BackgroundThe diagnosis of chronic obstructive pulmonary disease (COPD) is usually made based on history and physical exam alone. Symptoms of dyspnea, cough, and wheeze are nonspecific and attributable to a variety of diseases. Confirmatory testing to verify the airflow obstruction is available but rarely used, which may result in substantial misdiagnoses of COPD. The aim of this study is to evaluate the use of confirmatory testing and assess the accuracy of the diagnosis.MethodsFrom January 2011 through December 2013, 6,018 patients with COPD as a principal or leading diagnosis were admitted at a community teaching hospital. Of those, only 504 (8.4%) patients had spirometry performed during hospitalization. The studies were reviewed by two board-certified pulmonologists to verify presence of persistent airflow obstruction. Charts of these patients were then examined to determine if the spirometry results had changed the diagnosis or the treatment plan for these patients.ResultsSpirometry confirmed the diagnosis of COPD in 270 patients (69.2%) treated as COPD during their hospitalization. Restrictive lung disease was found to be present in 104 patients (26.6%) and normal in 16 patients (4.2%). Factors predictive of airflow obstruction included smoking status and higher pack-year history. Negative predictive factors included higher body mass index (BMI) and other medical comorbidities. These patients were significantly more likely to be misdiagnosed and mistreated as COPD.ConclusionUp to a third of patients diagnosed and treated as COPD in the hospital may be inaccurately diagnosed as COPD based on confirmatory spirometry testing. Factors contributing to the inaccuracy of diagnosis include less smoking history, high BMI, and associated comorbidities.

So that changes in production and binding of tumor necrosis factor-alpha during postpneumonectomy lung growth could be determined, rats underwent left lung resection and were killed 3, 7, or 14 days later, 1 hour after the injection of 3H-thymidine. Serum was collected, and the lungs were lavaged and perfused in vitro. Lung volumes were measured. Lungs were homogenized, and changes in lung weight, protein content, deoxyribonucleic acid content, deoxyribonucleic acid synthesis, and tyrosine kinase activity of different lobes were recorded. Tumor necrosis factor-alpha content of serum, lavage fluid, and perfusate was measured by an enzyme-linked immunoassay. The binding of tumor necrosis factor-alpha to membrane extracts of lung homogenates was measured by immunoblots. Whereas the cardiac lobe of the remaining right lung demonstrated larger increases in size than other lobes after pneumonectomy, there was no difference in any growth parameter between it and the other lung lobes. Serum tumor necrosis factor-alpha was detectable in sham-operated animals and increased significantly after pneumonectomy. However, by day 14, it was not different from the level in sham-operated animals. In contrast, tumor necrosis factor-alpha in lavage fluid remained significantly elevated, and its binding increased gradually throughout the study period. Tumor necrosis factor-alpha in perfusate did not demonstrate any rise. We conclude that lung growth after pneumonectomy is uniform among various lobes, which suggests that it is regulated by humoral factors. Because tumor necrosis factor-alpha, a cytokine known to stimulate cellular proliferation and matrix synthesis, is produced and bound to the lung during this process, it may be one of the humoral factors implicated in postpneumonectomy lung growth.

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Fluoroquinolones are a commonly prescribed class of medications for pneumonia. In the last decade, U.S. Food and Drug Administration (FDA) has issued warnings including tendinitis, clostridium difficile infection, aortic aneurysms and hypoglycemia in elderly patients. Despite these warnings, the Infectious Disease Society of America (IDSA) health care acquired pneumonia (HAP) guidelines and American Thoracic Society community acquired pneumonia (CAP) guidelines endorses fluoroquinolones as first line treatment. With fluoroquinolone restriction in many hospitals, including ours, the question remains whether restrictions on fluoroquinolones are affecting patient outcomes. This study analyzes the affects of levofloxacin restriction for the treatment of pneumonia. We examined the rate of readmission, c-diff rates and mortality before and after levofloxacin restriction was instituted.