Prevalence of airflow obstruction in patients attending a rapid access chest pain clinic.

BACKGROUND: Many UK hospitals have set-up specialised chest pain clinics to deal promptly and efficiently with cases of possible cardiac chest pain. It is possible that a proportion of patients attending these clinics will have a respiratory cause for their chest pain, or respiratory disease in addition to their cardiac pain. This study aimed to determine the prevalence of airflow obstruction, ischaemic heart disease and dual pathology in such patients. METHODS: Spirometry was performed on patients referred to a rapid access chest pain clinic over a 12-month period (target population of 400 patients). The main outcome measure was the prevalence of airflow obstruction (defined using spirometry), ischaemic heart disease and dual pathology. RESULTS: 405 subjects participated in the study. Abnormal spirometry was detected in 21% of patients (n=85). Airflow obstruction was the predominant lung function abnormality and was detected in 60 patients. Ischaemic heart disease was diagnosed in 21% of patients (n=85). Dual pathology was found in 4% of patients (n=17). CONCLUSIONS: Previous studies have reported a link between impaired lung function and future cardiovascular morbidity and mortality. This study suggests that airflow obstruction is an important alternative differential diagnosis in patients referred to a rapid access chest pain clinic. The identification of abnormal spirometry may help to better risk-stratify patients for future cardiovascular events and allow interventions to be instituted.

Is the prevalence of wheeze in children altered by neonatal BCG vaccination?

BACKGROUND: The prevalence of asthma and atopic disease has increased in recent decades, but precise reasons for this increase are unknown. BCG vaccination is thought to be among a group of vaccines capable of manipulating the immune system toward T(H)1 dominance and therefore reducing the likelihood of atopic disease. OBJECTIVE: The aim of this study was to determine the influence of neonatal BCG vaccination on the prevalence of wheeze in a large community population of children. METHOD: In a historical cohort study, a parent-completed questionnaire was used to identify the prevalence of wheeze in BCG-vaccinated and nonvaccinated children in Manchester, England. RESULTS: There were 2414 participants aged between 6 and 11 years. In a univariate analysis neonatal BCG vaccination was associated with a significantly lower prevalence of wheeze (odds ratio, 0.69; 95% CI, 0.55-0.86), and statistical significance was retained when the analysis was adjusted for potential confounders (odds ratio, 0.68; 95% CI, 0.53-0.87). CONCLUSION: These results demonstrate an association between asthma symptom prevalence and neonatal BCG vaccination, relating to a possible 27% reduction in prevalence, and are therefore of considerable public health importance. CLINICAL IMPLICATIONS: The capacity of neonatal BCG vaccination to reduce the prevalence of respiratory symptoms in children warrants further investigation.