Jan Olofson

Quality of life in patients with chronic alveolar hypoventilation

Measurements of health-related quality of life (HRQL) have not been reported in patients with chronic alveolar hypoventilation (CAH) before starting home mechanical ventilation. The purpose of this study was to investigate quality of life in a population of such patients. Forty-four consecutive patients with CAH due to previous polio, scoliosis, healed pulmonary tuberculosis or neuromuscular disease answered a battery of condition specific and generic (Sickness Impact Profile, Hospital Anxiety and Depression scale, Mood Adjective Check List) self-report questionnaires. Spirometry, arterial blood gases and overnight oxygen saturation were measured. Patients with untreated CAH had significantly impaired HRQL compared to historical data from a healthy reference population. Sleep-related problems were frequent. Age, underlying disease, and standard bicarbonate correlated significantly with HRQL measures, albeit with modest levels of explained variance (8–37%). Patients with chronic alveolar hypoventilation due to neuromuscular or restrictive chest wall disorders had severely impaired health-related quality of life. Age, the underlying disease and severity of hypoventilation are each related to the health-related quality of life decrements. Health-related quality of life measurements add important information to traditional clinical observations.

The impact of individual quality of life assessment on psychosocial attention in patients with chest malignancies: a randomized study

PurposeThe aims of this study were to investigate the impact of individual health-related quality of life (HRQL) evaluation on the attention towards symptom control and psychosocial function in advanced cancer patients.MethodsPatients with advanced lung cancer or mesothelioma who attended a pulmonary oncology outpatient clinic were randomized to either of two strategies for HRQL assessment. The experimental group (EG) answered the EORTC QLQ-C30 + LC13 questionnaire using a digital table interface, with outprint of aggregated scale scores presented to the consulting physician as a support for evaluation. The control group (CG) answered a paper version of the same questionnaire, which was stored for later analysis. Consultations were audio-recorded. Outcome measures were a quantitative content analysis of audio-recorded consultations and medical and psychosocial interventions abstracted from clinical records.ResultsOne hundred seventy-one patients were randomized and participated in the study. Issues regarding emotional function were more frequently discussed during consultations in the EG (p < 0.05). Similarly, interventions directed to emotional and social concerns were more frequent in the EG (p = 0.013 and p = 0.0036, respectively). HRQL measures over time were similar across the groups.ConclusionIndividual HRQL assessment increased the attention to psychosocial functioning in patients with chest malignancies.

Impact of home mechanical ventilation on health-related quality of life in patients with chronic alveolar hypoventilation: a prospective study.

Background:  Nocturnal ventilatory support by nasal positive pressure ventilation (NPPV) is an established treatment method in patients with chronic alveolar hypoventilation (CAH). The knowledge about its long‐term effects on health‐related quality of life (HRQL) is limited.

COPD ‘diagnosis’ based on spirometric reference equations

Introduction:  Chronic obstructive pulmonary disease (COPD) is suspected if the ratio between forced expired volume in 1 s (FEV1) and forced vital capacity is below 0.7 after bronchodilatation, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). As this ratio varies with age and gender, the lower limit of normality (LLN) of appropriate reference equations appears more adequate.

The single breath nitrogen test and mortality--A 38 years follow up.

BACKGROUND Spirometry data predict mortality, but are less sensitive to detect dysfunction in small airways as compared to the slope of phase III (the N2 slope) of the single breath nitrogen test. The association between the N2 slope and mortality has been studied with conflicting results. In the present study the prognostic importance of the N2 slope was tested taking spirometry variables into account. METHODS A systematic general population sample of 595 middle-aged men had a baseline investigation with lung function tests including spirometry and the N2 slope. Age, smoking, and anthropometry variables were registered. The cohort was followed up regarding survival for 38 years. RESULTS The sample was subdivided by tertiles of the N2 slope. A proportional hazards regression analysis was performed for each group of covariates: anthropometric, smoking variables, and spirometry variables, after accounting for age. Covariates with significant impact on mortality and the highest chi-square levels were smoking habit score and forced expired volume in 1 s corrected for height. These variables, in addition to age and the N2 tertiles were entered into a final proportional hazards regression analysis. In this multivariate model, mortality was significantly related to age (p < .0001), smoking habit score (p < .0001) and the N2 tertiles (p = .0004), but not to FEV1 when N2 slope was allowed for in the model. CONCLUSIONS Dysfunction in small airways as measured by the N2 slope is significantly associated with overall mortality in middle-aged men, and outrivals spirometry as a predictor in multivariate analysis.

Respiratory symptoms and peripheral airways disease in a cross-sectional study on a random population sample.

Objectives Respiratory symptoms are associated with spirometry results but more strongly with smoking history, suggesting that alterations in the lung other than those revealed by spirometry contribute to cause symptoms. Smoking may cause obstruction of peripheral airways that is poorly detected by spirometry. The slope of phase III of the single-breath nitrogen (N2) test detects smoking-induced alterations in smokers before spirometry is impaired. The aim of the present investigation was to study the association between respiratory symptoms and the slope of phase III adjusting for spirometry results and smoking history. Design Single-centre retrospective cross-sectional study. Setting University hospital in Gothenburg, Sweden. Participants A random population sample of 430 elderly men. Methods The presence of seven different respiratory symptoms were analysed by a multiple logistic regression model in relation to spirometry results, smoking history (pack-years) and the slope of phase III in a population sample of 430 elderly men, age span 50–67 years. Furthermore, smoking normalised values of the slope of phase III were calculated and differences between subjects reporting/not reporting symptoms were tested. Results The presence of some cough symptoms was significantly associated with a steep slope of phase III also when adjusting for spirometry results and smoking history. Furthermore, smoking normalised slope of phase III was significantly steeper among subjects with cough symptoms compared to those without cough symptoms. Conclusions Cough symptoms may be an effect of abnormalities in peripheral airways at least among elderly men.

Pre-operative evaluation of lung function test results

To the Editors: The European Respiratory Society/European Society of Thoracic Surgeons joint clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) were published in the July 2009 issue of the European Respiratory Journal 1. This comprehensive and very important document provides guidelines for the risk evaluation of candidates for lung cancer surgery. We fully agree that the lung function variables forced expiratory volume in 1 s (FEV …