Respiratory System Commons^™

Phenotypical Characterization Of Human Rhinovirus Infections In Severely Premature Children, Geovanny F. Perez, Bassem Kurdi, Rosemary Megalaa, Krishna Pancham, Shehlanoor Huseni, Natalia Isaza, Carlos E. Rodriguez-Martinez, Dinesh Pillai, Gustavo Nino

Pediatrics Faculty Publications

Background: Human Rhinovirus (HRV) has been identified as the most common cause of acute respiratory infections and hospitalizations in premature children. It is unclear if premature children are more susceptible to HRV due to their decreased pulmonary reserve or because they have enhanced lower airway reactivity to HRV.

Methods: We conducted a retrospective analysis of the clinical respiratory presentation of all PCR-confirmed HRV infections in full-term and premature children aged ≤ 3 years in our institution. Standardized respiratory distress scores were developed to examine lower airway obstruction (i.e., wheezing, hyperinflation, and sub-costal retractions) along with markers of decreased pulmonary reserve …

Performance Anxiety And The Benefits Of Proper Breathing For Singing, Kate Zecher

Undergraduate Theses

The intent of this thesis is to help those with Music Performance Anxiety, or anxiety in general, better understand their anxiety and its causes. They can then use this knowledge to reduce or control their symptoms in order to improve their performance, whether on a stage or in a classroom. One of the main symptoms of Music Performance Anxiety is constriction of the chest. It is one of the most debilitating symptoms to singers as it causes shortness of breath. Therefore, focusing on anxiety in relation to breathing will most benefit those with Music Performance Anxiety. In addition, learning about …

Mobile Critical Care Recovery Program (M-Ccrp) For Acute Respiratory Failure Survivors: Study Protocol For A Randomized Controlled Trial, Sikandar Khan, Ashok Biju, Sophia Wang, Sujuan Gao, Omar Irfan, Amanda Harrawood, Stephanie Martinez, Anthony Perkins, Frederick W. Unverzagt, Sue Lasiter

Medical College Documents

Background: Patients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors.
Methods: The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) – m-CCRP intervention versus attention control. Those in the intervention group will meet with a care coordinator after …

Clinical Management Of Pressure Control Ventilation: An Algorithmic Method Of Patient Ventilatory Management To Address “Forgotten But Important Variables”, Lonny Ashworth, Yasuhiro Norisue, Megan Koster, Jeff Anderson, Junko Takada, Hatsuyo Ebisu

Respiratory Therapy Faculty Publications and Presentations

Pressure controlled ventilation is a common mode of ventilation used to manage both adult and pediatric populations. However, there is very little evidence that distinguishes the efficacy of pressure controlled ventilation over that of volume controlled ventilation in the adult population. This gap in the literature may be due to the absence of a consistent and systematic algorithm for managing pressure controlled ventilation. This article provides a brief overview of the applications of both pressure controlled ventilation and volume controlled ventilation and proposes an algorithmic approach to the management of patients receiving pressure controlled ventilation. This algorithmic approach highlights the …

The South Sudan: Tuberculosis, Blake Schwarz

Global Public Health

The South Sudan is a country that recently gained independence from the Sudan after a bloody twenty year civil war. They lost nearly two million lives during the war, and are now ravaged by Tuberculosis, or TB. After gaining their independence in 2011, the South Sudan has an average of 18,000 cases of TB at any time. This would consider TB in the South Sudan an endemic, as it always has a base level of TB cases that does not vary. There is medication for TB that is available to the citizens on the South Sudan, but the prescription is …

Increase In Intra-Abdominal Pressure During Airway Suctioning-Induced Cough After A Successful Spontaneous Breathing Trial Is Associated With Extubation Outcome, Lonny Ashworth

Respiratory Therapy Faculty Publications and Presentations

Background: A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT).

Methods: Three hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a fluid …

Imaging-Based Clusters In Current Smokers Of The Copd Cohort Associate With Clinical Characteristics: The Subpopulations And Intermediate Outcome Measures In Copd Study (Spiromics), Babak Haghighi, Sanghun Choi, Jiwoong Choi, Eric A. Hoffman, Alejandro P. Comellas, John D. Newell, R. Graham Barr, Eugene Bleecker, Christopher B. Cooper, David Couper, Mei Lan Han, Nadia N. Hansel, Richard E. Kanner, Ella A. Kazerooni, Eric A.C. Kleerup, Fernando J. Martinez, Wanda O'Neal, Stephen I. Rennard, Prescott G. Woodruff, Ching-Long Lin

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Classification of COPD is usually based on the severity of airflow, which may not sensitively differentiate subpopulations. Using a multiscale imaging-based cluster analysis (MICA), we aim to identify subpopulations for current smokers with COPD.

METHODS: Among the SPIROMICS subjects, we analyzed computed tomography images at total lung capacity (TLC) and residual volume (RV) of 284 current smokers. Functional variables were derived from registration of TLC and RV images, e.g. functional small airways disease (fSAD%). Structural variables were assessed at TLC images, e.g. emphysema and airway wall thickness and diameter. We employed an unsupervised method for clustering.

RESULTS: Four clusters …

Use Of A 4-Week Up-Titration Regimen Of Roflumilast In Patients With Severe Copd, Henrik Watz, Nitin Bagul, Klaus F. Rabe, Stephen I. Rennard, Vijay Kt Alagappan, Jonas Román, Axel Facius, Peter Ma Calverley

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: The oral selective phosphodiesterase-4 inhibitor roflumilast (ROF) reduces exacerbations in patients with severe COPD. Adverse events (AEs) can cause early ROF discontinuation. Alternative dosing strategies may help patients continue their therapy.

METHODS: In this multicenter, double-blind trial, 1,321 patients with severe COPD were randomized 1:1:1 to 4 weeks' treatment with ROF 250 µg once daily (OD), 500 µg every other day (EOD), or 500 µg OD, each followed by ROF 500 µg OD for 8 weeks, plus standard therapy. The primary end point was the percentage of patients prematurely discontinuing study treatment.

RESULTS: Patients in the 250 µg OD/500 …

Towards Using A Physio-Cognitive Model In Tutoring For Psychomotor Tasks., Jong W. Kim, Chris Dancy, Robert A. Sottilare

Faculty Conference Papers and Presentations

We report our exploratory research of psychomotor task training in intelligent tutoring systems (ITSs) that are generally limited to tutoring in the desktop learning environment where the learner acquires cognitively oriented knowledge and skills. It is necessary to support computer-guided training in a psychomotor task domain that is beyond the desktop environment. In this study, we seek to extend the current capability of GIFT (Generalized Intelligent Frame-work for Tutoring) to address these psychomotor task training needs. Our ap-proach is to utilize heterogeneous sensor data to identify physical motions through acceleration data from a smartphone and to monitor respiratory activity through …

Centrilobular Emphysema And Coronary Artery Calcification: Mediation Analysis In The Spiromics Cohort, Surya P. Bhatt, Hrudaya P. Nath, Young-Il Kim, Rekha Ramachandran, Jubal R. Watts, Nina L.J. Terry, Sushil Sonavane, Swati P. Deshmane, Prescott G. Woodruff, Elizabeth C. Oelsner, Sandeep Bodduluri, Meilan K. Han, Wassim W. Labaki, J. Michael Wells, Fernando J. Martinez, R. Graham Barr, Mark T. Dransfield, Spiromics Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a two-to-five fold increase in the risk of coronary artery disease independent of shared risk factors. This association is hypothesized to be mediated by systemic inflammation but this link has not been established.

METHODS: We included 300 participants enrolled in the SPIROMICS cohort, 75 each of lifetime non-smokers, smokers without airflow obstruction, mild-moderate COPD, and severe-very severe COPD. We quantified emphysema and airway disease on computed tomography, characterized visual emphysema subtypes (centrilobular and paraseptal) and airway disease, and used the Weston visual score to quantify coronary artery calcification (CAC). We used …

Can Capture Be Used To Identify Undiagnosed Patients With Mild-To-Moderate Copd Likely To Benefit From Treatment?, Nancy K. Leidy, Fernando J. Martinez, Karen G. Malley, David M. Mannino, Meilan K. Han, Elizabeth D. Bacci, Randall W. Brown, Julia F. Houfek, Wassim W. Labaki, Barry J. Make, Catherine A. Meldrum, Wilson Quezada, Stephen I. Rennard, Byron Thomashow, Barbara P. Yawn

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE™) uses five questions and peak expiratory flow (PEF) thresholds (males ≤350 L/min; females ≤250 L/min) to identify patients with a forced expiratory volume in 1 second (FEV

METHODS: Data from the CAPTURE development study were used to test its sensitivity (SN) and specificity (SP) differentiating mild-to-moderate COPD (n=73) from no COPD (n=87). SN and SP for differentiating all COPD cases (mild to severe; n=259) from those without COPD (n=87) were also estimated. The modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT™) …

The Development Of Azd7624 For Prevention Of Exacerbations In Copd: A Randomized Controlled Trial, Naimish R. Patel, Danen M. Cunoosamy, Malin Fagerås, Ziad Taib, Sara Asimus, Tove Hegelund-Myrbäck, Sofia Lundin, Katerina Pardali, Nisha Kurian, Eva Ersdal, Cecilia Kristensson, Katarina Korsback, Robert Palmér, Mary N. Brown, Steven Greenaway, Leonard Siew, Graham W. Clarke, Stephen I. Rennard, Barry J. Make, Robert A. Wise, Paul Jansson

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: p38 mitogen-activated protein kinase (MAPK) plays a central role in the regulation and activation of pro-inflammatory mediators. COPD patients have increased levels of activated p38 MAPK, which correlate with increased lung function impairment, alveolar wall inflammation, and COPD exacerbations.

OBJECTIVES: These studies aimed to assess the effect of p38 inhibition with AZD7624 in healthy volunteers and patients with COPD. The principal hypothesis was that decreasing lung inflammation via inhibition of p38α would reduce exacerbations and improve quality of life for COPD patients at high risk for acute exacerbations.

METHODS: The p38 isoform most relevant to lung inflammation was assessed …

Increasing The Use Of Waveform Capnography In Neonatal And Pediatric Patients, Sherry Mccool, Lisa Pruitt, Olivia Kaullen

Posters

No abstract provided.

A Bronchiolitis Study: The Overuse Of Bronchiolitis Therapies In Children Admitted Into The Hospital, Jocelyn S. Canedo

Theses and Dissertations

Bronchiolitis is prevalent among infants of 0 to 12 months, and usually caused by a variation of viruses. Signs and symptoms consist of coughing, rapid breathing, and an occasional fever in some infants. Bronchiolitis is not treated with antibiotics, but rather with proper medical examination and other procedures. Chest radiographs, steroids, and certain bronchodilators are considered ineffective treatments. This study identified the amount of ineffective procedures being used in infants admitted into the pediatric emergency room, and the effect it had on the patient’s average hospital stay. Past medical records were used in this clinical study. Statistical analyses and graphs …

Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer

Journal of Patient-Centered Research and Reviews

Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who …

Impact Of Physician Education And Availability Of Parameters Regarding Esophageal Pressure And Transpulmonary Pressure On Clinical Decisions Involving Ventilator Management, Lonny Ashworth

Respiratory Therapy Faculty Publications and Presentations

Purpose: This study investigated the effects of physician education and the availability of P_eso and P_L data on physicians' decisions regarding ventilator management during specific simulated clinical conditions.

Materials and methods: The study was a prospective, before–after study using a case scenario–based questionnaire and a case simulator device comprising an Avea ventilator and an artificial lung and esophagus, which was connected to a Series 1101 Electronic Breathing Simulator. The 99 physicians participating in the study were provided with five simulated cases with on-time ventilator graphics without P_eso and P_L and completed a questionnaire on decisions they …

Global Respiratory Syncytial Virus-Associated Mortality In Young Children (Rsv Gold): A Retrospective Case Series, Nienke M. Scheltema, Angela Gentile, Florencia Lucion, D James Nokes, Patrick K. Munywoki, Shabir A. Madhi, Michelle J. Groome, Cheryl Cohen, Jocelyn Moyes, Syed Asad Ali

Department of Paediatrics and Child Health

Background: Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data.

Methods: In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive …

Measuring The Energy Of Ventilation And Circulation During Human Walking Using Induced Hypoxia, Masahiro Horiuchi, Yoshiyuki Fukuoka, Yoko Handa, Daijiro Abe, Herman Pontzer

Publications and Research

Energy expenditure (EE) during walking includes energy costs to move and support the body and for respiration and circulation. We measured EE during walking under three different oxygen concentrations. Eleven healthy, young, male lowlanders walked on a treadmill at seven gait speeds (0.67–1.83 m s−1) on a level gradient under normobaric normoxia (room air, 21% O2), moderate hypoxia (15% O2), and severe hypoxia (11% O2). By comparing the hypoxia-induced elevation in heart rate (HR [bpm]), ventilation (VE [L min−1]) with the change in energy expenditure (EE [W]) at each speed, we were able to determine circulatory and respiratory costs. In …

Hypersensitivity Of Vagal Pulmonary Afferents Induced By Tumor Necrosis Factor Alpha In Mice, Ruei-Lung Lin, Qihai Gu, Lu-Yuan Lee

Physiology Faculty Publications

Tumor necrosis factor alpha (TNFα), a pro-inflammatory cytokine, plays a significant role in the pathogenesis of allergic asthma. Inhalation of TNFα also induces airway hyperresponsiveness in healthy human subjects, and the underlying mechanism is not fully understood. A recent study reported that TNFα caused airway inflammation and a sustained elevation of pulmonary chemoreflex responses in mice, suggesting a possible involvement of heightened sensitivity of vagal pulmonary C-fibers. To investigate this possibility, the present study aimed to investigate the effect of a pretreatment with TNFα on the sensitivity of vagal pulmonary afferents in anesthetized mice. After TNFα (10 μg/ml, 0.03 ml) …

Effects Of Ankle Weights On Metabolic Response And Muscle Activity On A Lower Body Positive Pressure Treadmill 2017, Saige Hupman

Master's Theses

Lower body positive pressure (LBPP) treadmills are growing in popularity for rehabilitative use, as the benefits of exercising at partially supported body weight may induce faster recovery. It is unknown if there are certain practices that increase exercise intensity while maintaining positive effects of LBPP. Adding ankle weights when walking or running could increase intensity of rehabilitation programs while maintaining the comfort of supported body weight. PURPOSE: To measure metabolic response (VO2, RER, HR, Caloric expenditure), RPE, and lower limb electromyography (EMG) amplitudes of LBPP treadmill walking and running with and without ankle weights. METHODS: Sixteen participants (Age: 21.94 ± …

The Relationship Between Ratings Of Perceived Exertion And Heart Rate In Ncaa Division Iii Male Soccer Players 2017, Samuel J. Guider

Master's Theses

Every sport has specific physical demands of the human body. The amount of physiological load that an athlete endures during a bout of exercise can be described as training load (TL). Accurate calculation of training loads within athletes is important when it comes to strength and power development, as well as injury prevention and monitoring fatigue. Common methods used to calculate training loads for athletes include rating of perceived exertion (RPE) based methods, heart rate (HR) based methods, rate of oxygen consumption (VO2) methods, and blood lactate methods. Specifically with NCAA male soccer athletes, HR based methods and RPE based …

May 2017, Swosu Bulldog Wellness Committee

SWOSU BULLDOG WELLNESS

No abstract provided.

Mallampati Scoring And Its Relation To Obstructive Sleep Apnea, Austin Korczak

Honors Capstones

According to the American Sleep Apnea Association potentially 80% of moderate to severe cases of Obstructive Sleep Apnea (OSA) go undiagnosed with even optimistic estimates stating that at least 22 million Americans are afflicted by the disorder. These numbers are expected to continue to increase due to the rising rates of obesity in America. As a result, reliable criteria that can help physicians accurately predict the presence of an underlying sleep disorder, whose symptoms are masked during the day, is highly sought after. The objective of this research is to begin defining these criteria via a literature review of articles …

Cigarette Smoke Impairs A2a Adenosine Receptor Mediated Wound Repair Through Up-Regulation Of Duox-1 Expression., Zhi Tian, Hui Zhang, Jendayi Dixon, Nicole Traphagen, Todd A. Wyatt, Kusum K. Kharbanda, Samantha Simet, Narasaiah Kolliputi, Diane S Allen-Gipson

Journal Articles: Pulmonary & Critical Care Med

Cigarette smoke (CS) exposure and intrinsic factors such as the NADPH oxidases produce high levels of reactive oxygen species (ROS), ensuing inflammatory tissue injury. We previously demonstrated that CS-generated ROS, particularly hydrogen peroxide (H2O2), impaired adenosine stimulated wound repair. We hypothesized that CS exposure modulates expression of Dual oxidase 1 (Duox-1), a NADPH oxidases known to generate H2O2. To test this hypothesis, we used human bronchial epithelial cell line Nuli-1 and C57BL/6 mice. Cells were treated with 5% CS extract (CSE) for various periods of time, and mice were exposed to whole body CS for six weeks. Both CSE and …

Effect Of Low-Level Co2 On Innate Inflammatory Protein Response To Organic Dust From Swine Confinement Barns., David Schneberger, Jane M. Devasure, Kristina L. Bailey, Debra J. Romberger, Todd A. Wyatt

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Organic hog barn dust (HDE) exposure induces lung inflammation and long-term decreases in lung function in agricultural workers. While concentrations of common gasses in confined animal facilities are well characterized, few studies have been done addressing if exposure to elevated barn gasses impacts the lung immune response to organic dusts. Given the well documented effects of hypercapnia at much higher levels we hypothesized that CO2 at 8 h exposure limit levels (5000 ppm) could alter innate immune responses to HDE.

METHODS: Using a mouse model, C57BL/6 mice were nasally instilled with defined barn dust extracts and then housed in …

Effect Of Low-Level Co2 On Innate Inflammatory Protein Response To Organic Dust From Swine Confinement Barns., David Schneberger, Jane M. Devasure, Kristina L. Bailey, Debra J. Romberger, Todd A. Wyatt

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Organic hog barn dust (HDE) exposure induces lung inflammation and long-term decreases in lung function in agricultural workers. While concentrations of common gasses in confined animal facilities are well characterized, few studies have been done addressing if exposure to elevated barn gasses impacts the lung immune response to organic dusts. Given the well documented effects of hypercapnia at much higher levels we hypothesized that CO2 at 8 h exposure limit levels (5000 ppm) could alter innate immune responses to HDE.

METHODS: Using a mouse model, C57BL/6 mice were nasally instilled with defined barn dust extracts and then housed in …

The Effects Of Intrauterine Growth Restriction (Iugr) On The Pulmonary Surfactant And Lung Injury, Reza Khazaee

Western Research Forum

The Effects of Intrauterine Growth Restriction (IUGR) on the Pulmonary Surfactant and Lung Injury

Khazaee R¹, McCaig LA², Hardy D¹, Yamashita CM², Veldhuizen, RAW²

Department of Physiology and Pharmacology¹, Western University, London, ON, Canada. Lawson Health Research Institute², London, ON, Canada

Background: Acute respiratory distress syndrome (ARDS) is defined as severe lung dysfunction that occurs after an insult to the lung such as an infection. The lung dysfunction in ARDS is due to alterations to surfactant, a lipid-protein mixture coats the inside of the lung and …

Longitudinal Cardiovascular Outcomes Of Sleep Disordered Breathing In Children: A Meta-Analysis And Systematic Review., Zarmina Ehsan, Stacey L. Ishman, Thomas R. Kimball, Nanhua Zhang, Yuanshu Zou, Raouf S. Amin

Manuscripts, Articles, Book Chapters and Other Papers

Objectives: The presence of sleep disordered breathing (SDB) is known to impact long-term cardiovascular morbidity in adults; however, the long-term effects in children are poorly understood. We aimed to systematically review and synthesize studies published to date on the long-term effects of SDB in children.

Study Design: Meta-analysis and systematic review using PubMed, CINAHL, Embase, and Scopus (all indexed years).

Methods: We searched for English-language articles containing original human data from prospective studies, with ≥7 participants, in children ≤18 years of age. Data regarding study design, demographics, clinical characteristics, outcomes, level of evidence, and risk of bias were obtained. Articles …

Reduced Microrna-503 Expression Augments Lung Fibroblast Vegf Production In Chronic Obstructive Pulmonary Disease, Jun Ikari, Amy J. Nelson, Jannah Obaid, Alvaro Giron-Martinez, Kumiko Ikari, Fumihiko Makino, Shunichiro Iwasawa, Yoko Gunji, Maha Farid, Xingqi Wang, Hesham Basma, Dawn Demeo, Carol Feghali-Bostwick, Olaf Holz, Klaus Rabe, Xiangde Liu, Stephen I. Rennard

Journal Articles: Pulmonary & Critical Care Med

Alterations in microRNA (miRNA) expression may contribute to COPD pathogenesis. In COPD, lung fibroblast repair functions are altered in multiple ways, including extracellular mediator release. Our prior study revealed miR-503 expression is decreased in COPD lung fibroblasts, although the exact role played by miR-503 is undetermined. The current study examined a role of miR-503 in cytokine, growth factor and fibronectin production by lung fibroblasts from patients with and without COPD. Primary adult lung fibroblasts were isolated from patients with or without COPD. MiR-503 expression and interleukin (IL)-6, -8, PGE2, HGF, KGF, VEGF and fibronectin release were examined with or without …

Variability In Objective And Subjective Measures Affects Baseline Values In Studies Of Patients With Copd, Wayne H. Anderson, Jae Wook Ha, David J. Couper, Wanda K. O'Neal, R. Graham Barr, Eugene R. Bleecker, Elizabeth E. Carretta, Christopher B. Cooper, Claire M. Doerschuk, M. Bradley Drummond, Meilan K. Han, Nadia N. Hansel, Victor Kim, Eric C. Kleerup, Fernando J. Martinez, Stephen I. Rennard, Donald Tashkin, Prescott G. Woodruff, Robert Paine, Jeffrey L. Curtis, Richard W. Kanner, Spiromics Research Group

Journal Articles: Pulmonary & Critical Care Med

RATIONALE: Understanding the reliability and repeatability of clinical measurements used in the diagnosis, treatment and monitoring of disease progression is of critical importance across all disciplines of clinical practice and in clinical trials to assess therapeutic efficacy and safety.

OBJECTIVES: Our goal is to understand normal variability for assessing true changes in health status and to more accurately utilize this data to differentiate disease characteristics and outcomes.

METHODS: Our study is the first study designed entirely to establish the repeatability of a large number of instruments utilized for the clinical assessment of COPD in the same subjects over the same …