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Purpose Low diffusing capacity of the lung for carbon monoxide (D.sub.LCO) and spirometry values are associated with increased mortality risk. However, associations between mortality risk and cardiovascular disease with the transfer coefficient of the lung for carbon monoxide (K.sub.CO) and alveolar volume (V.sub.A) are unknown. This cohort study: (i) evaluated whether D.sub.LCO, K.sub.CO, and V.sub.A abnormalities are independently associated with cardiovascular morbidity and/or elevated mortality risk and, (ii) compared these associations with those using spirometry values. Methods Gas-diffusing capacity and spirometry data of 1165 adults seen at specialist respiratory outreach clinics over an 8-year period (241 with cardiovascular disease; 108 deceased) were analysed using multivariable Cox and logistic regression. Results D.sub.LCO, K.sub.CO, and V.sub.A values below the lower limit of normal (< - 1.64 Z-scores) were associated with elevated cardiovascular disease prevalence [respective odds ratios of 1.83 (95% CI 1.31-2.55), 1.56 (95% CI 1.08-2.25), 2.20 (95% CI 1.60-3.01)] and increased all-cause mortality risk [respective hazard ratios of 2.99 (95% CI 1.83-4.90), 2.14 (95% CI 1.38-3.32), 2.75 (95% CI 1.18-2.58)], after adjustment for factors including age, personal smoking, and respiratory disease. Compared to similar levels of spirometry abnormality, D.sub.LCO, K.sub.CO, and V.sub.A were associated with similar or greater mortality risk, and similar cardiovascular disease prevalence. Analysis of only those patients with clinical normal spirometry values (n = 544) showed these associations persisted for D.sub.LCO. Conclusion Low D.sub.LCO, K.sub.CO, and V.sub.A measurements are associated with cardiovascular disease prevalence. As risk factors of all-cause mortality, they are more sensitive than spirometry even among patients with no diagnosed respiratory disease., Author(s): Andrew J. Collaro [sup.1] [sup.2], Anne B. Chang [sup.1] [sup.2] [sup.3] [sup.4], Julie M. Marchant [sup.1] [sup.2], Mark D. Chatfield [sup.3] [sup.6], Annette Dent [sup.4] [sup.5] [sup.7], Kwun M. [...]

Purpose Northern Territory (NT)-based clinical service data suggest substantial lung function impairment amongst First Nations adults as young as 18-40 years. Our objectives were to describe the burden of disease and lung function of adults living in regional-remote Queensland, identify determinants of lung function, and evaluate the impact of a specialist respiratory outreach service on lung function. Methods Retrospective 8-year cohort study (February 2012-March 2020) of 1113 First Nations Australian adults (and 648 non-First Nations adults) referred to respiratory outreach clinics in regional-remote Queensland. Results In the combined cohort, the forced expiratory volume in 1 s (FEV.sub.1) was clinically abnormal for 54% of First Nations patients (51% of non-First Nations patients), forced vital capacity (FVC) for 46% (36%), FEV.sub.1/FVC% for 30% (36%), and gas diffusing capacity (D.sub.LCO) for 44% (37%). A respiratory diagnosis was assigned by a respiratory physician in 78% of First Nations (76% non-First Nations) patients. Smoking, household smoke exposure, underweight BMI, and respiratory disease were associated with reduced lung function. In the 40% of patients (709/1765) followed up, FEV.sub.1 and FVC significantly improved (mean change: zFEV.sub.1 = 0.15 [95% CI 0.10-0.20]; zFVC = 0.25 [0.20, 0.31]), and FEV.sub.1/FVC% significantly reduced (mean = - 0.10 [95%CI - 0.07 to - 0.03]), with no significant change in D.sub.LCO. Patients with COPD had lower FEV.sub.1 improvement, whilst underweight and obese patients had lower FVC improvement. Conclusion Regional-remote First Nations adult Queenslanders have higher lung function than previously reported, with no lung function decline observed at follow-up visit, including for those with respiratory disease., Author(s): Andrew J. Collaro [sup.1] [sup.2], Anne B. Chang [sup.1] [sup.2] [sup.3] [sup.4], Julie M. Marchant [sup.1] [sup.2], Mark D. Chatfield [sup.3] [sup.5], Annette Dent [sup.4] [sup.6], Tamara Blake [sup.1] [...]

Background and Objectives Indigenous Respiratory Outreach Care (IROC) is a culturally appropriate specialist respiratory service established to deliver multidisciplinary respiratory care to regional and remote Queensland communities. Our objective was to evaluate the impact of an outreach specialist respiratory service on the spirometry of children attending IROC clinics, particularly Indigenous children with asthma and bronchiectasis. Methods Retrospective single-arm cohort study of 189 children who performed spirometry at twelve sites across regional and remote Queensland between October 2010 and December 2017. Each child's baseline spirometry was compared to their best spirometry at follow-up visit occurring within (1) 12 months of their most recent visit with at least 12 months of specialist care and; (2) each year of their first 3 years of care. Results Forced expiratory volume in one second (FEV.sub.1) and forced vital capacity (FVC) z-scores improved significantly across the whole group from baseline to follow-up (change in z-scores ([DELTA]z) of FEV.sub.1 = 0.38, 95% CI 0.22, 0.53; [DELTA]zFVC = 0.36, 95% CI 0.21, 0.51). In subgroup analyses, lung function significantly improved in Indigenous children (n = 141, [DELTA]zFEV.sub.1 = 0.37, 95% CI 0.17, 0.57; [DELTA]zFVC = 0.36, 95% CI 0.17, 0.55) including those with asthma (n = 117, [DELTA]zFEV.sub.1 = 0.41, 95% CI 0.19, 0.64; [DELTA]zFVC = 0.46, 95% CI 0.24, 0.68) and bronchiectasis (n = 38, [DELTA]zFEV.sub.1 = 0.33, 95% CI 0.07, 0.59; [DELTA]zFVC = 0.26, 95% CI - 0.03, 0.53). Significant improvements in FEV.sub.1 and FVC were observed within the first and second year of follow-up for Indigenous children, but not for non-Indigenous children. Conclusion The IROC model of care in regional and remote settings leads to significant lung function improvement in Indigenous children with asthma and bronchiectasis., Author(s): Andrew J. Collaro [sup.1] [sup.2] , Anne B. Chang [sup.1] [sup.2] [sup.3] [sup.4] , Julie M. Marchant [sup.1] [sup.2] , Ian B. Masters [sup.1] [sup.2] , Leanne T. Rodwell [...]