5.1%); only 45.6% of the subjects with airflow obstruction by the LLN were also identified by the fixed cut-off. At baseline, FEV(1) (107%, 97%, 85%) progressively decreased and bronchial hyperresponsiveness (slope 7.84, 6.32, 5.57) progressively increased across the three groups. During follow-up, misidentified subjects had a significantly higher risk of developing chronic obstructive pulmonary disease and a significantly higher use of health resources (medicines, emergency department visits/hospital admissions) because of breathing problems than subjects without airflow obstruction (p<0.001). CONCLUSIONS: Our findings show the importance of using statistically derived spirometric criteria to identify airflow obstruction.

Magnetic phase diagram of layered cobalt dioxide LixCoO2.

The magnetism of LixCoO2 (LCO), which has a similar structure to NaxCoO2 (NCO), has been investigated by muon-spin spectroscopy and susceptibility measurements using samples with x=0.1-1 prepared by an electrochemical reaction. In the x range below 0.75, LCO was found to be Pauli paramagnetic down to 1.8 K, suggesting an intermediate- or weak-coupling regime, although disordered local moments, with volume fractions below approximately 20%, appear at low T for LCO with x > or = 0.5. The phase diagram and interactions of LCO are thus strikingly different from NCO, while the differences cannot be explained simply by structural differences between the two systems.

Chronic productive cough in young adults is very often due to chronic rhino-sinusitis.

BACKGROUND: Chronic productive cough is a common clinical problem; often potential causes outside the lower respiratory tract are forgotten or ignored. The aim of this study was to make a precise etiopathogenetic diagnosis of chronic productive cough in young adults. METHODS: In a clinical setting, 212 subjects (mean age 41+/-5 years) who had reported chronic productive cough in a previous postal survey of a young adult population underwent within two years clinical and functional investigations following a rational diagnostic approach. Two pulmonologists independently established the diagnosis using a clinically structured interview on nasal and respiratory symptoms, spirometry and other tests when appropriate (bronchodilator test or methacholine bronchial challenge, chest radiography); if rhino-sinusitis was suspected, subjects underwent an ENT examination with nasal endoscopy and/or sinus computed tomography. RESULTS: At the end of the diagnostic procedure, 87 subjects (41%) no longer had chronic productive cough and had normal function. Fifty-eight subjects (27%) had chronic rhino-sinusitis; seventeen subjects (8%) had asthma, and of these fourteen also had chronic rhino-sinusitis; 50 subjects (24%) had COPD stage 0+, of these seven also had chronic rhino-sinusitis. Chronic rhino-sinusitis was more frequent in females than in males (p<0.05). CONCLUSIONS: Both in clinical practice and in epidemiological studies, it is important to consider that the origin of chronic productive cough could be frequently outside the lower respiratory tract; a consistent percentage of young adults with persistent productive cough has indeed chronic rhino-sinusitis.

Evidence of two dimensionality in quasi-one-dimensional cobalt oxides.

The quasi-one-dimensional (Q1D) cobalt oxides A(N + 2)Co(n + 1)O(3n + 3) (A = Ca, Sr, and Ba, n = 1 - infinity) were investigated by muon-spin spectroscopy under applied pressures of up to 1.1 GPa. The relationship between the onset Néel temperature T(on)(N) and the interchain distance (d(ic)), which increases monotonically with n, is well fitted by the formula T(N)/T(N,0) = (1 - d(ic)/d(ic,o)(beta), here for T(on)(N) approximately 100 K for Ca(3)Co(2)O(6) (n = 1) and approximately 15 for BaCoCoO(3) (n = infinity at ambient P. The T(on)(N) - d(ic) curve also predicts a large dependence of Y(N) for the compounds with n > or = 5, i.e., in the vicinity of , while the compounds show only a very small effect. Indeed, our high-pressure mu(+) results show that of BaCoO(3) is enhanced by with a slope of 2.2 K(Gpa), whereas no detectable changes by P for both Ca(3)Co(2)O(6) and Sr(4)Co(3)O(9) (n = 2). This clearly confirms the role of the 2D-antiferromagnetic interaction on T(on)(N) in the Q1D cobalt oxides.

Static magnetic order in metallic K0.49CoO2.

By means of muon-spin spectroscopy, we have found that K0.49CoO2 crystals undergo successive magnetic transitions from a high-T paramagnetic state to a magnetic ordered state below 60 K and then to a second ordered state below 16 K, even though K0.49CoO2 is metallic at least down to 4 K. An isotropic magnetic behavior and wide internal-field distributions suggest the formation of a commensurate helical spin density wave (SDW) state below 16 K, while a linear SDW state is likely to exist above 16 K. It was also found that exhibits a further transition at 150 K presumably due to a change in the spin state of the Co ions. Since the dependence of the internal-field below 60 K was similar to that for Na0.5CoO2, this suggests that magnetic order is more strongly affected by the Co valence than by the interlayer distance or interaction and/or the charge ordering.

Dome-shaped magnetic phase diagram of thermoelectric layered cobaltites.

Using muon spin spectroscopy we have found that, for both NaxCoO(2) (0.6