Publications by authors named "Jose Joseph Vempilly"

5 Publications

  • Page 1 of 1

Air Trapping Correlates With Increased Frequency of Albuterol Use and Severity of Wheeze in Persistent Asthma.

Respir Care 2020 Jul 4;65(7):994-1000. Epub 2020 Feb 4.

Pulmonary Critical Care Medicine, University of California San Francisco, San Francisco, California.

Background: Symptoms of asthma have been shown to correlate poorly with spirometric variables of obstruction. We hypothesized that lung volume measurements might correlate with symptoms and frequency of rescue inhaler use in asthma.

Methods: Patients with persistent asthma on treatment for ≥12 months were enrolled from university-based clinics. The association between lung volumes, spirometry, asthma symptoms, and rescue inhaler use were explored by using linear modeling.

Results: Among the 120 subjects, 76% were women. The mean age ± SD was 52 ± 15 y. With regard to ethnicity, 64% of the subjects were caucasian, 23% were Hispanic, and 13% were African-American. Twenty-one percent of the subjects reported chest pain. There was no significant correlation between asthma symptoms or rescue inhaler use to spirometry indices of obstruction. The residual volume percent of predicted showed a significant association with the wheeze score (r = 0.32, = .001) and frequency of rescue inhaler use (r = 0.35, ≤ .001). Linear contrast analysis showed that the mean wheeze score ( = .003) and frequency of rescue inhaler ( = .007) use increased linearly from the lowest to the highest quartiles of residual volume. Furthermore, multiple regression analysis showed an association only to the residual volume percent predicted value to the pressurized metered-dose inhaler score and the wheeze score.

Conclusions: Frequent albuterol use and wheezing may be a sign of unrelieved air trapping. Chest pain is a unique symptom in persistent asthma, and the pathogenesis requires further studies. Lung volume measurement added to routine spirometry can help identify patients with asthma and with air trapping.
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July 2020

Increased E/A Ratio is a Risk Factor for the Formation of Pleural Effusion in Heart Failure.

Lung 2020 02 18;198(1):229-233. Epub 2019 Dec 18.

VA Medical Center, UCSF Fresno, 2615 E. Clinton Ave, Fresno, CA, 9370-2223, USA.

Purpose: Pleural effusion is a common finding in patients with congestive heart failure (CHF). The pathogenesis of pleural effusion in heart failure is multifactorial. However, the role of right and left ventricular function assessed by ECHO cardiogram has not been studied. Therefore, we explored the association between right and left ventricular parameters on echocardiogram in patients with heart failure with and without pleural effusion diagnosed using CT scan of chest.

Methods: A case-control study was utilized to explore the objectives. Using strict exclusion criteria, patients admitted with a single diagnosis of acute CHF were stratified into those with and without pleural effusion using CT scan of chest done at admission. Multiple logistic regression analysis was used to identify significant factors associated with pleural effusion.

Results: Among the 70 patients, 36 (51%) had pleural effusions. The mean E/A ratio in patients with effusion (2.53 ± 1.1) was significantly higher than in patients without effusion (1.15 ± 0.9), p < 0.01. Multiple logistic regression analysis showed that elevated E/A ratio was significantly associated with pleural effusion, OR 3.26 (95% CI 1.57-6.77, p < 0.009). Left ventricular ejection fraction (LVEF), septal E', lateral E', and medial E/E' ratio were not significantly different in patients with and without pleural effusion.

Conclusion: Elevated E/A ratio is a risk factor for the formation of pleural effusion in patients with heart failure.
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February 2020

Longer duration of asthma is significantly associated with increased RV/TLC ratio.

Respir Med 2017 03 2;124:44-48. Epub 2017 Feb 2.

Division of Pulmonary/Critical Care, UCSF-Fresno, USA. Electronic address:

Background: Although FEV1/FVC ratio has been shown to be negatively associated with longer duration of asthma; an association between RV/TLC ratio and longer duration of asthma has not been explored.

Material And Methods: Patients with established asthma for more than a year and met inclusion and exclusion criteria were recruited. Data obtained by questionnaire after informed consent was obtained, Pulmonary function tests and laboratory results were collected through chart review. Correlation and multiple linear regressions were used to analyze the data.

Results: Among the 93 subjects, 61 were women. The mean age of patients was 58 ± 15 years, and the mean duration of asthma was 21 ± 18 years. The ethnic composition included: Caucasians 64%, Hispanics 28% and other groups 8%. The FEV1/FVC ratio was not significantly associated with duration of asthma (R2 = 0.15, p = 0.05). However, the RV/TLC ratio was significantly associated with duration of asthma (R2 = 0.46, p < 0.001).

Conclusion: RV/TLC ratio may be a better indicator than FEV1/FVC ratio to detect airway obstruction related to longer duration of asthma. Lung volume measurements should be done in addition to spirometry to detect changes related to airway obstruction in patients with longer duration of asthma.
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March 2017

Office spirometry correlates with laboratory spirometry in patients with symptomatic asthma and COPD.

Clin Respir J 2017 Nov 22;11(6):805-811. Epub 2015 Dec 22.

Division of Pulmonary and Critical Care, University of California, San Francisco, Fresno, CA, USA.

Objectives: Spirometry remains underutilized in the evaluation of obstructive lung disease. While office spirometry (OS) has been compared to formal laboratory-based spirometry (LS) in healthy subjects, the correlation has never been formally assessed in patients with symptomatic obstructive lung disease. The aim of this study was to investigate the correlation in this population.

Methods: We used a retrospective study design to analyze spirometry data from patients that underwent both OS and LS. Two flow sensing office (portable) spirometers were used and compared with laboratory-based (body plethymosgraph) spirometer. Accuracy and reliability were assessed using Bland Altman analysis.

Results: Among 185 patients with symptomatic obstructive lung disease, 129 had undergone both OS and LS. Of these, 107 patients had both tests performed less than 90 days apart and were included in final analyses. Mean age was 54 years with mean FEV1 of 1.97 L (65% predicted). Ninety-two patients had airflow obstruction, as determined by a FEV1/FVC ratio of <70%. We found significant correlation in the values between OS and LS for both FEV1 and FVC (r = 0.937 and 0.90, respectively, P < 0.001). Eighty-seven percent of patients had a concordant spirometry in terms of airflow obstruction. Correlation was independent of the office spirometer (and hence the Flow-sensing mechanism) used.

Conclusions: In patients with known asthma and chronic obstructive pulmonary disease (COPD), OS is accurate and reliable when compared to formal laboratory-based spirometry. Routine use of OS should be encouraged to improve spirometry utilization and healthcare outcomes in patients with Asthma and COPD.
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November 2017

Severe tracheomalacia in the ICU: identification of diagnostic criteria and risk factor analysis from a case control study.

Respir Care 2013 Feb;58(2):340-7

Department of Pulmonary and Critical Care, University of California, San Francisco-Fresno, Fresno, CA 93701, USA.

Background: Severe tracheomalacia (STM) is being increasingly recognized as a cause for respiratory failure in the ICU. The diagnosis is often overlooked, as chest radiography appears normal, and the role of invasive diagnostic testing for this diagnosis is not well described in the ICU setting. The prevalence and risk factors for STM are not known, and computed tomography (CT) based diagnostic criteria for ventilated patients are not well studied.

Methods: Patients admitted between January 2008 and December 2010, with respiratory failure and who failed ventilator discontinuation or required reintubation, were screened for the presence of any tracheal collapse, utilizing prior CT of the chest. Bronchoscopically confirmed cases were compared with age and sex matched controls to identify risk factors.

Results: Twenty-five subjects were identified as having STM, which represented 0.7% of ICU admissions and 1.6% of subjects with respiratory failure. The mean ICU stay was significantly longer in STM (30 d, 95% CI 19.7-40 d), compared to controls (4.4 d, 95% CI 3.6-5.2 d). Obesity (odds ratio 1.26, 95% CI 1.04-1.54) and gastro-esophageal reflux (odds ratio 31, 1.7- 586) were associated with increased risk for STM. The pre-intubation PaCO2 (68 mm Hg, 95% CI 57-79 mm Hg) was significantly higher in STM, compared to controls (38 mm Hg, 95% CI 35-41). The distal tracheal antero-posterior diameter (2.80 mm, 95% CI 2.15-3.46) was significantly lower in STM. A receiver operating characteristic analysis showed a distal tracheal antero-posterior diameter < 7 mm to be the optimal cutoff measurement to diagnose STM.

Conclusion: STM was associated with prolonged ICU stay. A distal tracheal antero-posterior diameter < 7 mm on a non-intubated CT chest was suggestive of STM that required a confirmatory bronchoscopy. Gastroesophageal reflux disease and obesity were potential risk factors.
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February 2013