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Pulmonary Rehabilitation |

The Prevalence of Obstructive Lung Pattern on Pulmonary Function Tests in Patients With Congestive Heart Failure

Larry Ladi, MD; Thomas Lee, MD; Michael Sherman, MD
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Drexel, Philadelphia, PA


Chest. 2013;144(4_MeetingAbstracts):825A. doi:10.1378/chest.1705123
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Abstract

SESSION TITLE: Physiology/PFTs/Rehabilitation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Congestive heart failure (CHF) presenting as wheezing (“cardiac asthma”) is well described and has been ascribed to intraluminal edema fluid, bronchial mucosal swelling, and reflex bronchoconstriction. Prior studies of pulmonary function in CHF, however, demonstrate a predominant restrictive pattern. We report on the prevalence of obstruction in smokers and never-smokers with CHF.

METHODS: After Institutional Review Board approval, we conducted a retrospective review of pulmonary function tests of patients 18 years of age or greater with a diagnosis of congestive heart failure performed between 2008 and 2012. Subjects were grouped by smoking status as “smokers” (current or former smokers) or “never smokers”. Obstruction was defined as an FEV-1/SVC ratio less than 70% and restriction defined by a total lung capacity less than the lower limit of normal (approximately 80% predicted). Data is presented as mean + SD.

RESULTS: 344 subjects were identified; 229 were smokers and 115 patients were never-smokers. Demographics included an average age of 49 + 13 years-old, 62% male and BMI 31.7 + 7.8 kg/m2. Forty one percent of all subjects were noted to be obstructed; 49.1% demonstrated a restrictive defect and 16.6% were both restrictive and obstructed. Never-smokers average age was 49 + 14 with a gender distribution of 53.9% male and 46.1% female. Thirty three percent of never-smokers demonstrated obstruction, 53.0% demonstrated a restrictive defect, and 15.7% were both restricted and obstructed.

CONCLUSIONS: Previous studies of pulmonary function in patients with CHF have revealed a restrictive lung pattern. In our study, we noted that 33% of our subjects who were never-smokers and diagnosed with CHF demonstrated an obstructive pattern on pulmonary function testing. To our knowledge, the prevalence of obstruction in CHF has not been previously reported.

CLINICAL IMPLICATIONS: Further studies are warranted to evaluate whether these physiologic changes reflect permanent alterations of lung anatomy or result solely from potentially reversible alterations of lung hydrodynamics, and whether the degree of lung obstruction is associated with severity of heart failure per New York Heart Failure classification.

DISCLOSURE: The following authors have nothing to disclose: Larry Ladi, Thomas Lee, Michael Sherman

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