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Grønseth R, Erdal M, Tan WC, Obaseki DO, Amaral AFS, Gislason T, Juvekar SK, Koul PA, Studnicka M, Salvi S, Burney P, Buist AS, Vollmer WM, Johannessen A. Unemployment in chronic airflow obstruction (CAO) around the world: Results from the Burden of Obstructive Lung Disease (BOLD) study. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.pa1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hartl S, Breyer-Kohansal R, Breyer MK, Urban M, Studnicka M, Burghuber OC. Blood eosinophils and obstructive lung diseases – results from the population-based Austrian LEAD Study. Epidemiology 2017. [DOI: 10.1183/1393003.congress-2017.pa2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Horner A, Soriano JB, Puhan MA, Studnicka M, Kaiser B, Vanfleteren LEGW, Gnatiuc L, Burney P, Miravitlles M, García-Rio F, Ancochea J, Menezes AM, Perez-Padilla R, Montes de Oca M, Torres-Duque CA, Caballero A, González-García M, Buist S, Flamm M, Lamprecht B. Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study. Respir Res 2017; 18:162. [PMID: 28835234 PMCID: PMC5569455 DOI: 10.1186/s12931-017-0643-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND COPD prevalence is highly variable and geographical altitude has been linked to it, yet with conflicting results. We aimed to investigate this association, considering well known risk factors. METHODS A pooled analysis of individual data from the PREPOCOL-PLATINO-BOLD-EPI-SCAN studies was used to disentangle the population effect of geographical altitude on COPD prevalence. Post-bronchodilator FEV1/FVC below the lower limit of normal defined airflow limitation consistent with COPD. High altitude was defined as >1500 m above sea level. Undiagnosed COPD was considered when participants had airflow limitation but did not report a prior diagnosis of COPD. RESULTS Among 30,874 participants aged 56.1 ± 11.3 years from 44 sites worldwide, 55.8% were women, 49.6% never-smokers, and 12.9% (3978 subjects) were residing above 1500 m. COPD prevalence was significantly lower in participants living at high altitude with a prevalence of 8.5% compared to 9.9%, respectively (p < 0.005). However, known risk factors were significantly less frequent at high altitude. Hence, in the adjusted multivariate analysis, altitude itself had no significant influence on COPD prevalence. Living at high altitude, however, was associated with a significantly increased risk of undiagnosed COPD. Furthermore, subjects with airflow limitation living at high altitude reported significantly less respiratory symptoms compared to subjects residing at lower altitude. CONCLUSION Living at high altitude is not associated with a difference in COPD prevalence after accounting for individual risk factors. However, high altitude itself was associated with an increased risk of undiagnosed COPD.
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Affiliation(s)
- Andreas Horner
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021 Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Kaiser
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Lowie E. G. W. Vanfleteren
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Louisa Gnatiuc
- Respiratory Epidemiology and Public Health, Imperial College, London, UK
| | - Peter Burney
- Respiratory Epidemiology and Public Health, Imperial College, London, UK
| | - Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d’Hebron. Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Francisco García-Rio
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ. Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Julio Ancochea
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana M. Menezes
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Rogelio Perez-Padilla
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Maria Montes de Oca
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Carlos A. Torres-Duque
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
| | - Andres Caballero
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
- Clínica Reina Sofía, Bogotá, Colombia
| | | | - Sonia Buist
- Oregon Health and Science University, Portland, Oregon USA
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021 Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - for the BOLD Collaborative Research Group
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021 Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Respiratory Epidemiology and Public Health, Imperial College, London, UK
- Servicio de Neumología, Hospital Universitari Vall d’Hebron. Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ. Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
- Clínica Reina Sofía, Bogotá, Colombia
- Oregon Health and Science University, Portland, Oregon USA
| | - the EPI-SCAN Team
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021 Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Respiratory Epidemiology and Public Health, Imperial College, London, UK
- Servicio de Neumología, Hospital Universitari Vall d’Hebron. Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ. Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
- Clínica Reina Sofía, Bogotá, Colombia
- Oregon Health and Science University, Portland, Oregon USA
| | - the PLATINO Team
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021 Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Respiratory Epidemiology and Public Health, Imperial College, London, UK
- Servicio de Neumología, Hospital Universitari Vall d’Hebron. Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ. Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
- Clínica Reina Sofía, Bogotá, Colombia
- Oregon Health and Science University, Portland, Oregon USA
| | - the PREPOCOL Study Group
- Department of Pulmonary Medicine, Kepler University Hospital, Krankenhausstrasse 9, A4021 Linz, Austria
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Respiratory Epidemiology and Public Health, Imperial College, London, UK
- Servicio de Neumología, Hospital Universitari Vall d’Hebron. Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ. Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
- Clínica Reina Sofía, Bogotá, Colombia
- Oregon Health and Science University, Portland, Oregon USA
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Amaral AFS, Coton S, Kato B, Tan WC, Studnicka M, Janson C, Gislason T, Mannino D, Bateman ED, Buist S, Burney PGJ. Lung function defects in treated pulmonary tuberculosis patients. Eur Respir J 2017; 47:352-3. [PMID: 26721972 DOI: 10.1183/13993003.01366-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- André F S Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Sonia Coton
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Bernet Kato
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Wan C Tan
- University of British Columbia Heart Lung Innovation Center, Vancouver, BC, Canada
| | - Michael Studnicka
- Dept of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Christer Janson
- Dept of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland and Landspitali University Hospital, Reykjavik, Iceland
| | - David Mannino
- Division of Pulmonary Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Eric D Bateman
- Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonia Buist
- Oregon Health and Sciences University, Portland, OR, USA
| | - Peter G J Burney
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
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Weiss G, Steinacher I, Lamprecht B, Kaiser B, Mikes R, Sator L, Hartl S, Wagner H, Studnicka M. Development and validation of the Salzburg COPD-screening questionnaire (SCSQ): a questionnaire development and validation study. NPJ Prim Care Respir Med 2017; 27:4. [PMID: 28127061 PMCID: PMC5434771 DOI: 10.1038/s41533-016-0005-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/30/2016] [Accepted: 10/25/2016] [Indexed: 12/21/2022] Open
Abstract
Chronic obstructive pulmonary disease prevalence rates are still high. However, the majority of subjects are not diagnosed. Strategies have to be implemented to overcome the problem of under-diagnosis. Questionnaires could be used to pre-select subjects for spirometry and thereby help reducing under-diagnosis. We report a brief, simple, self-administrable and validated chronic obstructive pulmonary disease questionnaire to increase the pre-test probability for chronic obstructive pulmonary disease diagnosis in subjects undergoing confirmatory spirometry. In 2005, we completed the Austrian Burden of Obstructive Lung Disease-study in 1258 subjects aged >40 years. Post-bronchodilator spirometry was performed, and non-reversible airflow limitation defined by FEV1/FVC ratio below the lower limit of normal. Questions from the Salzburg chronic obstructive pulmonary disease screening-questionnaire were selected using a logistic regression model, and risk scores were based on regression-coefficients. A training sub-sample (n = 800) was used to create the score, and a test sub-sample (n = 458) was used to test it. In 2008, an external validation study was done, using the same protocol in 775 patients from primary care. The Salzburg chronic obstructive pulmonary disease screening questionnaire was composed of items related to “breathing problems”, “wheeze”, “cough”, “limitation of physical activity”, and “smoking”. At the >=2 points cut-off of the Salzburg chronic obstructive pulmonary disease screening questionnaire, sensitivity was 69.1% [95%CI: 56.6%; 79.5%], specificity 60.0% [95%CI: 54.9%; 64.9%], the positive predictive value 23.2% [95%CI: 17.7%; 29.7%] and the negative predictive value 91.8% [95%CI: 87.5%; 95.7%] to detect post bronchodilator airflow limitation. The external validation study in primary care confirmed these findings. The Salzburg chronic obstructive pulmonary disease screening questionnaire was derived from the highly standardized Burden of Obstructive Lung Disease study. This validated and easy to use questionnaire can help to increase the efficiency of chronic obstructive pulmonary disease case-finding. Scientists in Austria have developed a brief, simple questionnaire to identify patients likely to have early-stage chronic lung disease. Chronic obstructive pulmonary disease (COPD) is notoriously difficult to diagnose, and the condition often causes irreversible lung damage before it is identified. Finding a simple, cost-effective method of pre-screening patients with suspected early-stage COPD could potentially improve treatment responses and limit the burden of extensive lung function (‘spirometry’) tests on health services. Gertraud Weiss at Paracelsus Medical University, Austria, and co-workers have developed and validated an easy-to-use, self-administered questionnaire that could prove effective for pre-screening patients. The team trialed the five-point Salzburg COPD-screening questionnaire on 1258 patients. Patients scoring 2 points or above on the questionnaire underwent spirometry tests. The questionnaire seems to provide a sensitive and cost-effective way of pre-selecting patients for spirometry referral.
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Affiliation(s)
- Gertraud Weiss
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria.
| | - Ina Steinacher
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler-University-Hospital, Linz, Austria.,Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Bernhard Kaiser
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Romana Mikes
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Lea Sator
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Helga Wagner
- Department for Statistics, University of Linz, Linz, Austria
| | - M Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
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Neunhäuserer D, Steidle-Kloc E, Weiss G, Kaiser B, Niederseer D, Hartl S, Tschentscher M, Egger A, Schönfelder M, Lamprecht B, Studnicka M, Niebauer J. Supplemental Oxygen During High-Intensity Exercise Training in Nonhypoxemic Chronic Obstructive Pulmonary Disease. Am J Med 2016; 129:1185-1193. [PMID: 27427325 DOI: 10.1016/j.amjmed.2016.06.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physical exercise training is an evidence-based treatment in chronic obstructive pulmonary disease, and patients' peak work rate is associated with reduced chronic obstructive pulmonary disease mortality. We assessed whether supplemental oxygen during exercise training in nonhypoxemic patients with chronic obstructive pulmonary disease might lead to superior training outcomes, including improved peak work rate. METHODS This was a randomized, double-blind, controlled, crossover trial. Twenty-nine patients with chronic obstructive pulmonary disease (aged 63.5 ± 5.9 years; forced expiratory volume in 1 second percent predicted, 46.4 ± 8.6) completed 2 consecutive 6-week periods of endurance and strength training with progressive intensity, which was performed 3 times per week with supplemental oxygen or compressed medical air (flow via nasal cannula: 10 L/min). Each session of electrocardiography-controlled interval cycling lasted 31 minutes and consisted of a warm-up, 7 cycles of 1-minute intervals at 70% to 80% of peak work rate alternating with 2 minutes of active recovery, and final cooldown. Thereafter, patients completed 8 strength-training exercises of 1 set each with 8 to 15 repetitions to failure. Change in peak work rate was the primary study end point. RESULTS The increase in peak work rate was more than twice as high when patients exercised with supplemental oxygen compared with medical air (0.16 ± 0.02 W/kg vs 0.07 ± 0.02 W/kg; P < .001), which was consistent with all other secondary study end points related to exercise capacity. The impact of oxygen on peak work rate was 39.1% of the overall training effect, whereas it had no influence on strength gain (P > .1 for all exercises). CONCLUSIONS We report that supplemental oxygen in nonhypoxemic chronic obstructive pulmonary disease doubled the effect of endurance training but had no effect on strength gain.
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Affiliation(s)
- Daniel Neunhäuserer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Italy
| | - Eva Steidle-Kloc
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria
| | - Gertraud Weiss
- University Clinic of Pneumology, Paracelsus Medical University of Salzburg, Austria
| | - Bernhard Kaiser
- University Clinic of Pneumology, Paracelsus Medical University of Salzburg, Austria
| | - David Niederseer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Division of Cardiology, University Heart Centre, University Hospital Zurich, Switzerland
| | - Sylvia Hartl
- First Internal Department of Pulmonary Medicine, Otto-Wagner Hospital, Vienna, Austria
| | - Marcus Tschentscher
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria
| | - Andreas Egger
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria
| | - Martin Schönfelder
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria
| | - Bernd Lamprecht
- University Clinic of Pneumology, Paracelsus Medical University of Salzburg, Austria; Department of Pulmonary Medicine, Faculty of Medicine, Kepler-University-Hospital, Johannes Kepler University, Linz, Austria
| | - Michael Studnicka
- University Clinic of Pneumology, Paracelsus Medical University of Salzburg, Austria
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Austria; Research Institute for Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University of Salzburg, Austria.
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Horak F, Doberer D, Eber E, Horak E, Pohl W, Riedler J, Szépfalusi Z, Wantke F, Zacharasiewicz A, Studnicka M. Diagnosis and management of asthma - Statement on the 2015 GINA Guidelines. Wien Klin Wochenschr 2016; 128:541-54. [PMID: 27370268 PMCID: PMC5010591 DOI: 10.1007/s00508-016-1019-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 11/06/2022]
Abstract
This statement was written by a group of pulmonologists and pediatric pulmonologists belonging to the corresponding professional associations ÖGP (Austrian Society for Pulmonology) and ÖGKJ (Austrian Society for pediatric and adolescent medicine) to provide a concise overview of the latest updates in the 2015 GINA Guidelines and to include aspects that are specific to Austria.
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Affiliation(s)
- Fritz Horak
- Allergy Center Vienna West, Hütteldorfertraße 46, 1150, Vienna, Austria.
| | - Daniel Doberer
- Wilhelminen Hospital, Department of Internal and Pulmonary Medicine, Teaching Hospital of the Medical University of Vienna, Montleartstraße 37, 1160, Vienna, Austria
| | - Ernst Eber
- Clinical Department of Pediatric Pulmonology and Allergology University Clinic for Pediatric and Adolescent Medicine, Graz University, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Elisabeth Horak
- Pediatric Pulmonology/Allergology, Department of Pediatric and Adolescent Medicine Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Wolfgang Pohl
- Department of Respiratory and Lung Diseases, Hietzing Hospital, Karl Landsteiner Institute for Experimental and Clinical Pulmonology, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Josef Riedler
- Department of Pediatric and Adolescent Medicine, Kardinal Schwarzenberg Hospital, Kardinal-Schwarzenbergstraße 2-6, 5620, Schwarzach, Austria
| | - Zsolt Szépfalusi
- Clin. Department for Pediatric Pulmonology, Allergology and Endocrinology, University Clinic for Pediatric and Adolescent Medicine, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Felix Wantke
- Floridsdorf Allergy Center, Franz Jonas Platz 8/6, 1210, Vienna, Austria
| | - Angela Zacharasiewicz
- Department of Pediatric and Adolescent Medicine, Wilhelminen Hospital, Montleartstr.37, 1160, Vienna, Austria
| | - Michael Studnicka
- University Clinic for Pulmonology, Hospital Salzburg, University Hospital of Paracelsus Private Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Rodrigues M, Stark H, Rendl G, Rettenbacher L, Datz L, Studnicka M, Pirich C. Diagnostic performance of [18F] FDG PET-CT compared to bone scintigraphy for the detection of bone metastases in lung cancer patients. Q J Nucl Med Mol Imaging 2016; 60:62-68. [PMID: 26844431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accurate staging of lung cancer is essential for effective patient management and selection of appropriate therapeutic strategy. The aim of this paper was to compare the value of bone scintigraphy and FDG PET-CT for detecting bone metastases in lung cancer patients and the impact of these modalities in disease staging. METHODS One hundred sixty-four lung cancer patients who had undergone both FDG PET-CT and bone scintigraphy within 14 days were included into this study. The analysis of FDG PET-CT and bone scintigraphy was carried out patient- and lesion-based. RESULTS One hundred twenty-one patients were negative and 43 patients positive for bone metastases. FDG PET-CT found bone metastases in 42/43 patients and bone scintigraphy in 38/43 patients. Sensitivity, specificity and accuracy of FDG PET-CT and bone scintigraphy for detecting bone metastases were 97.7%, 100% and 99.4%, and 87.8%, 97.5% and 94.2%, respectively. FDG PET-CT identified 430 bone metastases and bone scintigraphy 246 bone metastases. Skull was the only region where bone scintigraphy identified more lesions than FDG PET-CT. Based on both scintigraphic modalities disagreement concerning disease stage was found in 3 patients. CONCLUSION FDG PET-CT yielded a higher sensitivity, specificity and accuracy than bone scintigraphy for identifying bone metastases in lung cancer patients. FDG PET-CT thus can be recommended for initial staging of lung cancer patients without applying bone scintigraphy for the detection of bone metastases.
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Affiliation(s)
- Margarida Rodrigues
- Department of Nuclear Medicine and Endocrinology, Paracelsus Medical University Salzburg, Austria -
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Vanfleteren LE, Lamprecht B, Studnicka M, Kaiser B, Gnatiuc L, Burney P, Wouters EF, Franssen FM. Body mass index and chronic airflow limitation in a worldwide population-based study. Chron Respir Dis 2016; 13:90-101. [PMID: 26768010 DOI: 10.1177/1479972315626012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nutritional status has been associated with clinical outcome in chronic airflow limitation (CAL), but epidemiological studies are scarce. We aimed to assess the relationship between body mass index (BMI) and CAL, taking into account confounding factors. 18,606 participants (49% male, 21% smokers, mean age: 55.8 ± 11.2 years, mean BMI: 26.7 ± 5.5 kg/m(2)) of the BOLD initiative from 26 sites in 23 countries were included. CAL was defined as post-bronchodilator forced expiratory volume in the first second/forced vital capacity < lower limit of normal. Low and obese BMI were defined as <21 kg/m(2) and ≥30 kg/m(2), respectively. Multivariate logistic regression analysis controlled for confounders age, sex and smoking, and meta-analysis of between-site heterogeneity and clustering. Prevalence of low and obese BMI, smoking history and prevalence of CAL were highly variable between sites. After adjustment for confounders, the meta-analysis of all sites showed that compared to subjects without CAL, low BMI was more frequent, (adjusted odds ratio (OR): 2.23 (95% confidence interval: 1.75, 2.85)) and conversely, obesity was less frequent in subjects with CAL (adjusted OR: 0.78 (0.65, 0.94)). In a worldwide population sample, CAL was associated with lower BMI, even after adjusting for confounding factors age, gender, smoking and between-site heterogeneity. These results indicate a CAL-specific association with body composition.
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Affiliation(s)
- Lowie Egw Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Kaiser
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Louisa Gnatiuc
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Emiel Fm Wouters
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Frits Me Franssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Lamprecht B, Soriano JB, Studnicka M, Kaiser B, Vanfleteren LE, Gnatiuc L, Burney P, Miravitlles M, García-Rio F, Akbari K, Ancochea J, Menezes AM, Perez-Padilla R, Montes de Oca M, Torres-Duque CA, Caballero A, González-García M, Buist S. Determinants of underdiagnosis of COPD in national and international surveys. Chest 2016; 148:971-985. [PMID: 25950276 DOI: 10.1378/chest.14-2535] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD ranks within the top three causes of mortality in the global burden of disease, yet it remains largely underdiagnosed. We assessed the underdiagnosis of COPD and its determinants in national and international surveys of general populations. METHODS We analyzed representative samples of adults aged ≥ 40 years randomly selected from well-defined administrative areas worldwide (44 sites from 27 countries). Postbronchodilator FEV1/FVC < lower limit of normal (LLN) was used to define chronic airflow limitation consistent with COPD. Undiagnosed COPD was considered when participants had postbronchodilator FEV1/FVC < LLN but were not given a diagnosis of COPD. RESULTS Among 30,874 participants with a mean age of 56 years, 55.8% were women, and 22.9% were current smokers. Population prevalence of (spirometrically defined) COPD ranged from 3.6% in Barranquilla, Colombia, to 19.0% in Cape Town, South Africa. Only 26.4% reported a previous lung function test, and only 5.0% reported a previous diagnosis of COPD, whereas 9.7% had a postbronchodilator FEV1/FVC < LLN. Overall, 81.4% of (spirometrically defined) COPD cases were undiagnosed, with the highest rate in Ile-Ife, Nigeria (98.3%) and the lowest rate in Lexington, Kentucky (50.0%). In multivariate analysis, a greater probability of underdiagnosis of COPD was associated with male sex, younger age, never and current smoking, lower education, no previous spirometry, and less severe airflow limitation. CONCLUSIONS Even with substantial heterogeneity in COPD prevalence, COPD underdiagnosis is universally high. Because effective management strategies are available for COPD, spirometry can help in the diagnosis of COPD at a stage when treatment will lead to better outcomes and improved quality of life.
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Affiliation(s)
- Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria; Faculty of Medicine, Johannes-Kepler-University, Linz, Austria.
| | - Joan B Soriano
- Instituto de Investigación, Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Catédra UAM-Linde, Madrid, Spain
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Kaiser
- Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Lowie E Vanfleteren
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Program Development Centre, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
| | - Louisa Gnatiuc
- Respiratory Epidemiology and Public Health, Imperial College, London, England
| | - Peter Burney
- Respiratory Epidemiology and Public Health, Imperial College, London, England
| | - Marc Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | | | - Kaveh Akbari
- Department of Radiology, General Hospital Linz (Akh Linz), Linz, Austria
| | - Julio Ancochea
- Servicio de Neumología, Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana M Menezes
- Programa de Pós-Graduacão em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Rogelio Perez-Padilla
- Institute of Respiratory Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Maria Montes de Oca
- Servicio de Neumonología, Hospital Universitario de Caracas, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | - Carlos A Torres-Duque
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia; Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia
| | - Andres Caballero
- Asociación Colombiana de Neumología y Cirugía de Tórax, Bogotá, Colombia; Clínica Reina Sofía, Bogotá, Colombia
| | | | - Sonia Buist
- Oregon Health & Science University, Portland, OR
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Hartl S, Lopez-Campos JL, Pozo-Rodriguez F, Castro-Acosta A, Studnicka M, Kaiser B, Roberts CM. Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD Audit. Eur Respir J 2015; 47:113-21. [PMID: 26493806 DOI: 10.1183/13993003.01391-2014] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/17/2015] [Indexed: 11/05/2022]
Abstract
Studies report high in-hospital and post-discharge mortality of chronic obstructive pulmonary disease (COPD) exacerbations varying depending upon patient characteristics, hospital resources and treatment standards. This study aimed to investigate the patient, resource and organisational factors associated with in-hospital and 90-day post-discharge mortality and readmission of COPD exacerbations within the European COPD Audit. The audit collected data of COPD exacerbation admissions from 13 European countries.On admission, only 49.7% of COPD patients had spirometry results available and only 81.6% had blood gases taken. Using logistic regression analysis, the risk associated with in-hospital and post-discharge mortality was higher age, presence of acidotic respiratory failure, subsequent need for ventilatory support and presence of comorbidity. In addition, the 90-day risk of COPD readmission was associated with previous admissions. Only the number of respiratory specialists per 1000 beds, a variable related to hospital resources, decreased the risk of post-discharge mortality.The European COPD Audit identifies risk factors associated with in-hospital and post-discharge mortality and COPD readmission. Addressing the deficiencies in acute COPD care such as making spirometry available and measuring blood gases and providing noninvasive ventilation more regularly would provide opportunities to improve COPD outcomes.
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Affiliation(s)
- Sylvia Hartl
- Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Vienna, Austria Dept of Respiratory and Critical Care, Otto Wagner Hospital, Vienna, Austria
| | | | - Francisco Pozo-Rodriguez
- Respiratory Dept and Research Institute, doce de Octubre University Hospital, CIBERES, Madrid, Spain
| | - Ady Castro-Acosta
- Respiratory Dept and Research Institute, doce de Octubre University Hospital, CIBERES, Madrid, Spain
| | - Michael Studnicka
- Respiratory Dept, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Bernhard Kaiser
- Respiratory Dept, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Michael Roberts
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Mikes RE, Jordan F, Hutarew G, Studnicka M. First line crizotinib in anaplastic lymphoma kinase (ALK) rearranged squamous cell lung cancer. Lung Cancer 2015; 90:614-6. [PMID: 26519123 DOI: 10.1016/j.lungcan.2015.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/08/2015] [Accepted: 10/11/2015] [Indexed: 11/18/2022]
Abstract
Recently the superiority of Crizotinib to standard first-line pemetrexed-plus-platinum chemotherapy in patients with previously untreated advanced ALK-positive NSCLC has been demonstrated. We report of a 36-year-old never smoker with advanced squamous cell carcinoma, presenting with a left lower lobe lesion, N3 nodal disease and multiple metastases (pleura, adrenal, muscle, bone). Despite squamous histology we decided on molecular testing. IHC for ALK was positive and confirmatory fluorescent in situ hybridization showed translocation of ALK. Although there is little evidence on ALK rearrangements in squamous NSCLC we decided on first line treatment with Crizotinib (250 mg twice daily). Eight and twelve weeks after treatment initiation a whole-body FDG fusion PET/CT scan showed dramatic tumor response with little remaining metabolic uptake in the left lobe and a single bone lesion. This evidence raises the question whether ALK testing should be done in never smokers with squamous NSCLC in the absence of oncogenic driver mutations. To our knowledge, this the first report of first line treatment of full squamous ALK-positive NSCLC with crizotinib.
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Affiliation(s)
- Romana E Mikes
- Department of Pulmonary Medicine, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
| | - Franziska Jordan
- Department of Pulmonary Medicine, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
| | - Georg Hutarew
- Department of Pathology, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
| | - Michael Studnicka
- Department of Pulmonary Medicine, University Clinic Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria.
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Amaral AFS, Coton S, Kato B, Tan WC, Studnicka M, Janson C, Gislason T, Mannino D, Bateman ED, Buist S, Burney PGJ. Tuberculosis associates with both airflow obstruction and low lung function: BOLD results. Eur Respir J 2015; 46:1104-12. [PMID: 26113680 DOI: 10.1183/13993003.02325-2014] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/01/2015] [Indexed: 11/05/2022]
Abstract
In small studies and cases series, a history of tuberculosis has been associated with both airflow obstruction, which is characteristic of chronic obstructive pulmonary disease, and restrictive patterns on spirometry. The objective of the present study was to assess the association between a history of tuberculosis and airflow obstruction and spirometric abnormalities in adults.The study was performed in adults, aged 40 years and above, who took part in the multicentre, cross-sectional, general population-based Burden of Obstructive Lung Disease study, and had provided acceptable post-bronchodilator spirometry measurements and information on a history of tuberculosis. The associations between a history of tuberculosis and airflow obstruction and spirometric restriction were assessed within each participating centre, and estimates combined using meta-analysis. These estimates were stratified by high- and low/middle-income countries, according to gross national income.A self-reported history of tuberculosis was associated with airflow obstruction (adjusted odds ratio 2.51, 95% CI 1.83-3.42) and spirometric restriction (adjusted odds ratio 2.13, 95% CI 1.42-3.19).A history of tuberculosis was associated with both airflow obstruction and spirometric restriction, and should be considered as a potentially important cause of obstructive disease and low lung function, particularly where tuberculosis is common.
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Affiliation(s)
- André F S Amaral
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Sonia Coton
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Bernet Kato
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK
| | - Wan C Tan
- University of British Columbia Heart Lung Innovation Center, Vancouver, BC, Canada
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland and Landspitali University Hospital, Reykjavik, Iceland
| | - David Mannino
- Division of Pulmonary Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Eric D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonia Buist
- Oregon Health & Sciences University, Portland, OR, USA
| | - Peter G J Burney
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College, London, UK For a list of the BOLD collaborators see the Acknowledgements
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Zehentmayr F, Söhn M, Exeli AK, Wurstbauer K, Tröller A, Deutschmann H, Fastner G, Fussl C, Steininger P, Kranzinger M, Belka C, Studnicka M, Sedlmayer F. Normal tissue complication models for clinically relevant acute esophagitis (≥ grade 2) in patients treated with dose differentiated accelerated radiotherapy (DART-bid). Radiat Oncol 2015; 10:121. [PMID: 26018527 PMCID: PMC4450607 DOI: 10.1186/s13014-015-0429-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 05/25/2015] [Indexed: 12/13/2022] Open
Abstract
Background One of the primary dose-limiting toxicities during thoracic irradiation is acute esophagitis (AE). The aim of this study is to investigate dosimetric and clinical predictors for AE grade ≥ 2 in patients treated with accelerated radiotherapy for locally advanced non-small cell lung cancer (NSCLC). Patients and methods 66 NSCLC patients were included in the present analysis: 4 stage II, 44 stage IIIA and 18 stage IIIB. All patients received induction chemotherapy followed by dose differentiated accelerated radiotherapy (DART-bid). Depending on size (mean of three perpendicular diameters) tumors were binned in four dose groups: <2.5 cm 73.8 Gy, 2.5–4.5 cm 79.2 Gy, 4.5–6 cm 84.6 Gy, >6 cm 90 Gy. Patients were treated in 3D target splitting technique. In order to estimate the normal tissue complication probability (NTCP), two Lyman models and the cutoff-logistic regression model were fitted to the data with AE ≥ grade 2 as statistical endpoint. Inter-model comparison was performed with the corrected Akaike information criterion (AICc), which calculates the model’s quality of fit (likelihood value) in relation to its complexity (i.e. number of variables in the model) corrected by the number of patients in the dataset. Toxicity was documented prospectively according to RTOG. Results The median follow up was 686 days (range 84–2921 days), 23/66 patients (35 %) experienced AE ≥ grade 2. The actuarial local control rates were 72.6 % and 59.4 % at 2 and 3 years, regional control was 91 % at both time points. The Lyman-MED model (D50 = 32.8 Gy, m = 0.48) and the cutoff dose model (Dc = 38 Gy) provide the most efficient fit to the current dataset. On multivariate analysis V38 (volume of the esophagus that receives 38 Gy or above, 95 %-CI 28.2–57.3) was the most significant predictor of AE ≥ grade 2 (HR = 1.05, CI 1.01–1.09, p = 0.007). Conclusion Following high-dose accelerated radiotherapy the rate of AE ≥ grade 2 is slightly lower than reported for concomitant radio-chemotherapy with the additional benefit of markedly increased loco-regional tumor control. In the current patient cohort the most significant predictor of AE was found to be V38. A second clinically useful parameter in treatment planning may be MED (mean esophageal dose). Electronic supplementary material The online version of this article (doi:10.1186/s13014-015-0429-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Franz Zehentmayr
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria. .,Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Matthias Söhn
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Ann-Katrin Exeli
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Karl Wurstbauer
- Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Almut Tröller
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Department of Radiation Oncology, William Beaumont Health System, 3601 W. Thirteen Mile Road, Royal Oak, MI, 48073, USA.
| | - Heinz Deutschmann
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria. .,Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Gerd Fastner
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Christoph Fussl
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Philipp Steininger
- Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Manfred Kranzinger
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Claus Belka
- Department of Radiotherapy and Radiation Oncology, Ludwig-Maximilians-Universität Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Michael Studnicka
- Univ.-Klinik für Pneumologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
| | - Felix Sedlmayer
- Univ.-Klinik für Radiotherapie und Radio-Onkologie, Landeskrankenhaus Salzburg, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria. .,Institute for Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Austria.
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Grabcanovic-Musija F, Obermayer A, Stoiber W, Krautgartner WD, Steinbacher P, Winterberg N, Bathke AC, Klappacher M, Studnicka M. Neutrophil extracellular trap (NET) formation characterises stable and exacerbated COPD and correlates with airflow limitation. Respir Res 2015; 16:59. [PMID: 25994149 PMCID: PMC4455316 DOI: 10.1186/s12931-015-0221-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/13/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND COPD is a progressive disease of the airways that is characterized by neutrophilic inflammation, a condition known to promote the excessive formation of neutrophil extracellular traps (NETs). The presence of large amounts of NETs has recently been demonstrated for a variety of inflammatory lung diseases including cystic fibrosis, asthma and exacerbated COPD. OBJECTIVE We test whether excessive NET generation is restricted to exacerbation of COPD or whether it also occurs during stable periods of the disease, and whether NET presence and amount correlates with the severity of airflow limitation. PATIENTS, MATERIALS AND METHODS Sputum samples from four study groups were examined: COPD patients during acute exacerbation, patients with stable disease, and smoking and non-smoking controls without airflow limitation. Sputum induction followed the ECLIPSE protocol. Confocal laser microscopy (CLSM) and electron microscopy were used to analyse samples. Immunolabelling and fluorescent DNA staining were applied to trace NETs and related marker proteins. CLSM specimens served for quantitative evaluation. RESULTS Sputum of COPD patients is clearly characterised by NETs and NET-forming neutrophils. The presence of large amounts of NET is associated with disease severity (p < 0.001): over 90 % in exacerbated COPD, 45 % in stable COPD, and 25 % in smoking controls, but less than 5% in non-smokers. Quantification of NET-covered areas in sputum preparations confirms these results. CONCLUSIONS NET formation is not confined to exacerbation but also present in stable COPD and correlates with the severity of airflow limitation. We infer that NETs are a major contributor to chronic inflammatory and lung tissue damage in COPD.
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Affiliation(s)
- Fikreta Grabcanovic-Musija
- University Clinic of Pneumology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
| | - Astrid Obermayer
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Walter Stoiber
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Wolf-Dietrich Krautgartner
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Peter Steinbacher
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Nicole Winterberg
- Department of Mathematics, University of Salzburg, Salzburg, Austria.
| | | | - Michaela Klappacher
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Michael Studnicka
- University Clinic of Pneumology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
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Wurstbauer K, Deutschmann H, Zehentmayr F, Fussl C, Dagn K, Kopp P, Porsch P, Maurer B, Blaukovitsch M, Studnicka M, Sedlmayr F. DART-BID (Differentiated Accelerated Radiation Therapy–1.8 Gy Twice Daily) for Locoregionally Advanced NSCLC: Mature Results of a Novel Therapeutic Approach. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Blaukovitsch M, Hofer J, Hutarew G, Müllauer L, Ingrid SK, Studnicka M. ROS1 mutation and treatment with crizotinib in a 30-year old Caucasian woman with stage IV non-small cell lung cancer/adenocarcinoma and complete remission. Thorac Cancer 2014; 5:455-9. [PMID: 26767038 DOI: 10.1111/1759-7714.12106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 02/27/2014] [Indexed: 11/28/2022] Open
Abstract
In this case report we describe a 30 year-old Caucasian woman with a histopathological diagnosis of pulmonary adenocarcinoma in both lungs with lipidic and micropapillary growth pattern and ROS1 (C-ros oncogene 1, receptor tyrosine kinase) rearrangement. There is evidence that crizotinib can be used for molecular target therapy in these patients. We enrolled the patient in an off-label program for the treatment of ROS1 rearranged adenocarcinomas with the EML4/anaplastic lymphoma kinase inhibitor crizotinib. After a follow-up of eight weeks we saw a complete remission in both lungs without any signs of metabolic tumor activity. This report shows the importance of testing young patients with adenocarcinomas of the lung for rare oncogenic driver mutations, such as ROS1, with possible molecular treatment options.
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Affiliation(s)
- Markus Blaukovitsch
- Department of Pulmology, SALK, Medical University of Salzburg Salzburg, Austria
| | - Johann Hofer
- Department of Pulmology, SALK, Medical University of Salzburg Salzburg, Austria
| | - Georg Hutarew
- Department of Pathology, SALK, Medical University of Salzburg Salzburg, Austria
| | - Leonhard Müllauer
- Department of Pathology, AKH Wien, Medical University of Vienna Wien, Austria
| | | | - Michael Studnicka
- Department of Pulmology, SALK, Medical University of Salzburg Salzburg, Austria
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Burney P, Jithoo A, Kato B, Janson C, Mannino D, Niżankowska-Mogilnicka E, Studnicka M, Tan W, Bateman E, Koçabas A, Vollmer WM, Gislason T, Marks G, Koul PA, Harrabi I, Gnatiuc L, Buist S. Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty--a BOLD analysis. Thorax 2014; 69:465-73. [PMID: 24353008 PMCID: PMC3995258 DOI: 10.1136/thoraxjnl-2013-204460] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/20/2013] [Accepted: 11/22/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a commonly reported cause of death and associated with smoking. However, COPD mortality is high in poor countries with low smoking rates. Spirometric restriction predicts mortality better than airflow obstruction, suggesting that the prevalence of restriction could explain mortality rates attributed to COPD. We have studied associations between mortality from COPD and low lung function, and between both lung function and death rates and cigarette consumption and gross national income per capita (GNI). METHODS National COPD mortality rates were regressed against the prevalence of airflow obstruction and spirometric restriction in 22 Burden of Obstructive Lung Disease (BOLD) study sites and against GNI, and national smoking prevalence. The prevalence of airflow obstruction and spirometric restriction in the BOLD sites were regressed against GNI and mean pack years smoked. RESULTS National COPD mortality rates were more strongly associated with spirometric restriction in the BOLD sites (<60 years: men rs=0.73, p=0.0001; women rs=0.90, p<0.0001; 60+ years: men rs=0.63, p=0.0022; women rs=0.37, p=0.1) than obstruction (<60 years: men rs=0.28, p=0.20; women rs=0.17, p<0.46; 60+ years: men rs=0.28, p=0.23; women rs=0.22, p=0.33). Obstruction increased with mean pack years smoked, but COPD mortality fell with increased cigarette consumption and rose rapidly as GNI fell below US$15 000. Prevalence of restriction was not associated with smoking but also increased rapidly as GNI fell below US$15 000. CONCLUSIONS Smoking remains the single most important cause of obstruction but a high prevalence of restriction associated with poverty could explain the high 'COPD' mortality in poor countries.
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Affiliation(s)
- Peter Burney
- National Heart & Lung Institute, Imperial College, London, UK
| | - Anamika Jithoo
- National Heart & Lung Institute, Imperial College, London, UK
| | - Bernet Kato
- National Heart & Lung Institute, Imperial College, London, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine & Allergology, Uppsala University, Uppsala, Sweden
| | | | | | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Wan Tan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Bateman
- University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ali Koçabas
- Cukurova University School of Medicine, Adana, Turkey
| | | | | | - Guy Marks
- Woolcock Institute of Medical Research, Sydney, Australia
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | - Louisa Gnatiuc
- National Heart & Lung Institute, Imperial College, London, UK
| | - Sonia Buist
- Oregon Health & Sciences University, Portland, Oregon, USA
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Burney P, Kato B, Janson C, Mannino D, Studnicka M, Tan W, Bateman E, Koçabas A, Vollmer WM, Gislason T, Marks G, Koul PA, Gnatiuc L, Buist S. Chronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty: a BOLD analysis--authors' reply. Thorax 2014; 69:869-70. [PMID: 24789424 DOI: 10.1136/thoraxjnl-2014-205474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Peter Burney
- National Heart & Lung Institute, Imperial College, London, UK
| | - Bernet Kato
- National Heart & Lung Institute, Imperial College, London, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine & Allergology, Uppsala University, Uppsala, Sweden
| | - David Mannino
- Division of Pulmonary Critical Care and Sleep Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Wan Tan
- James Hogg Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Bateman
- Division of Pulmonology, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ali Koçabas
- Department of Chest Diseases, Cukurova University School of Medicine, Adana, Turkey
| | | | | | - Guy Marks
- Woolcock Institute of Medical Research, Sydney, Australia
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Louisa Gnatiuc
- National Heart & Lung Institute, Imperial College, London, UK
| | - Sonia Buist
- Oregon Health & Sciences University, Portland, Oregon, USA
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70
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Lamprecht B, Vanfleteren LE, Studnicka M, Allison M, McBurnie MA, Vollmer WM, Tan WC, Nielsen R, Nastalek P, Gnatiuc L, Kaiser B, Janson C, Wouters EFM, Burney P, Buist AS. Sex-related differences in respiratory symptoms: results from the BOLD Study. Eur Respir J 2014; 42:858-60. [PMID: 24000253 PMCID: PMC3759301 DOI: 10.1183/09031936.00047613] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lamprecht B, Mahringer A, Soriano JB, Kaiser B, Buist AS, Studnicka M. Is spirometry properly used to diagnose COPD? Results from the BOLD study in Salzburg, Austria: a population-based analytical study. Prim Care Respir J 2014; 22:195-200. [PMID: 23538703 PMCID: PMC6442781 DOI: 10.4104/pcrj.2013.00032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background: Current guidelines recommend spirometry to confirm a diagnosis of chronic obstructive pulmonary disease (COPD). Aims: To investigate whether a self-reported diagnosis of COPD is associated with prior spirometry and whether a correct diagnosis of COPD is more likely when spirometry was performed. Methods: We used data from the population-based Austrian Burden of Obstructive Lung Disease (BOLD) study. Participants were aged >40 years and completed post-bronchodilator spirometry. Reported COPD diagnosis and reported prior lung function test were based on questionnaire. Persistent airflow limitation was defined as post-bronchodilator forced expiratory volume in one second/forced vital capacity ratio <0.7, corresponding with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) grade I+, and GOLD grade II+ was also investigated. A correct diagnosis of COPD was defined as a reported physician's diagnosis of COPD and the presence of persistent airflow limitation. Results: 68 (5.4%) of 1,258 participants reported a prior physician's diagnosis of COPD. Of these, only 17 (25.0%) reported a lung function test within the past 12 months and 46 (67.6%) at any time in the past. The likelihood for a correct COPD GOLD grade I+ diagnosis was similar among subjects reporting a lung function test during the last 12 months (likelihood ratio 2.07, 95% CI 0.89 to 5.50) and those not reporting a lung function during the last 12 months (likelihood ratio 2.78, 95% CI 1.58 to 4.87). Similar likelihood ratios were seen when GOLD grade II+ was investigated and when lung function was reported at any time in the past. Conclusions: One-third of subjects with a reported diagnosis of COPD never had a lung function test. When spirometry was reported, this did not increase the likelihood of a correct COPD diagnosis.
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Affiliation(s)
- Bernd Lamprecht
- Department of Pulmonary Medicine, Paracelsus Medical University Hospital, Salzburg, Austria.
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72
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Wurstbauer K, Deutschmann H, Dagn K, Zehentmayr F, Fussl C, Kopp P, Porsch P, Maurer B, Studnicka M, Sedlmayer F. OC-0066: DART-bid: A novel therapeutic approach for locoregionally advanced nonresected non-small cell lung cancer. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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73
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Weiss G, Steinacher I, Lamprecht B, Schirnhofer L, Kaiser B, Sönnichsen A, Studnicka M. Detection of chronic obstructive pulmonary disease in primary care in Salzburg, Austria: findings from the real world. ACTA ACUST UNITED AC 2013; 87:136-43. [PMID: 24296512 DOI: 10.1159/000354796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major public health burden and profoundly affects individuals suffering from the disease. However, the majority of subjects with COPD are still undiagnosed. OBJECTIVES To evaluate COPD prevalence and detection strategies for COPD in the primary-care setting. METHODS The study was conducted in a random sample of general practitioner (GP) offices in Salzburg (Austria). A questionnaire and post-bronchodilator (PBD) spirometry was administered to patients aged ≥ 40 years. Nonreversible airway obstruction was considered when PBD FEV1/FVC was <0.70. Severity of spirometrically defined COPD was graded according to the GOLD recommendations. RESULTS 60 GP offices were randomly selected for study participation, however only 30 (50.0%) were willing to participate. 1,230 of 9,820 (12.52%) patients consented to the protocol. Quality of PBD spirometry was evaluated, and 882 (71.7%) met ATS/ERS quality criteria. 7.5% (95% CI: 5.7-9.4%) of the patients had COPD grade II+ (FEV1/FVC <0.7 and FEV1 <80% of predicted), but only 22.4% of them reported a prior physician's diagnosis of COPD. Similar results were seen for the 2005 Salzburg BOLD (Burden of Obstructive Lung Disease) sample with regard to COPD GOLD II+ prevalence (10.7%) and proportion of underdiagnosis (82.3%). CONCLUSION COPD in the primary-care setting is as prevalent and underdiagnosed as reported recently for the BOLD study. The surprisingly low participation rate of GPs and patients indicates that prevention of COPD is not a health priority, and that awareness for COPD has to heightened before case-finding strategies will be successful.
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Pircher A, Wasle IK, Mian M, Gamerith G, Ulsperger E, Studnicka M, Mohn-Staudner A, Hilbe W, Fiegl M. Docetaxel in the treatment of non-small cell lung cancer (NSCLC) -- an observational study focusing on symptom improvement. Anticancer Res 2013; 33:3831-3836. [PMID: 24023316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Results of an observational study on docetaxel-based therapy in non-small cell lung cancer (NSCLC) with focus on symptom control and therapy response, are reported. PATIENTS AND METHODS A total of 233 patients with NSCLC treated with docetaxel-containing therapy were analyzed. RESULTS The pre-existing symptoms of cough, dyspnea and pain markedly improved after three cycles of docetaxel-based therapy. Regression of symptoms was strongly associated with therapy response, but unexpectedly, patients with stable disease had also a substantial benefit. Alltogether, the response after three cycles was complete in 0.9% and partial in 26.6% of patients, respectively. CONCLUSION Symptom control was achieved in the majority of cases, which received three cycles of docetaxel-based therapy. Thus, a clinical benefit was regularly reached shortly after initiation of chemotherapy.
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Affiliation(s)
- Andreas Pircher
- Medical University of Innsbruck, Department of Internal Medicine V, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Janson C, Marks G, Buist S, Gnatiuc L, Gislason T, McBurnie MA, Nielsen R, Studnicka M, Toelle B, Benediktsdottir B, Burney P. The impact of COPD on health status: findings from the BOLD study. Eur Respir J 2013; 42:1472-83. [PMID: 23722617 PMCID: PMC3844139 DOI: 10.1183/09031936.00153712] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to describe the impact of chronic obstructive pulmonary disease (COPD) on health status in the Burden of Obstructive Lung Disease (BOLD) populations. We conducted a cross-sectional, general population-based survey in 11 985 subjects from 17 countries. We measured spirometric lung function and assessed health status using the Short Form 12 questionnaire. The physical and mental health component scores were calculated. Subjects with COPD (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <0.70, n = 2269) had lower physical component scores (44±10 versus 48±10 units, p<0.0001) and mental health component scores (51±10 versus 52±10 units, p = 0.005) than subjects without COPD. The effect of reported heart disease, hypertension and diabetes on physical health component scores (-3 to -4 units) was considerably less than the effect of COPD Global Initiative for Chronic Obstructive Lung Disease grade 3 (-8 units) or 4 (-11 units). Dyspnoea was the most important determinant of a low physical and mental health component scores. In addition, lower forced expiratory volume in 1 s, chronic cough, chronic phlegm and the presence of comorbidities were all associated with a lower physical health component score. COPD is associated with poorer health status but the effect is stronger on the physical than the mental aspects of health status. Severe COPD has a greater negative impact on health status than self-reported cardiovascular disease and diabetes. COPD is related to worse health status: impairment is greater than in self-reported cardiovascular diseases or diabeteshttp://ow.ly/p1cIx
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Affiliation(s)
- Christer Janson
- Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
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76
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Prosch H, Studnicka M, Eisenhuber E, Olschewski H, Stiefsohn E, Hartl S, Herold C, Burghuber O, Mostbeck G. Stellungnahme der Österreichischen Röntgengesellschaft und der Österreichischen Gesellschaft für Pneumologie. Wien Klin Wochenschr 2013; 125:339-45. [DOI: 10.1007/s00508-013-0356-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/20/2013] [Indexed: 11/24/2022]
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77
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Pircher A, Wasle I, Mian M, Ulsperger E, Wilthoner K, Studnicka M, Pirker R, Hilbe W, Fiegl M. Docetaxel Therapie im fortgeschrittenen nicht-kleinzelligen Bronchialkarzinom (NSCLC) - Resultate einer Observationsstudie mit Fokus auf Verbesserung von Tumor-assoziierten Symptomen unter Therapie. Pneumologie 2013. [DOI: 10.1055/s-0033-1345071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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78
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Fiegl M, Steger GG, Studnicka M, Eisterer W, Jaeger C, Willenbacher W. Pegfilgrastim prophylaxis in patients at different levels of risk for chemotherapy-associated febrile neutropenia: an observational study. Curr Med Res Opin 2013; 29:505-15. [PMID: 23444969 DOI: 10.1185/03007995.2013.781018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Guidelines for using granulocyte colony-stimulating factor (G-CSF) in patients receiving chemotherapies with 10-20% (intermediate) risk for febrile neutropenia (FN) recommend additional assessment of patient-related FN risk factors. OBJECTIVE The current study evaluated adherence to guideline recommendations and analysed modalities of pegfilgrastim use. METHODS Adult cancer patients scheduled to receive a chemotherapy regimen assessed by the investigators as intermediate FN risk and who received pegfilgrastim were prospectively enrolled in this observational study from 2007-2010. Risk factors at study entry, treatment modalities and FN assessment were documented by investigators, whereas guideline adherence was centrally checked in a post-hoc analysis, according to guideline categorizations. RESULTS Thirty-seven centres enrolled 335 evaluable patients with solid and hematologic neoplasias. Although physicians initially rated the FN risk of all chemotherapies as intermediate, after central re-assessment this applied only to 63.9% of regimens; 21.2% were reassessed as low risk and 14.9% as high risk. Pegfilgrastim was used as primary prophylaxis in 80.3% of all patients. The most frequent FN risk factors considered by physicians when deciding to use pegfilgrastim were female gender, advanced disease, age ≥ 65 years, and anaemia. FN incidence was higher in patients with ≥ 4 FN risk factors than those with <4 risk factors (10% vs. 4.3%; p = 0.055) and in patients with severe comorbidity than those without (13.6% vs. 4.5%; p = 0.014). Overall FN rate was 5.7%. LIMITATIONS Due to the observational design of the study, findings are descriptive in nature. Post-hoc assessment of chemotherapy FN risk was determined by author's opinion in some cases. CONCLUSIONS Overall, there was good adherence of Austrian physicians to guideline recommendations; however, there are chemotherapy regimens and clinical settings in which FN risk assignment is unclear in the literature. FN incidence with pegfilgrastim prophylaxis was similar to that reported in other observational and randomized studies.
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Affiliation(s)
- Michael Fiegl
- University Hospital, Medical University of Innsbruck, Innsbruck, Austria.
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79
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Wurstbauer K, Deutschmann H, Dagn K, Kopp P, Zehentmayr F, Lamprecht B, Porsch P, Wegleitner B, Studnicka M, Sedlmayer F. DART-bid (Dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily)--a novel approach for non-resected NSCLC: final results of a prospective study, correlating radiation dose to tumor volume. Radiat Oncol 2013; 8:49. [PMID: 23497555 PMCID: PMC3606417 DOI: 10.1186/1748-717x-8-49] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 02/25/2013] [Indexed: 12/25/2022] Open
Abstract
Background Sequential chemo-radiotherapies with intensive radiation components deliver promising results in non-resected non-small cell lung cancer (NSCLC). In general, radiation doses are determined by dose constraints for normal tissues, not by features relevant for tumor control. DART-bid targets directly the doses required for tumor control, correlating doses to tumor volume in a differentiated mode. Materials/Methods Radiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5–4.5 cm/4.5–6.0 cm/>6.0 cm; mean number of three perpendicular diameters). ICRU-doses of 73.8 Gy/79.2 Gy/84.6 Gy/90.0 Gy, respectively, were applied. Macroscopically involved nodes were treated with a median dose of 59.4 Gy, nodal sites about 6 cm cranial to involved nodes electively with 45 Gy. Fractional doses were 1.8 Gy twice daily (bid). 2 cycles chemotherapy were given before radiotherapy. Between 2004 and 2009, 160 not selected patients with 164 histologically/cytologically proven NSCLC were enrolled; Stage I: 38 patients; II: 6 pts.; IIIA: 69 pts.; IIIB: 47 pts. Weight loss >5%/3 months: 38 patients (24%). Primary endpoints are local and regional tumor control rates at 2 years (as >90% of locoregional failures occur within 2 years). Secondary endpoints are survival and toxicity. With a minimum follow-up time of 2 years for patients alive, the final results are presented. Results 32 local and 10 regional recurrences occurred. The local and regional tumor control rates at 2 years are 77% and 93%, respectively. The median overall survival (OS) time is 28.0 months, the 2- and 5-year OS rates are 57% and 19%, respectively. For stage III patients, median OS amounts to 24.3 months, 2- /5-year OS rates to 51% and 18%, respectively. 2 treatment-related deaths (progressive pulmonary fibrosis) occurred in patients with pre-existing pulmonary fibrosis. Further acute and late toxicity was mild. Conclusions This novel approach yields a high level of locoregional tumor control and survival times. In general it is well tolerated. In all outcome parameters it seems to compare favourably with simultaneous chemo-radiotherapies, at present considered ‘state of the art’; and is additionally amenable for an unselected patient population.
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Affiliation(s)
- Karl Wurstbauer
- Department of Radiation Oncology and radART-Institute for research and development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria.
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80
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Jithoo A, Enright PL, Burney P, Buist AS, Bateman ED, Tan WC, Studnicka M, Mejza F, Gillespie S, Vollmer WM. Case-finding options for COPD: results from the Burden of Obstructive Lung Disease study. Eur Respir J 2013; 41:548-55. [PMID: 22743668 PMCID: PMC3529919 DOI: 10.1183/09031936.00132011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to compare strategies for chronic obstructive pulmonary disease (COPD) case finding using data from the Burden of Obstructive Lung Disease study. Population-based samples of adults aged ≥40 yrs (n = 9,390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of differently staged algorithms that used questionnaire data and/or peak expiratory flow (PEF) data to identify persons at risk for COPD and, hence, needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1,000 people. For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%) but required confirmatory spirometry in 80% of participants. Use of PEF necessitated confirmatory spirometry in only 19-22% of subjects, with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in <9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case-finding strategy. Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults aged ≥40 yrs. These findings should be validated in real-world settings such as the primary care environment.
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Affiliation(s)
- Anamika Jithoo
- National Heart and Lung Institute, Imperial College London, London, UK
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81
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Nawara C, Rendl G, Wurstbauer K, Lackner B, Rettenbacher L, Datz L, Studnicka M, Sedlmayer F, Pirich C. The impact of PET and PET/CT on treatment planning and prognosis of patients with NSCLC treated with radiation therapy. Q J Nucl Med Mol Imaging 2012; 56:191-201. [PMID: 22402822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM 18F fluoro-deoxy-glucose (FDG) positron emission tomography (PET)-imaging improves the diagnostic accuracy in staging non small cell lung cancer (NSCLC) with possible impact on survival. This prospective study aimed to investigate the impact of PET and PET/CT on treatment planning and prognosis in patients with NSCLC treated with radiation therapy. METHODS From October 2003 to January 2008, 91 consecutive patients with proven NSCLC stage T1-4N0-3M0 (clinical stages: I-IIIb) underwent accelerated, twice daily radiation therapy in target splitting technique. 70 patients received chemotherapy before radiation therapy (76%). All patients underwent PET or PET/CT-imaging and were followed up for a median time of 30 months. Imaging findings were interpreted visually and a SUV cut-off of 2.5 was applied for delineation of tumor borders. Changes in staging and planning treatment volumes (PTV) due to PET or PET/CT-imaging and survival were defined as primary study endpoints. The impact of tumor-type, stage, age, gender, weight loss and FDG-uptake in PET imaging as measured by the standardized uptake value (SUV) on survival were analysed as secondary endpoints. RESULTS PET imaging provided additional diagnostic information over CT alone in 20% (N.=18) of our study population, leading to upstaging in 17% of them, respectively. In 5 patients (5.5% of 91) atelectasis could be separated from tumor tissue, PTV was altered in 9% (N.=8). 39 patients (43%) died during the observation period, mean overall survival was 32.3 months (95% Confidence intervalI 27.6-37.1) and tumor specific survival was 36.9 months (95 % CI 32.0-42.0), respectively. One- and two year survival rates reached 90.1% and 67.7%, respectively. Multivariate analysis did not reveal any significant prognostic impact of tumor-type, stage, age, gender or FDG-uptake as given by SUVmax (mean 13.6±6.8) or SUVmean (mean 5.5±1.6). CONCLUSION The use of FDG-PET- and PET/CT-imaging provided incremental information relevant for treatment-planning in about 10 % of patients with NSCLC undergoing accelerated radiation therapy with curative intent. This prospective trial did not provide evidence for the assumption that the SUV might be an independent predictor of outcome.
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Affiliation(s)
- C Nawara
- Department of Nuclear Medicine and Endocrinology, Paracelsus Medical University, Salzburg, Austria
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Lamprecht B, Porsch P, Wegleitner B, Strasser G, Kaiser B, Studnicka M. Electromagnetic navigation bronchoscopy (ENB): Increasing diagnostic yield. Respir Med 2012; 106:710-5. [PMID: 22391437 DOI: 10.1016/j.rmed.2012.02.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 02/03/2012] [Accepted: 02/06/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine factors associated with diagnostic yield of ENB. METHODS In 112 consecutive patients referred to our department between March 2010 and December 2010 the diagnostic work-up for solitary pulmonary lesions included a FDG-PET-CT scan, and ENB in combination with ROSE. The final diagnosis was confirmed by histopathological evaluation of specimen obtained either by ENB, or - if ENB was not diagnostic - by CT-guided fine needle aspiration or surgery. RESULTS Thirty-seven (33%) subjects were female, mean age was 66.7 (±1.04) years. The mean diameter of lesions was 27mm (range: 6-46mm). In 83.9% the combination of PET-CT, ENB, and ROSE established a correct diagnosis, as defined by the definite histopathological result. 15.2% (17/112) of lesions were benign, and 84.8% (95/112) were malignant. For 112 procedures we observed a steep learning curve with a diagnostic yield of 80% and 87.5% for the first 30 and last 30 procedures, respectively. The diagnostic yield in lesions ≤20mm and >20mm in diameter was 75.6% and 89.6% (p=0.06), respectively. No significant difference in diagnostic yield was seen depending on lung function, and the localization of the lesions. Two cases (1.8%) of pneumothorax were seen during and up to 24h after bronchoscopy, none of them required a chest tube. CONCLUSION Diagnostic yield increased with experience but was independent from the size of the lesion, the localisation in the lungs, and lung function. The diagnostic yield of ENB can be as high as for CT-guided transthoracic biopsies but carries a significantly lower complication rate.
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Affiliation(s)
- B Lamprecht
- Department of Pulmonary Medicine, Paracelsus Medical University Hospital, Muellner Hauptstrasse 48, A-5020 Salzburg, Austria.
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83
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Popper H, Wrba F, Gruber-Mösenbacher U, Hulla W, Pirker R, Hilbe W, Studnicka M, Mohn-Staudner A, Ploner F. A histology-based algorithm in the molecular diagnosis of mutations of the epidermal growth factor receptor (EGFR)–in non-small-cell lung cancer (NSCLC)*. memo 2012. [DOI: 10.1007/s12254-011-0319-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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84
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Manzenreiter R, Kienberger F, Marcos V, Schilcher K, Krautgartner WD, Obermayer A, Huml M, Stoiber W, Hector A, Griese M, Hannig M, Studnicka M, Vitkov L, Hartl D. Ultrastructural characterization of cystic fibrosis sputum using atomic force and scanning electron microscopy. J Cyst Fibros 2011; 11:84-92. [PMID: 21996135 DOI: 10.1016/j.jcf.2011.09.008] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 09/13/2011] [Accepted: 09/19/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) lung disease is characterized by perpetuated neutrophilic inflammation with progressive tissue destruction. Neutrophils represent the major cellular fraction in CF airway fluids and are known to form neutrophil extracellular traps (NETs) upon stimulation. Large amounts of extracellular DNA-NETs are present in CF airway fluids. However, the structural contribution of NETs to the matrix composition of CF airway fluid remains poorly understood. We hypothesized that CF airway fluids consist of distinct DNA-NETs that are associated to subcellular structures. METHODOLOGY/PRINCIPAL FINDINGS We employed atomic force microcopy (AFM) and scanning electron microcopy to ultrastructurally characterize the nature of CF sputum and the role of NETs within the extracellular CF sputum matrix. These studies demonstrate that CF sputum is predominantly composed of a high-density meshwork of NETs and NETosis-derived material. Treatment of CF sputum with different DNases degraded CF NETs and efficiently liquefied the mucous-like structure of CF sputum. Quantitative analysis of AFM results showed the presence of three globular fractions within CF sputum and the larger two ones featured characteristics of neutrophil ectosomes. CONCLUSIONS/SIGNIFICANCE These studies suggest that excessive NET formation represents the major factor underlying the gel-like structure of CF sputum and provide evidence that CF-NETs contain ectosome-like structures that could represent targets for future therapeutic approaches.
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Affiliation(s)
- Reinhard Manzenreiter
- School of Applied Health and Social Sciences, Upper Austria University of Applied Sciences, Linz, Austria
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85
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Enright P, Vollmer W, Lamprecht B, Jensen R, Jithoo A, Tan W, Studnicka M, Burney P, Gillespie S, Buist A. Quality of Spirometry tests performed by 9893 adults in 14 countries: The BOLD Study. Respir Med 2011; 105:1507-15. [DOI: 10.1016/j.rmed.2011.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/11/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
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86
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Popper H, Wrba F, Gruber-Mösenbacher U, Hulla W, Pirker R, Hilbe W, Studnicka M, Mohn-Staudner A, Ploner F. [Histology-based algorithm in the molecular diagnosis of mutations of the Epidernal Growth Factor Receptor (EGFR) in non-small cell lung cancer]. Wien Klin Wochenschr 2011; 123:316-21. [PMID: 21604158 DOI: 10.1007/s00508-011-1573-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 02/16/2011] [Indexed: 01/20/2023]
Abstract
Patients with stage IIIB and IV non-small cell lung carcinoma (NSCLC) harboring an activating mutation of the Epidermal Growth Factor Receptor (EGFR) Gene should be treated first-line with Gefitinib, an EGFR tyrosine kinase inhibitor (TKI). EGF receptor mutations are most common in adenocarcinomas, especially non-mucinous type, rare in squamous cell carcinomas and sarcomatoid carcinomas, and do not occur in neuroendocrine carcinomas. Therefore, the Pulmonary Pathology Working Group of the Austrian Society of Pathology, after intense discussions and in consensus with Oncologists and Pulmonologists, recommends a priori EGFR mutation analysis for all cases of adenocarcinoma, and for all other NSCLC upon clinical request. This will markedly reduce waiting time for those patients, which most likely will have the greatest benefit from EGFR TKI therapy.
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Affiliation(s)
- Helmut Popper
- Institut für Pathologie, MedUni Graz, Graz, Austria.
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87
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Wurstbauer K, Weise H, Deutschmann H, Kopp P, Merz F, Studnicka M, Nairz O, Sedlmayer F. Non-small cell lung cancer in stages I-IIIB: Long-term results of definitive radiotherapy with doses ≥ 80 Gy in standard fractionation. Strahlenther Onkol 2010; 186:551-7. [PMID: 20936459 DOI: 10.1007/s00066-010-2108-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 06/28/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate therapeutic outcome of dose escalation ≥ 80 Gy in nonresected non-small cell lung cancer (NSCLC). PATIENTS AND METHODS 124 consecutive patients with histologically/cytologically proven NSCLC were enrolled. Tumor stage I, II, IIIA, and IIIB was diagnosed in 30, eight, 39, and 47 patients, respectively. 38 patients (31%) had weight loss > 5% during the 3 months before diagnosis. A median dose of 88.2 Gy (range 80.0-96.0 Gy), 69.3 Gy (63.0-88.0 Gy) and 56.7 Gy was applied to primary lesions, involved lymph nodes, and elective nodes (within a region of about 6 cm cranial to macroscopically involved nodes), respectively. Daily fractional ICRU doses of 2.0-2.2 Gy were delivered by the conformal target-splitting technique. 58 patients (47%) received induction chemotherapy, in median two cycles prior to radiotherapy. RESULTS Median follow-up time of all patients was 19 months, of patients alive 72.4 months (69-121 months). The cumulative actual overall survival rate at 2 and 5 years amounts to 39% and 11.3%, respectively, resulting in a median overall survival time of 19.6 months. According to stages I, II, IIIA, and IIIB, the median overall survival times are 31.8, 31.4, 19.0, and 14.5 months, respectively. The locoregional tumor control rate at 2 years is 49%. Apart from one treatment-related death (pneumonitis), acute toxicity according to EORTC/RTOG scores was moderate: lung grade 2 (n = 7), grade 3 (n = 3); esophagus grade 1 (n = 11); heart grade 3 (n = 1, pericarditis). No late toxicity grade > 1 has been observed. CONCLUSION Sequential, conventionally fractionated high-dose radiotherapy by conformal target splitting is well tolerated. The results for survival and locoregional tumor control seem to at least equalize the outcome of simultaneous chemoradiation approaches, which, at present, are considered "state of the art" for patients with nonresected NSCLC. A higher potential of radiation therapy might be reached by accelerated fractionation regimens.
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Affiliation(s)
- Karl Wurstbauer
- University Clinic of Radiotherapy and Radiation Oncology and radART - Institute for research and development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria.
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88
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Lamprecht B, McBurnie MA, Vollmer WM, Gudmundsson G, Welte T, Nizankowska-Mogilnicka E, Studnicka M, Bateman E, Anto JM, Burney P, Mannino DM, Buist SA. COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest 2010; 139:752-763. [PMID: 20884729 PMCID: PMC3168866 DOI: 10.1378/chest.10-1253] [Citation(s) in RCA: 344] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Never smokers comprise a substantial proportion of patients with COPD. Their characteristics and possible risk factors in this population are not yet well defined. Methods: We analyzed data from 14 countries that participated in the international, population-based Burden of Obstructive Lung Disease (BOLD) study. Participants were aged ≥ 40 years and completed postbronchodilator spirometry testing plus questionnaires about respiratory symptoms, health status, and exposure to COPD risk factors. A diagnosis of COPD was based on the postbronchodilator FEV1/FVC ratio, according to current GOLD (Global Initiative for Obstructive Lung Disease) guidelines. In addition to this, the lower limit of normal (LLN) was evaluated as an alternative threshold for the FEV1/FVC ratio. Results: Among 4,291 never smokers, 6.6% met criteria for mild (GOLD stage I) COPD, and 5.6% met criteria for moderate to very severe (GOLD stage II+) COPD. Although never smokers were less likely to have COPD and had less severe COPD than ever smokers, never smokers nonetheless comprised 23.3% (240/1,031) of those classified with GOLD stage II+ COPD. This proportion was similar, 20.5% (171/832), even when the LLN was used as a threshold for the FEV1/FVC ratio. Predictors of COPD in never smokers include age, education, occupational exposure, childhood respiratory diseases, and BMI alterations. Conclusion: This multicenter international study confirms previous evidence that never smokers comprise a substantial proportion of individuals with COPD. Our data suggest that, in addition to increased age, a prior diagnosis of asthma and, among women, lower education levels are associated with an increased risk for COPD among never smokers.
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Affiliation(s)
- Bernd Lamprecht
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
| | | | | | - Gunnar Gudmundsson
- Department of Respiratory Medicine, Allergy, and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical University, Hannover, Germany
| | | | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Eric Bateman
- University of Cape Town, Cape Town, South Africa
| | - Josep M Anto
- Centre for Research in Environmental Epidemiology, Barcelona, Spain
| | - Peter Burney
- Department of Public Health Sciences, King's College London, London, England
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89
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Schirnhofer L, Lamprecht B, Firlei N, Kaiser B, Buist AS, Halbert RJ, Allison MJ, Studnicka M. Using Targeted Spirometry to Reduce Non-Diagnosed Chronic Obstructive Pulmonary Disease. Respiration 2010; 81:476-82. [DOI: 10.1159/000320251] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/09/2010] [Indexed: 11/19/2022] Open
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90
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Wurstbauer K, Deutschmann H, Kopp P, Kranzinger M, Merz F, Nairz O, Studnicka M, Sedlmayer F. Nonresected non-small-cell lung cancer in Stages I through IIIB: accelerated, twice-daily, high-dose radiotherapy--a prospective Phase I/II trial with long-term follow-up. Int J Radiat Oncol Biol Phys 2009; 77:1345-51. [PMID: 19910140 DOI: 10.1016/j.ijrobp.2009.06.060] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 06/24/2009] [Accepted: 06/24/2009] [Indexed: 12/25/2022]
Abstract
PURPOSE Our purpose was to investigate the tolerability of accelerated, twice-daily, high-dose radiotherapy. The secondary endpoints were survival and locoregional tumor control. METHODS AND MATERIALS Thirty consecutive patients with histologically/cytologically proven non-small-cell lung cancer were enrolled. Tumor Stage I, II, IIIA, and IIIB was found in 7, 3, 12, and 8 patients, respectively. We applied a median of 84.6 Gy (range, 75.6-90.0 Gy) to the primary tumors, 63.0 Gy (range, 59.4-72.0 Gy) to lymph nodes, and 45 Gy to nodes electively (within a region of about 6 cm cranial to macroscopically involved sites). Fractional doses of 1.8 Gy twice daily, with an interval of 11 hours, were given, resulting in a median treatment time of 35 days. In the majority of patients the conformal target-splitting technique was used. In 19 patients (63%) two cycles of induction chemotherapy were given. The median follow-up time of survivors is 72 months (range, 62-74 months). RESULTS We found Grade 1, 2 and 3 acute esophageal toxicity in 11 patients (37%), 2 patients (7%), and 2 patients (7%), respectively. Grade 2 acute pneumonitis was seen in 2 patients (7%). No late toxicity greater than Grade 1 was observed. The actual overall survival rates at 2 and 5 years are 63% and 23%, respectively; the median overall survival, 27.7 months. In 9 patients a local failure occurred, 7 of them presenting initially with an atelectasis without availability of 18-fluorodeoxyglucose-positron emission tomography staging at that time. In 4 patients recurrence occurred regionally. CONCLUSIONS This Phase I/II trial with long-term follow-up shows low toxicity with promising results for survival and locoregional tumor control.
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Affiliation(s)
- Karl Wurstbauer
- Department of Radiation Oncology, Paracelsus Medical University, Salzburg, Austria.
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91
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Steinacher I, Lamprecht B, Lobendanz M, Zoller H, Dartevelle P, Fadel E, Studnicka M. Successful surgical treatment of thoracic multiorgan lymphangiomatosis. Wien Klin Wochenschr 2009; 121:644-7. [DOI: 10.1007/s00508-009-1249-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 08/24/2009] [Indexed: 12/01/2022]
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92
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Lamprecht B, Schirnhofer L, Kaiser B, Buist S, Studnicka M. Non-reversible airway obstruction in never smokers: Results from the Austrian BOLD study. Respir Med 2008; 102:1833-8. [DOI: 10.1016/j.rmed.2008.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 06/30/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
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93
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Ludwig H, Auberger T, Burghuber OC, Gnant M, Hopfinger G, Jäger U, Keil F, Kornek G, Linkesch W, Petru E, Pirker R, Pittermann E, Reinthaller A, Samonigg H, Steger G, Stockenhuber F, Studnicka M, Weiss G, Zielinski C. Einsatz von Erythropoese-stimulierenden Proteinen bei anämischen Patienten mit malignen Erkrankungen. Wien Klin Wochenschr 2008; 120:507-13. [DOI: 10.1007/s00508-008-1007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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94
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Wurstbauer K, Deutschmann H, Kopp P, Kranzinger M, Merz F, Nairz O, Studnicka M, Sedlmayer F. NSCLC: primary tumor size--radiation dose-related accelerated, twice daily radiotherapy by target splitting, preceded by 2 cycles of chemotherapy--first results of a prospective study. Strahlenther Onkol 2008; 183 Spec No 2:38-40. [PMID: 18167008 DOI: 10.1007/s00066-007-2015-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Karl Wurstbauer
- University Clinic of Radiation Oncology, Salzburger Landeskliniken und Paracelsus Medizinische Privatuniversität, Salzburg, Austria.
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95
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96
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Schirnhofer L, Lamprecht B, Vollmer WM, Allison MJ, Studnicka M, Jensen RL, Buist AS. COPD prevalence in Salzburg, Austria: results from the Burden of Obstructive Lung Disease (BOLD) Study. Chest 2007; 131:29-36. [PMID: 17218553 DOI: 10.1378/chest.06-0365] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND COPD is projected to be the third leading cause of death worldwide by 2020. The Burden of Obstructive Lung Disease initiative was started to measure the prevalence of COPD in a standardized way and to provide estimates of the social and economic burden of disease. METHODS We surveyed a gender-stratified, population-based sample of 2,200 adults >or= 40 years of age. The findings of prebronchodilator and postbronchodilator spirometry, as well as information on smoking and reported respiratory disease was recorded. Irreversible airflow obstruction was defined as a postbronchodilator FEV(1)/FVC ratio of < 0.70. RESULTS For 1,258 participants with good-quality postbronchodilator spirometry findings, the overall prevalence of COPD at stage I or higher was 26.1%, and was equal in men and women. The prevalence of COPD stage II or higher (FEV(1)/FVC ratio, < 0.7; FEV(1), < 80% predicted) was 10.7%. The prevalence of COPD stage I+, and COPD stage II+, increased with age and cigarette smoking. A doctor diagnosis of COPD was reported by only 5.6% of participants. CONCLUSION One quarter of residents of Salzburg County (Austria) who were >or= 40 years of age had at least mild irreversible airflow obstruction. The high prevalence of COPD highlights the impending health-care crisis that will affect many countries as a result of this greatly underappreciated condition.
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Affiliation(s)
- Lea Schirnhofer
- Department of Pneumology, Paracelsus Private Medical School, Salzburg, Austria
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97
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Firlei N, Lamprecht B, Schirnhofer L, Kaiser B, Studnicka M. Die Prävalenz der COPD in Österreich – die erwartete Entwicklung bis 2020. Wien Klin Wochenschr 2007; 119:513-8. [DOI: 10.1007/s00508-007-0867-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 08/20/2007] [Indexed: 11/24/2022]
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98
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Lamprecht B, Schirnhofer L, Tiefenbacher F, Kaiser B, Buist SA, Studnicka M, Enright P. Six-second spirometry for detection of airway obstruction: a population-based study in Austria. Am J Respir Crit Care Med 2007; 176:460-4. [PMID: 17556719 DOI: 10.1164/rccm.200702-337oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The presence of airway obstruction is currently defined by Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines on the basis of the post-bronchodilator (BD) FEV(1)/FVC. It has been proposed that the traditional FVC can be replaced with the shorter and less demanding FEV(6) for detecting airway obstruction. OBJECTIVES A comparison of FEV(1)/FVC and FEV(1)/FEV(6) for the detection of airway obstruction in population-based post-bronchodilator spirometry data. METHODS A population-based sample of 1,349 adults participated in the Burden of Obstructive Lung Disease study in Austria. Specially trained and certified technicians conducted pre-BD and post-BD spirometry according to American Thoracic Society guidelines and administered standardized questionnaires. A total of 93% of the post-BD test sessions were acceptable, and were included in this analysis. The Third National Health and Nutrition Examination Survey reference equations were used to calculate predicted values and lower limits of normal (LLN) for FEV(1), FEV(6), FVC, FEV(1)/FVC, and FEV(1)/FEV(6). MEASUREMENTS AND MAIN RESULTS The post-BD FEV(1)/FVC was below the LLN in 199 (15.8%) subjects. The sensitivity of the FEV(1)/FEV(6) for airway obstruction depended greatly on the threshold of percent predicted FEV(1) also used in the definition. The overall sensitivity of FEV(1)/FEV(6) for a diagnosis of airway obstruction, as defined by FEV(1)/FVC (including participants with an FEV(1) above the LLN), was 72.9%, with 98.8% specificity. The sensitivity increased to 98.0% when a low FEV(1) was also required to diagnose post-BD airway obstruction. The discordant cases had long forced expiratory times, often showed a flow-volume curve pattern consistent with two-compartment emptying, and were more often never-smokers. CONCLUSIONS Six-second spirometry maneuvers (which measure FEV(6)) are as sensitive and specific for post-BD airway obstruction as traditional (prolonged exhalation time) FVC maneuvers only when the definition of airway obstruction includes a low FEV(1).
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Affiliation(s)
- Bernd Lamprecht
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
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99
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Lamprecht B, Schirnhofer L, Kaiser B, Studnicka M, Buist AS. Farming and the prevalence of non-reversible airways obstruction: results from a population-based study. Am J Ind Med 2007; 50:421-6. [PMID: 17497693 DOI: 10.1002/ajim.20470] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Occupational exposure to noxious dusts, gases, and fumes most likely contributes to obstructive lung disease. We studied whether self-reported farming work is associated with non-reversible airways obstruction. METHODS Following the burden of obstructive lung disease (BOLD) study protocol, we surveyed a gender-stratified population-based sample of 2,200 adults aged 40 years and over. Pre- and post-bronchodilator spirometry, as well as information on smoking, occupation, and reported respiratory disease was recorded. According to GOLD criteria, non-reversible airways obstruction was defined as a post-bronchodilator forced expiratory volume (FEV(1))/forced vital capacity (FVC) < 0.70. Occupational and smoking history was based on questionnaire. Farming was defined as ever working in this occupation for 3 months or longer. RESULTS For 1,258 participants with complete data (post-bronchodilator spirometry and questionnaire data), 288 (=22.9%) reported farming. Among the 288 participants reporting farming, the prevalence of non-reversible airways obstruction was 30.2%. Farming was significantly associated with airways obstruction: chronic obstructive pulmonary disease (COPD) GOLD stage I or higher (OR 1.5; 95% CI 1.1-2.0) and COPD GOLD stage II or higher (OR 1.8; 95% CI 1.2-2.7). The latter estimate was unchanged when adjustment for competing risks gender, age, and smoking was done. In this population the risk for non-reversible airways obstruction attributable to farming was 7.7%. CONCLUSION Farming should be considered a risk factor for non-reversible airways obstruction.
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Affiliation(s)
- B Lamprecht
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria.
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100
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Hilbe W, Aigner K, Dittrich C, Eckmayr J, Fiegl M, Flicker M, Forstner B, Greil R, Jamnig H, Krajnik G, Lang A, Mohn-Staudner A, Schinko H, Studnicka M, Pirker R, Ploner F, Rothmund J, Schiller L, Zabernigg A, Zöchbauer-Müller S. Expertenempfehlung 2006 zur rationalen Zweitlinien-Therapie beim nicht-kleinzelligen Bronchuskarzinom. Wien Klin Wochenschr 2007; 119:259-66. [PMID: 17492355 DOI: 10.1007/s00508-007-0792-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Wolfgang Hilbe
- Medizinische Universität Innsbruck, Klinische Abteilung für Allgemeine Innere Medizin, Schwerpunkt Onkologie, Innsbruck, Austria.
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