Rebuttal from Dr Berger et al

Details

• Personal Author:
  Berger KI ; Goldring RM ; Oppenheimer BW
• Description:
  We agree that the holy grail of pulmonary physiologists is a test that detects early chronic airway disease. Although Dr Enright remains "cautiously optimistic" that forced oscillation technique (FOT) can serve this purpose, there are sufficient data to mitigate his caution. Diagnosis of Early Airway Disease: Accumulating literature provides evidence for enhanced diagnostic capabilities of FOT vs spirometry (reviews cited in our point editorial 2 ). Despite normal spirometry, FOT abnormalities in those studies indicate small airway dysfunction based on bronchodilator responsiveness and correlation with symptom severity, quality of life, and response to treatment. Moreover, isolated improvement in FOT metrics during treatment occurs with simultaneous improvement in airway and alveolar inflammation as well as with bronchial hyperreactivity (methacholine). Populations exposed to dust from the World Trade Center collapse provide a unique opportunity to address the role of FOT in detecting small airway disease because histologic evaluation demonstrated distal penetration of inhaled particles with small airway injury. Our group's large case-control study reaffirms the role of FOT in detection of small airway disease in subjects with normal spirometry. The magnitude of dust exposure was only associated with FOT abnormalities in subjects with new-onset persistent respiratory symptoms. Furthermore, we demonstrated an association between FOT abnormalities and systemic inflammation in other exposed subjects. FOT in Subjects With Established COPD: The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study suggested that a proportion of patients with COPD and abnormal spirometric findings may have FOT measures in the normal range. This conclusion was based on prediction equations derived from the control group. However, the equations had poor correlation, dictating wide CIs. In fact, the normative range used was at or above the upper end of previously published values. A more recent large normative dataset has demonstrated values significantly lower than those of the ECLIPSE control group. Lack of correlation in the ECLIPSE study between FOT and CT imaging airway metrics is expected because smaller airways (< 2 mm) are not visible radiographically. Moreover, lack of correlation between FOT and focal emphysema is not unexpected because FOT parameters do not directly assess parenchymal destruction. [Description provided by NIOSH]
• Subjects:
  Dust Lung Lung Diseases Methacholine Compounds Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety
• Keywords:
  Airway Obstruction Chronic Obstructive Pulmonary Disease COPD Diseases Dust Exposure Dusts Lung Disease Lung Function Methacholines Oscillography Particulate Dust Particulates Physiological Testing Pulmonary System Pulmonary System Disorders Quality Of Life Respiratory System Disorders Spirometry

  More +
• ISSN:
  0012-3692
• Document Type:
  Text
• Funding:
  Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  148
• Issue:
  5
• NIOSHTIC Number:
  nn:20050806
• Citation:
  Chest 2015 Nov; 148(5):1137-1138
• Contact Point Address:
  Kenneth I. Berger, MD, New York University School of Medicine, 240 E 38th St, Room M-15, New York, NY 10016
• Email:
  kenneth.berger@nyumc.org
• Federal Fiscal Year:
  2016
• Performing Organization:
  NYC Health + Hospitals Corporation (HHC)
• Peer Reviewed:
  True
• Start Date:
  20110929
• Source Full Name:
  Chest
• End Date:
  20170331
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:49247c3fc4b88ad983cbe224bfd30228589d1f668b990200a0b40d1065fdfe1dafba973d9b056ace3dee23fbd710baf222577e0297fd310dbfb386c107c2bad7
• Download URL:
  https://stacks.cdc.gov/view/cdc/211018/cdc_211018_DS1.pdf
• File Type:
  [PDF - 131.23 KB ]