The clinical respiratory journal
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Requirements for diagnostic tests include high validity and good repeatability. ⋯ When designing a study to examine a diagnostic test, the following principles should be followed. First, the order of performance of the diagnostic test and the gold standard in repeated measurements should be randomised. Second, in repeated measurements, the test situations should be equal. Third, the technicians performing the tests should be blinded to the data obtained in the other test or to the result of the gold standard. A pilot study is recommended before conducting the study to examine the diagnostic test.
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The role of inhaled corticosteroids (ICS) on disease progression in asthmatic children is not yet clear. ⋯ One-fifth of young children with recurrent bronchial obstruction had received inhaled corticosteroids by age 2 years. Lung function appeared to improve in children using ICS from the start of symptoms of OAD until 2 years of age, mostly in children with the longest duration of treatment. However, use of ICS during the first 2 years of life in children with OAD did not reduce asthma present 8 years later. A scoring system based on severity and frequency of OAD during the first 2 years of life predicted current asthma at 10 years of age. One in five 10-year-old children in the city of Oslo at some time had asthma.
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Comparative Study
COPD 'diagnosis' based on spirometric reference equations.
Chronic obstructive pulmonary disease (COPD) is suspected if the ratio between forced expired volume in 1 s (FEV(1)) 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 GOLD criterion is inadequate because of substantial overestimation in 60-year-old never-smokers. LLNs of the various reference equations are unreliable because of obvious lack of consistency. Spirometric criteria for airway obstruction, and suspicion of COPD, therefore need to be revised.
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Baseline clinical and physiological variables have been described as relevant predictors of survival among patients with idiopathic pulmonary fibrosis (IPF). However, substantial heterogeneity in both survival time and mortality has been observed with many of these predictive factors. The incidence and mortality rates of IPF vary from country to country, with race potentially contributing to such variations. ⋯ Finger clubbing is a significant predictive variable and was associated with a 5-fold increase in mortality. Other baseline demographic characteristics as well as pulmonary function tests were not predictive of prognosis in Middle Eastern patients with IPF. It appears that IPF patients of Middle Eastern descent have a longer median survival curve compared to other races.
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Obstructive sleep apnoea syndrome (OSAS) is a prevalent condition that covaries with cardiovascular complications and most likely with arterial hypertension and diabetes mellitus. ⋯ The diagnosis of OSAS should be performed with a polygraph, and the first-line treatment of moderate to severe OSAS is CPAP. Lastly, compliance for this treatment should be optimised with regular clinical controls.