CHEST Guidelines-Association-Between-Baseline-Airflow-Obstruction-a

Association-Between-Baseline-Airflow-Obstruction-a

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The document discusses a correspondence regarding the study by Mohamed Hoesein et al., which investigated the rate of lung function decline among male heavy smokers with varying degrees of baseline airflow obstruction. Deepak Aggarwal and Prasanta Raghab Mohapatra highlight that the study's criteria might have included patients with other diseases such as asthma, which typically does not lead to progressive lung function decline. They suggest that segregating patients based on serial spirometry could have improved specificity. The inclusion of nonsmokers and consideration of other risk factors like air pollution could have provided a better understanding of COPD progression. Additionally, the impact of acute COPD exacerbations and treatment on lung function decline were suggested as factors needing closer examination.<br /><br />In response, Firdaus A.A. Mohamed Hoesein and Pieter Zanen clarify that their study focused on heavy smokers and that asthma was not specifically included or excluded due to its equal prevalence across groups. They assert that exacerbations were unlikely to have affected FEV1 decline significantly due to low frequencies in early-stage COPD among their cohort. Furthermore, the response notes evidence suggesting that bronchodilator or steroid treatments do not significantly alter the long-term decline in lung function.<br /><br />Additionally, the document includes a letter from Nishi Rawat discussing ICU staffing, particularly the role of 24-hour intensivist coverage in both academic and community settings. Rawat emphasizes the challenges of manpower shortages and the need for research into alternative staffing methods, such as remote monitoring or expanded hospitalist coverage, in community ICU settings. This is crucial given the small regional pool of intensivists and the high proportion of nonacademic ICUs in the U.S. Rawat advocates for a shift in focus toward community ICU staffing to ensure effective use of the limited number of trained intensivists available.

Keywords

lung function decline

heavy smokers

airflow obstruction

COPD progression

asthma

spirometry

exacerbations

ICU staffing

intensivist coverage

community ICUs