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Borg B.M.,Immunology and Respiratory Medicine | Thompson B.R.,Monash University
Respiratory Care | Year: 2012

BACKGROUND: The statement of the American Thoracic Society and European Respiratory Society on the measurement of static lung volumes (SLV) suggests a preferred and alternate method for measuring and calculating SLV. OBJECTIVE: To determine if differences in functional residual capacity (FRC), vital capacity (VC), residual volume (RV), and total lung capacity (TLC), obtained using preferred and alternate measurement and calculation methodologies, exist in a clinical setting. METHODS: Patients attending for SLV at a hospital-based laboratory were recruited. Following spirometry, SLV was measured via body plethysmography, using the preferred and alternate methods in random order. Volumes were calculated using the preferred and alternate calculation methods. Subjects were classified according to standard ventilatory function interpretative strategies. Differences of the means between the measurement methods, and calculation methods were assessed. RESULTS: One hundred eight data sets were analyzed. Significant, but small differences (< 150 mL) in the means for VC and TLC, and RV and TLC were found in the normal and restricted groups, respectively. No significant differences in SLV parameters were found in subjects with air-flow obstruction. Twelve of the 108 changed ventilatory function classification between methods, with the alternate method delivering a lower inspiratory capacity and TLC without a change in RV in 66% of this subgroup. Identical results were obtained when data were analyzed using both calculation methods. CONCLUSIONS: Differences in FRC, VC, RV, and TLC obtained using the preferred and alternate measurement methodologies exist in the clinical setting in select classification groups and individuals. Differing calculation methods dependent on measurement method used may be unnecessary. © 2012 Daedalus Enterprises. Source

Hoy R.,Immunology and Respiratory Medicine | Hoy R.,Monash University
Current Opinion in Allergy and Clinical Immunology | Year: 2012

PURPOSE OF REVIEW: This review summarizes recent literature regarding the association of nonorganic laryngeal dysfunction with occupational exposures. Laryngeal dysfunction may masquerade as asthma and is an important consideration in patients with work-associated respiratory symptoms. RECENT FINDINGS: Although there is lack of consensus regarding clinical features, vocal cord dysfunction (VCD) is the most well appreciated form of nonorganic laryngeal dysfunction. There are significant gaps in the literature regarding the occupational epidemiology of laryngeal dysfunction, however, occupational exposures such as upper airway irritants may be associated with the onset of symptoms. Recurrent work-associated laryngeal dysfunction has been described in occupational groups including the military and professional athletes. Recent theories have considered that VCD may be a state of laryngeal hyperresponsiveness associated with both intrinsic and extrinsic factors. SUMMARY: Laryngeal dysfunction is an important consideration in patients with work-associated respiratory symptoms. Clinicians should have a high index of suspicion, in particular, if symptoms are associated with exposure to a respiratory irritant. Situations of high psychological stress may also be associated with recurrent symptoms. There is a requirement for evidence-based guidelines for the diagnosis and management of laryngeal dysfunction, which should also address work-related factors. © 2012 Lippincott Williams & Wilkins, Inc. Source

Tai A.,Womens and Childrens Hospital | Tran H.,Murdoch Childrens Research Institute | Roberts M.,Royal Melbourne Hospital | Clarke N.,Murdoch Childrens Research Institute | And 3 more authors.
Thorax | Year: 2014

Introduction There is epidemiological evidence to suggest that events in childhood influence lung growth and constitute a significant risk for adult COPD. The aim of the study is to evaluate for an association between childhood asthma and adult COPD. Methods This longitudinal, prospective study of 6-7- year-old children with asthma has been regularly reviewed every 7 years to the current analysis at 50 years of age. Participants completed respiratory questionnaires and lung function spirometry with postbronchodilator response. At the age of 50, subjects were classified to the following subgroups: non-asthmatics, asthma remission, current asthma and COPD which was defined by FEV1 to FVC ratio postbronchodilator of less than 0.7. Results Of the remaining survivors, 346 participated in the current study ( participation rate of 76%) of whom 197 completed both questionnaire and lung function testing. As compared with children without symptoms of wheeze to the age of 7, (non-asthmatics) children with severe asthma had an adjusted 32 times higher risk for developing COPD (95% CI 3.4 to 269). In this cohort, 43% of the COPD group had never smoked. There was no evidence of a difference in the rate of decline in FEV1 (mL/year, 95th CI) between the COPD group (17, 10 to 23) and the other groups: non-asthmatics (16, 12 to 21), asthma remission (20, 16 to 24) and current asthma (19, 13 to 25). Conclusions Children with severe asthma are at increased risk of developing COPD. Source

Glaspole I.,Immunology and Respiratory Medicine | Goh N.S.L.,Austin Hospital
Chronic Respiratory Disease | Year: 2010

Of the idiopathic interstitial pneumonias, idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP) have provoked the most debate and discussion. Although the two diseases are distinct entities, diagnosis is not always straightforward and requires a multidisciplinary approach, integrating clinical, radiological and histologic information. Although there is currently no effective treatment for either disease, the importance of differentiating NSIP from IPF lies in the management of the individual patient, with particular focus on outcome and pace of change, and enrolment into novel treatment trials of IPF. © 2010 The Author(s). Source

Prickett S.R.,Monash University | Voskamp A.L.,Monash University | Dacumos-Hill A.,Monash University | Symons K.,Immunology and Respiratory Medicine | And 2 more authors.
Journal of Allergy and Clinical Immunology | Year: 2011

Background: Peanut allergy is a life-threatening condition; there is currently no cure. Although whole allergen extracts are used for specific immunotherapy for many allergies, they can cause severe reactions, and even fatalities, in peanut allergy. Objective: This study aimed to identify short, T-cell epitope-based peptides that target allergen-specific CD4+ T cells but do not bind IgE as candidates for safe peanut-specific immunotherapy. Methods: Multiple CD4+ T-cell lines specific for the major peanut allergen Ara h 2 were generated from PBMCs of 16 HLA-diverse subjects with peanut allergy by using 5,6-carboxyfluorescein diacetate succinimidylester-based methodology. Proliferation and ELISPOT assays were used to identify dominant epitopes recognized by T-cell lines and to confirm recognition by peripheral blood T cells of epitope-based peptides modified for therapeutic production. HLA restriction of core epitope recognition was investigated by using anti-HLA blocking antibodies and HLA genotyping. Serum-IgE peptide-binding was assessed by dot-blot. Results: Five dominant CD4+ T-cell epitopes were identified in Ara h 2. In combination, these were presented by HLA-DR, HLA-DP, and HLA-DQ molecules and recognized by T cells from all 16 subjects. Three short peptide variants containing these T-cell epitopes were designed with cysteine-to-serine substitutions to facilitate stability and therapeutic production. Variant peptides showed HLA-binding degeneracy, did not bind peanut-specific serum IgE, and could directly target TH2-type T cells in peripheral blood of subjects with allergy. Conclusion: Short CD4+ T-cell epitope-based Ara h 2 peptides were identified as novel candidates for a T-cell-targeted peanut-specific immunotherapy for an HLA-diverse population. © 2010 American Academy of Allergy, Asthma and Immunology. Source

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