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might be different between the races.”
Does the evidence hold up
Gerard J. Criner, MD, serves as Philadelphia
clinical center director for the National Institute
of Health’s massive COPDGene study. The
underlying purpose of the study, Dr. Criner said,
is to discover if there are independent genetic
factors that can explain racial and gender differences
in susceptibility to smoking and COPD.
“We’re identifying different patterns found on
X-ray — more airway disease, more emphysema,
more airways obstruction — things that no one
could articulate before, without study information,”
Dr. Criner said. “We may discover separate
clinical phenotypes found in COPD patients
that have some relationship to race.”
While variables of susceptibility may exist,
Dr. Criner emphasized that in more than 10,000
COPD patients involved in the study there is a
substantial amount of genetic mixture that has
occurred over the generations. “So, there may
be more variability than can be explained by
gender or race,” he said. “But we won't know
for sure until data has been analyzed. We need
to use caution. It still remains to be seen.”
But Dr. Dransfield drew a line in the genetic
susceptibility debate, noting there are most certainly
differences between the races. “It’s a touchy
subject, but there clearly are,” he said. “It’s not all
about access of care and quality of care, as some
might suggest. That’s another issue that is valid.
But there is still more. Just as there are differences
between men and women that have to do
with hormones, so are there differences between
the races in a variety of gene frequencies. There
could be lots of differences, including nicotine
metabolism, how well the body deals with oxygen
stress, or how aggressively the neutrophils in the
body respond to the stimulus from cigarette
smoke. We are not all exactly the same.”
And both men agreed that genetic factors,
working in concert with environmental factors
— such as an urban or rural atmosphere, or
exposure to certain pollutants or chemical substances
— could point toward heightened COPD
susceptibility.
Why does it matter
“Biological Environmental Physiological I
don’t know. It could be all of them, none of them,
or a combination,” said a reflective Dr. Criner,
who is also a professor, chief of pulmonary and
critical care medicine, and director of the intensive
care unit and ventilator rehabilitation unit
at Temple University Hospital, Philadelphia.
But he stated with certainty that when it comes
to patient care, defining the susceptibility variables
will have landmark effects. Once it is established
that there are distinct presentations of this disease
predicted by certain characteristics of gender or
race, patients will be followed earlier, more carefully,
and their outcomes may be different.
“If we can identify certain proteins or genes
or combinations that could indicate a different
prognosis or even identify potential targets for
treatment, that will have significant impact on
improved practice,” Dr. Criner said. “And it will
certainly give more credence to the notion of
personalized health care. We can’t treat everybody
the same.” n
Contact Valerie Neff Newitt at vnewitt
@advanceweb.com
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QUESTIONS
Contact Kristen Ziegler at
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or kziegler@advanceweb.com
Ask the Expert
Q: I am considering using one-way valves to prevent cross contaminations
in my spirometry testing. Is this the best method
A: One-way valves can be a potential cost-saving consumable that prevent inhalation through
a reusable sensor for hygiene purposes. However, in terms of diagnostic spirometry, the
inspiration following the forced expiration is key information to assess patient compliance.
Compared to a one-way valve, a disposable turbine that is singularly packed and factorycalibrated
guarantees hygiene and cost-effectiveness, along with the advantage of adding
full-featured diagnostic capabilities of a complete flow/volume loop as recommended by the
American Thoracic Society.
—Donald Melnikoff, president, MIR Medical International Research USA
20 ADVANCE for Healthcare Careers