Hashir Majid

Utility of exhaled nitric oxide in the diagnosis and management of asthma.

Purpose of review The fraction of nitric oxide in exhaled air (FeNO) is elevated in the presence of airway inflammation, and it may be a useful biomarker in asthma. The purpose of the present review is to highlight the current literature investigating the use of exhaled nitric oxide in the diagnosis and management of asthma. Recent findings The measurement of exhaled nitric oxide has been studied in normal populations and in asthmatics. FeNO appears to be a useful screening tool for asthma, although nondisease factors may confound the interpretation of an elevated FeNO level. Clinical trials investigating the use of FeNO measurements in predicting asthma exacerbation and tailoring maintenance therapy have had varying success. Further studies incorporating individualized FeNO profiles into treatment algorithms are needed. Summary FeNO shows promise as a tool in the diagnosis and treatment of asthma. However, further studies are needed to address outstanding questions about its exact role in guiding asthma management.

Influence of gender and anthropometric measures on severity of obstructive sleep apnea.

PurposeGender differences influence upper airway anatomy and physiology. The purpose of our study was to evaluate the influence of gender as well as anthropometric measures on severity of obstructive sleep apnea (OSA).MethodsA retrospective review of patients referred to our sleep laboratory for evaluation of OSA was done. Patients with a diagnosis of OSA (Respiratory Disturbance Index (RDI) > 5) were included in the study. Anthropometric measurements were available for all the patients included in the study. Measurements of subjects’ height, weight, neck size, and waist and hip sizes were used in the study; waist–hip ratio and neck-to-height ratio were calculated.ResultsThree hundred eighty-six females and 661 males were included. Women were older than men and had a higher body mass index (BMI) and waist-to-hip ratio; men had a thicker neck circumference and a higher neck-to-height ratio. The severity of OSA was significantly higher in males (RDI 41.2 ± 27.9 in men vs. 30.0 ± 26.7 in women, p < 0.0001) despite a lower BMI and age in the men. Severity of OSA, as measured by RDI, varied significantly with changes in anthropometric measures such as neck circumference, and waist and hip sizes in both genders. Waist-to-hip ratio was associated with severity of OSA in men but not in women (p = 0.19 and 0.0001 in women and men, respectively). However, no single anthropometric value was found to be strongly predictive of OSA severity.ConclusionDespite having a higher mean BMI and age, women have lower RDI compared with men. Waist-to-hip ratio is more predictive of severity of OSA in men than in women. However, the correlation of anthropometric measures with severity of OSA was weak in our subjects.

The Pharmacotherapy of Chronic Obstructive Pulmonary Disease in the Elderly: An Update

Chronic obstructive pulmonary disease (COPD) is a disorder of the airways characterized by inflammation and airflow limitation. It is a major cause of morbidity and mortality globally and its prevalence is on the rise. COPD is predominantly a disease of the older age group. As the average life-span increases world-wide, and the burden of COPD increases, correct recognition and optimal management of this disease has become essential in the elderly. In the proceeding article, changes in the respiratory system associated with normal aging, as well as with COPD are reviewed. Important implications of aging in COPD management are also discussed.