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- Clinical Indicators of Smear-Positive Pulmonary Tuberculosis Among Hospitalized Patients. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):910A.
Respiratory Infections Posters ISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: The Philippines has a high TB burden. All hospitalized patients with suspected pulmonary tuberculosis (PTB) are placed in respiratory isolation until they are proven non-infectious by negative sputum AFB smears. Lack of specific criteria that point to positive smears often lead to overisolation and increased healthcare cost. The purpose of the study was to identify the clinical indicators of smear-positive PTB patients,METHODS: Charts of all patients admitted within a one-year period to the Isolation Ward due to suspicion of PTB in a tertiary regional referral hospital in the Philippines were reviewed . The proportion of factors including clinical presentation, chest x-ray (CXR) and physical findings which had significant association with smear-positive PTB were determined. A logistic regression model was then made to determine which set of variables had the strongest association with smear-positive PTB.Of the 92 patients studied, 28% had smear-positive PTB. Variables not significantly associated with smear-positive PTB included: history of PTB exposure, cough of at least 2 weeks, night sweats, hemoptysis, lymphadenopathy and CXR findings of upper lobe infiltrates, hilar adenopathy, and pleural effusion. Variables significantly associated with smear-positive PTB included cavitation (58% vs. 5%, p<0.001) or diffuse infiltrates on CXR (31% vs. 11%, p=0.018), history of anorexia (35% vs. 15%, p=0.048), fatigue (38% vs. 9%,p=0.002) and weight loss(54% vs. 27%, p=0.027), and physical finding of fever (31% vs. 9%, p=0.009) and rales on auscultation (58% vs. 32%, p=0.022). No smear-positive PTB patient presented with a normal CXR. The most discriminative indicator of smear-positive PTB was cavitation on CXR with a positive and negative predictive value of 83% and 85%, respectively. With logistic regression, variables that were significantly associated with smear-positive PTB were weight loss,fatigue, fever on admission and CXR findings of diffuse infiammatory infiltrates or cavitation.CONCLUSIONS: Although overisolation was not a significant problem in the institution, patients who are suspected of PTB but have a normal CXR or who does not have any of the following - weight loss, fatigue and fever, CXR findings of diffuse infiammatory infiltrates or cavitation, may not need to be isolated.CLINICAL IMPLICATIONS: In a resource-constrained country with high burden of the PTB,identification of admission clinical parameters can help clinicians decide which PTB cases need to be placed in isolation.The following authors have nothing to disclose: Rylene Baquilod, Albert RafananNo Product/Research Disclosure Information.
- Pulmonary Vascular Dimensions as an Indicator of Pulmonary Hypertension in Scleroderma. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):847A.
DVT/PE/Pulmonary Hypertension Posters IVSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Pulmonary artery diameter (dPA) on chest Computed Tomogram (CT) > 2.9cm and dPA/ dAo (Aorta diameter) >1 has been reported to indicate pulmonary arterial hypertension (PAH) but results are variable with pulmonary fibrosis. Limited information is available on the relation of dPA and dPA/dAo with mean Pulmonary Artery Pressure (mPAP) in patients with PAH associated with Scleroderma (Scl-PAH), many of whom have concomitant pulmonary fibrosis. The objective of this study was to determine (i) if mPAP and Pulmonary Vascular Resistance (PVR) in patients with Scl-PAH correlates with dPA and dPA/dAo and (ii) if there is a significant difference in the dPA and dPA/dAo in Scleroderma patients with and without PAH.METHODS: We reviewed the records of 31 patients with Scl-PAH and 10 patients with Scleroderma without PAH (SCl-NoPAH). Patient demographics, mPAP, and PVR on initial right heart catheterization (RHC) were obtained. Initial CT scans were reviewed with a radiologist who measured the dPA, in the axial sections on mediastinal window, 1cm above level of the bifurcation, using electronic calipers. dAo was measured at the same level as dPA. Correlation between mPAP and dPA and dPA/dAo respectively in Scl-PAH was determined by Pearson's test for linear correlation. Linear regression was used to compare mPA, PVR, dPA and dPA/dAo in Scl-PAH and Scl-NoPAH.RESULTS: In patients with Scl-PAH, dPA correlated with mPAP (r= 0.39; p=0.02) but not with PVR(r= 0.23; p=0.22); dPA/dAo did not show a significant correlation with mPAP (r=0.04, p=0.8) and PVR (r=0.033, p=0.8). mPAP in Scl-PAH was 36.3±10 mmHg, and 18.7±5 in Scl-NoPAH (p<0.0001). dPA in Scl-PAH was 3.4±0.5cm; in Scl-NoPAH was 2.6±0.2 cm (p<0.0001). dPA/dAo in Scl-PAH was 1.14±0.1 cm; in Scl-NoPAH was 0.88±0.07 cm (p<0.0001). dPA and dPA/dAo was significantly higher in Scl-PAH.CONCLUSIONS: In patients with Scl-PAH, dPA on chest CT correlates with mPAP and is also significantly higher than in Scl-No PAH.CLINICAL IMPLICATIONS: Whether dPA can be used to identify which Scleroderma patients have PAH and should be referred for a RHC should be confirmed in larger studies.DISCLOSURE: The following authors have nothing to disclose: Julianne Nichols, Raymond Foley, D. DattaNo Product/Research Disclosure Information.
- Pleomorphic Lung Carcinoma: A Notoriously Aggressive Tumor With Rapid Progression. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):663A.
Cancer Student/Resident Case Report Posters IISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Pleomorphic Lung Carcinoma is a rare poorly differentiated non-small-cell lung carcinoma (NSCLC) containing at least 10% sarcomatoid tumor component, in the WHO histological classification of lung tumors, accounting only 0.1-1.0% of all primary lung cancers. It has a rapid progression and highly morbid course with limited treatment options. We present a case of Pleomorphic Lung Carcinoma (PLC) which rapidly progressed, leading to a fatal outcome.68-year-old man came to ED with complaints of worsening of shortness of breath for one month. Patient denied any cough, hemoptysis, sputum production or weight loss. He had a 52 pack-year history of smoking. Physical examination revealed decrease air entry in left lower lung base which was consistent with chest roentgenogram finding. CT scan revealed bulky adenopathy of left hilum with extensive infiltrates throughout left lower lobe. Patient had Bronchoscopy which showed fungating mass partially obstructing left main bronchus. Biopsy showed spindle cells, giant cells and squamous cells consistent with PLC. Molecular studies showed that tumor was negative for EGFR. However, patient presented again after 3 weeks with worsening dyspnea. PET scan showed multiple hypermetabolic lymph nodes/masses in the left perihilar region and prevascular region. Repeat Bronchoscopy showed complete occlusion of left main stem bronchus. He was discharged home initially and was started on NSCLC chemotherapy. He received 2 cycles of chemotherapy before developing complications and was discharged under hospice care.DISCUSSION: PLC is a rare and very aggressive tumor with high mortality because of lack of evidence-based clinical guidelines in literature for its management due to the rarity of the tumor. MIB-1 index is an indicator of tumor cell growth and proliferation. It is said to be significantly higher in sarcomatous elements than carcinomatous elements. Rapid progression of PLC is also said to come from its sarcomatous component of these tumors through activation of epithelial mesenchymal transition, which is also associated with tumor invasion and metastasis in various carcinomas. EGFR are strongly expressed in NSCLC. Expression of different EGFR mutations is related to the biphasic histological appearance in PLC. Therefore, EGFR inhibitors can be effective in shrinking tumors in such patients.Early diagnosis and aggressive follow-up are most important factors in treatment of PLC. Knowledge of biological & clinical behavior of PLC is fundamental in approaching them aggressively. Reference #1: Fujioka S, Nakamura H, Adachi Y, et al. Pleomorphic carcinoma of the lung in which the sarcomatous element grew rapidly: a case report. Ann Thorac Cardiovasc Surg 2009; 15: 111-4.Reference #2: Shintani Y, Ohta M, Iwasaki T, Ikeda N, Tomita E, Kawahara K. Pulmonary pleomorphic carcinoma with rapid progression. Asian Cardiovasc Thorac Ann. 2013 Apr;21(2):231-4.DISCLOSURE: The following authors have nothing to disclose: Muhammad Azam, Jandark Yuseif, Sarah Asghar, Eyoel Abebe, Shaiquel Jilani, Khalid Zakaria, Sarwan KumarNo Product/Research Disclosure Information.
- Significance of Diffuse Pulmonary Infiltrates in Patients With Lung Cancer. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):602A.
Lung Cancer Posters IISESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Pulmonary infiltrates in lung cancer patients can represent a number of diagnoses including infectious pneumonia, drug/radiation pneumonitis, and/or progression of disease. Only sparse information is available describing the nature of infiltrates and outcome in this population. We designed a study to further improve understanding of this particular process in lung cancer patients.METHODS: We performed a retrospective chart review of patients admitted to a major teaching cancer center with a combined diagnosis of abnormal radiograph/pneumonia and lung cancer from January 2008 to December 2010. Data including patient demographics, cancer type and treatment received, hospital course, and survival were reviewed.RESULTS: A total of 84 admissions in 24 men (44%) and 31 (56%) women were studied. Age on admission ranged from 41 to 87 years old (mean age=66.7). The most common histological type of lung cancer was adenocarcinoma (42%), followed by squamous cell carcinoma (13%). 68% of patients had stage IV lung cancer. In 64 % of cases patients received chemotherapy and/or radiation treatment in the preceding 3 months. The mean hospital stay was 8 days (range 3 days to 60 days). In 42% of cases radiographs were consistent with bilateral infiltrates. 35% of unilateral infiltrates were ipsilateral to the site of original lung cancer. 12% of admissions led to respiratory failure requiring mechanical ventilation. In 85% of cases microbiologic work up yielded no specific causative organism. All patients received antibiotics. Bronchoscopy was performed in 11% of all cases, with three cases showing progression of disease. 85% of admissions led to home discharge. Five patients were discharged to hospice, eight patients died in the hospital.Etiology of pulmonary infiltrates remained unclear in the majority of lung cancer patients. Bilateral infiltrates did not lead to worsening outcome since most deaths occurred in patients with unilateral infiltrates. Respiratory failure requiring intubation on initial presentation was an indicator for mortality during hospitalization. Although bronchoscopy was rarely performed, when it was, it showed clinically significant findings, such as progression of disease.Since the majority of patients with lung cancer had a good outcome, they should be aggressively treated when presenting with new pulmonary infiltrates. When clinically appropriate, bronchoscopy should be performed as it may reveal significant findings such as progression of disease.The following authors have nothing to disclose: Elvina Khusainova, Robert Lee, Diane StoverNo Product/Research Disclosure Information.
- Use of Chest Computed Tomography Angiogram as a Predictor of Diastolic Dysfunction and Pulmonary Hypertension. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):578A.
Ultrasound and Other Imaging PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Diastolic dysfunction (DD), an increasing problem, may result in heart failure with preserved ejection fraction, as well as an associated complication of pulmonary hypertension. A common method for earlier detection of these underdiagnosed disorders could be beneficial for patient outcome. We hypothesize that (1) there will be a correlation between left atrial (LA) size on chest computed tomography angiography (CTA) and echocardiography (Echo), (2) CTA LA size will be larger in those with DD, and (3) main pulmonary artery/Aorta (PA/Aorta) ratio will be larger in those with elevated PA pressures.METHODS: We conducted a retrospective, cross sectional analysis using 127 hospitalized patients who underwent both CTA and Echo within 48 hours of each other. LA size was determined on CTA using the maximum anterior-posterior diameter of the midline in its middle 50%. PA sizes were measured using the widest diameter perpendicular to the long axis at the level of PA bifurcation. Ascending aorta diameter was measured at the same level, and used to calculate the PA/Aorta ratio as standardization. We statistically analyzed LA sizes, LA vs E/E', LA size in normal diastolic function vs. mild, moderate or severe DD, and PA/Aorta in patients with normal vs. elevated estimated Echo PA pressure.RESULTS: There was a strong correlation between LA sizes on CTA and Echo (r=0.7753 r2=0.6011 p<0.0001 n=127). A moderate correlation existed between CTA LA size and Echo E/E' (r=0.4456 r2=0.1986 p<0.0001 n=76). The PA/Aorta measured on CTA in patients with elevated estimated PA pressures (>35 mmHg n=38) was 0.98±0.16, and was significantly different compared to patients with normal PA pressures (≤35 mmHg n=49), 0.89±0.12 (p=0.0028). ANOVA and post-hoc Tukey's revealed a significant difference in CTA LA size between patients with normal diastolic function on Echo, 3.57±0.81 cm (n=65), vs. moderate DD, 4.25±0.66 cm (n=27), or severe DD, 4.56±0.43 cm (n=10) (p<0.0001), but not mild DD (4.12±0.62cm, p>0.05, n=10).CONCLUSIONS: There is a strong correlation between LA sizes obtained on CTA and Echo. A moderate correlation exists between CTA LA size and Echo E/E'. CTA LA size can function as an indicator of moderate and severe DD. CTA serves as a reliable predictor of elevated PA pressures based on determinations of PA/Aorta ratio.CLINICAL IMPLICATIONS: For patients admitted to the emergency department with chest pain and/or dyspnea, enlarged CTA LA size and PA/Aorta ratio may suggest the presence of DD or pulmonary hypertension, respectively.DISCLOSURE: The following authors have nothing to disclose: Adam Lick, Raman Danrad, David Smith, Dana Aiello, Matthew LammiNo Product/Research Disclosure Information.
- Respiratory Volume Monitoring Provides a Better Assessment of Respiratory Status Than Capnography-Based Respiratory Rate Monitoring During Upper Endoscopic Procedures. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):560A.
Patient Safety Initiative PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Continuous respiratory monitoring during endoscopic procedures, while necessary, is often challenging. Current clinical practice based on oximetry and capnography may be able to detect severe respiratory compromise but lacks the fidelity to detect early onset of hypoventilation. It is generally accepted that EtCO2 measurements in non-intubated patients are often unreliable and as a result, the capnography-derived respiratory rate (RR) is often used as an indicator of respiratory sufficiency, since a direct measure of minute ventilation (MV) has been previously unavailable. A respiratory volume monitor (RVM) alongside capnography and oximetry monitors in the endoscopy suite was studied.Continuous respiratory traces were collected from 51 patients (age: 54 ± 5 yrs, BMI: 28 ± 2 kg/m2) undergoing upper endoscopy (EGD and ERCP) under procedural sedation, using an impedance-based RVM (ExSpiron, Respiratory Motion, Inc., Waltham, MA). Standard oximetry, capnography, heart rate (HR), and blood pressure (BP) data were automatically recorded during the procedure. Here we evaluated the frequency of available capnography and oximetry measurements as well as the ability of RR to predict inadequate ventilation (MV < 40% MVBASELINE).RESULTS: In this cohort only 59% of the automatically recorded HR and BP measurements had a corresponding EtCO2 measurement (18% of these measurements were outside a physiologically-relevant range) and only 37% had a corresponding RR from the capnograph. Meanwhile, the RVM reported a RR throughout 97% of the monitored period. Further analysis showed that while MV and RR are functionally related, the correlation between low RR and low MV is weak (r=0.05). In fact, a simple threshold alarm based on RR alone (set at RR<6 b/min) would fail to detect more than 80% of all inadequate ventilation events.CONCLUSIONS: This study confirmed the frequent lack of meaningful EtCO2 data in patients undergoing procedures around the airway such as upper endoscopy. Importantly, we also demonstrated unreliability of the corresponding capnography-based RR. Even when available, the RR measurements were a weak predictor of a patient's overall respiratory status.CLINICAL IMPLICATIONS: The RVM can provide continuous MV and RR measurements, which characterize respiratory status better than RR alone giving providers a truer picture of respiratory status which can allow for timely interventions and improve patient safety.C. Marshall MacNabb: Employee: Respiratory Motion, Inc. Diane Ladd: Employee: Respiratory Motion, Inc. The following authors have nothing to disclose: Katherine Holley, Paige Georgiadis, Hayk Minasyan, Anurag Shukla, Donald MathewsNo Product/Research Disclosure Information.
- A Rare Recovery: A Favorable Outcome in Disseminated VZV and ARDS in a Transplant Patient With CF. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):461A.
Miscellaneous Student/Resident Case Report Posters ISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Disseminated varicella zoster virus (VZV) infection with visceral involvement in lung transplant patients is a rare entity with high morbidity and mortality. VZV reactivation occurs in the presence of cellular immunosuppression.1 Severe disease presents in the transplant population with much of the mortality arising from pulmonary graft dysfunction.2 We present a case of disseminated VZV in a patient with double lung transplant notable for favorable return to function after multi-system organ failure (MSOF) and acute respiratory distress syndrome (ARDS).Our patient is a 44-year-old male with cystic fibrosis, 19 years status post double lung transplant, who presented with right upper quadrant abdominal pain and rash. Physical exam revealed a crusting, vesicular rash on his face, trunk, and abdomen and abdominal tenderness. Initial laboratory studies revealed leukocytosis, thrombocytopenia, hyponatremia, acute kidney injury complicating underlying chronic kidney disease, and elevated transaminases. Portable chest x-ray at this time was unremarkable.DISCUSSION: Given evidence of evolving MSOF, he was admitted to our medical intensive care unit. He was started on broad-spectrum antibiotics and high dose acyclovir, along with varicella immunoglobulin. The patient developed worsening respiratory distress and altered mental status attributed to acyclovir-induced encephalopathy and uremia and was mechanically ventilated. Bronchoscopy was performed, revealing only scant petechiae without endobronchial ulcerations. Chest CT identified diffuse bilateral airspace disease consistent with ARDS. The patient required renal replacement therapy. After nearly one month of hospitalization, the patient was discharged home. He will continue on lifelong oral acyclovir for viral suppression.CONCLUSIONS: This case highlights a uniquely favorable outcome in a patient with remote double lung transplant with disseminated VZV with visceral involvement. Recovery of graft function from ARDS was notable. Bronchoscopy did not show bronchial ulcerations. Interestingly, ulcerations have been suggested by a case series to be an indicator of more advanced varicella pneumonitis.3 The case further confirms the role of intravenous acyclovir, intravenous immunoglobulin, and early intensive care unit transfer in the pulmonary transplant patient with disseminated VZV.Reference #1: Fuks L, Shitrit D, Fox BD, et al. Herpes zoster after lung transplantation: Incidence, timing, and outcome. Ann Thorac Surg. 2009 Feb; 87(2): 423-6.Reference #2: Partridge DG and McKendrick MW. The treatment of varicella-zoster virus infection and its complications. Expert Opin Pharmacother. 2009 Apr; 10(5): 797-812.Reference #3: Inokuchi R, Nakamura K, Sato H et al. Bronchial ulceration as a prognostic indicator for varicella pneumonia: Case report and systematic literature review. J Clin Virol. 2013 Apr;56(4): 360-4.DISCLOSURE: The following authors have nothing to disclose: Geoffrey Bass, William Healy, Stephen Kirkby, Amy Pope-HarmanNo Product/Research Disclosure Information.
- Intensity of Vasopressor Therapy as a Predictor of In-Hospital Death In Patients With Septic Shock. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):229A.
Sepsis & Septic Shock PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Septic shock is the most common cause of death in the intensive care unit, exhibiting a mortality rate of 40 to 60%. Several studies have compared mortalities associated with different vasopressors, but no study has evaluated vasopressor intensity as a prognostic indicator. In this study, therefore, we investigated the association between intensity of vasopressor therapy and in-hospital mortality in patients with septic shock.METHODS: This retrospective cohort study included adult patients (age≥18 years) hospitalized at a community teaching hospital during 2010 with a principal or secondary diagnosis of septic shock and received one or more vasopressors. Intensity of vasopressor therapy served as the predictor variable, and in-hospital survival status served as the outcome variable. Two different measures of therapeutic intensity were considered: (1) peak number of simultaneously administered vasopressors and (2) peak vasopressor dose load (norepinephrine (mg/min) + epinephrine (mg/min) + 0.5×dopamine (mg/kg/min) + 0.1×phenylephrine (mg/min)). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) associated with various peak intensity levels were calculated for a model that predicts death in patients receiving at least the indicated peak number of pressors, i.e. ≥1 to ≥4, and the indicated peak vasopressor load, i.e. ≥1 to ≥50.RESULTS: A total of 129 hospitalizations (128 patients) were included in these analyses. Patients were 72.5 (±15.5) years of age on average (range: 19 to 101 years); 50.0% were male. In-hospital mortality (PPV (95% CI)) by peak number of simultaneous vasopressors were as follows: ≥1, 55.0% (46.5, 63.6), ≥2, 66.7% (52.9, 78.6), ≥3, 83.3% (58.6, 96.4), and ≥4, 100% (39.8, 100). In-hospital mortality (PPV (95% CI)) by peak vasopressor load were as follows: ≥1, 55.0% (46.0, 63.8), ≥10, 61.8% (50.9, 71.9), ≥30, 77.1% (59.9, 89.6), and ≥50, 83.3% (35.9, 99.6).CONCLUSIONS: In-hospital mortality increased as the number of simultaneous vasopressors and the peak vasopressor load increased. Preliminary analyses, therefore, suggest that these measures of vasopressor intensity may serve as tools for predicting in-hospital septic shock mortality risk; however, additional data are needed before any final conclusions can be reached.CLINICAL IMPLICATIONS: Vasopressor intensity could assist with treatment decision-making when caring for patients with septic shock.DISCLOSURE: The following authors have nothing to disclose: Mediha Ibrahim, Imnett Habtes, Shweta Upadhyay, Jeffrey Berger, Patricia Patrick, Donald Brand, Peter SpieglerNo Product/Research Disclosure Information.
- Lung Volume Indices Correlate Better With the Duration of Asthma Than Spirometry. [JOURNAL ARTICLE]
- Chest 2014 Oct 1; 146(4_MeetingAbstracts):15A.
AsthmaSESSION TYPE: Original Investigation SlidePRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AMPURPOSE: Persistent asthma symptoms have been associated with chronic airway inflammation. Further, longer duration of asthma may portend small airway remodeling. However, Spirometry has not been useful in assessing small airway dysfunction. Recently, we reported abnormal lung volume indices in presence of normal spirometry variables in mild to moderate persistent asthma. In this prospective cross sectional study, we investigated the association between lung volume indices and chronicity of asthma.METHODS: Subjects with asthma symptoms for more than a year and on therapy were included. Subjects consented for study, had a full lung function done within 11 months and were administered a questionnaire. Further, subjects' charts were reviewed for additional data. Exclusion criteria: DLCO <70%, presence of CHF, any lung parenchymal disease and pregnancy. Data was analyzed using general linear model. Outcome variables were FEV1/FVC ratio and RV/RLC ratio. Fixed factors: gender, ethnicity, and tobacco use. Co-variables: age, height, weight and asthma duration. Full factor analysis with interactions was used.RESULTS: Mean age of 95 patients was 57.14 years SD±15.55 with 33% male and 66% female. Ethnicity was Caucasian 64%, Hispanic 28% and others 10%. Smoking status was non-smokers 67%, current smokers 5% and ex-smokers 27%. Mean asthma duration was 21.75 years SD±18.60. The Mean FEV1% predicted was 82.19 SD±21.65, FEV1/FVC ratio 73.59 SD±10.31; RV% predicted 118.85 SD±30.07 and RV/TLC was 42.48 SD±8.55. When FEV1/FVC ratio was used as a dependent variable, the model was not significant (p 0.122). However, when RV/TLC ratio was used as a dependent variable, the following variables were found to be significant: Age. β 0.27 CI 95% (0.17 - 0.38) P <0.001; duration of asthma. β 0.15 CI 95% (0.07 - 0.24) p <0.001. There were no significant interactions among gender, ethnicity and smoking.CONCLUSIONS: Abnormal RV/TLC ratio was significantly associated with longer duration of asthma; FEV1/FVC was not.CLINICAL IMPLICATIONS: RV/TLC may be a better indicator for assessing small airway dysfunction related to chronicity of asthma than FEV1/FVC.DISCLOSURE: The following authors have nothing to disclose: Kazi Rahman, Anupama Tiwari, Belayneh Abejie, Vipul Jain, Jose JosephNo Product/Research Disclosure Information.