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Vitacca M, Paneroni M. Use simple tools to improve complex conditions. Eur J Intern Med 2024:S0953-6205(24)00221-8. [PMID: 38762434 DOI: 10.1016/j.ejim.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/14/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Michele Vitacca
- Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane (Bs), Italy.
| | - Mara Paneroni
- Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane (Bs), Italy
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Sethi DK, Rhodes J, Ferris R, Banka R, Clarke A, Mishra EK. Breathlessness Predicts Mortality in Adults: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e39192. [PMID: 37332470 PMCID: PMC10276653 DOI: 10.7759/cureus.39192] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Breathlessness is a commonly encountered symptom, and although its relationship with mortality is well established for many conditions, less clear is this relationship in healthy adults. This systematic review and meta-analysis examines whether breathlessness is associated with mortality in a general population. This is important in understanding the impact of this common symptom on a patient's prognosis. This review was registered with PROSPERO (CRD42023394104). Medline, EMBASE, CINAHL and EMCARE were searched for the terms 'breathlessness' and 'survival' or 'mortality' on January 24, 2023. Longitudinal studies of >1,000 healthy adults comparing mortality between breathless and non-breathless controls were eligible for inclusion. If an estimate of effect size was provided, studies were included in the meta-analysis. Eligible studies underwent critical appraisal, data extraction and risk of bias assessment. A pooled effect size was estimated for the relationship between the presence of breathlessness and mortality and levels of severity of breathlessness and mortality. Of 1,993 studies identified, 21 were eligible for inclusion in the systematic review and 19 for the meta-analysis. Studies were of good quality with a low risk of bias, and the majority controlled for important confounders. Most studies identified a significant relationship between the presence of breathlessness and increased mortality. A pooled effect size was estimated, with the presence of breathlessness increasing the risk of mortality by 43% (risk ratio (RR): 1.43, 95% confidence interval (CI): 1.28-1.61). As breathlessness severity increased from mild to severe, mortality increased by 30% (RR: 1.30, 95% CI: 1.21-1.38) and 103%, respectively (RR: 2.03, 95% CI: 1.75-2.35). The same trend was seen when breathlessness was measured using the modified Medical Research Council (mMRC) Dyspnoea Scale: mMRC grade 1 conferred a 26% increased mortality risk (RR: 1.26, 95% CI: 1.16-1.37) compared with 155% for grade 4 (RR: 2.55, 95% CI: 1.86-3.50). We conclude that mortality is associated with the presence of breathlessness and its severity. The mechanism underlying this is unclear and may reflect the ubiquity of breathlessness as a symptom of many diseases.
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Affiliation(s)
- Dheeraj K Sethi
- Norwich Medical School, University of East Anglia, Norwich, GBR
- Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - James Rhodes
- Norwich Medical School, University of East Anglia, Norwich, GBR
| | - Rebecca Ferris
- Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Radhika Banka
- Respiratory Medicine, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, IND
| | - Allan Clarke
- Norwich Medical School, University of East Anglia, Norwich, GBR
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Liu D, Wang Z, Zhuang Y, Wang Y, Zhang J, Wang R, Cao J, Feng J. Chronic Breathlessness in Obstructive Sleep Apnea and the Use of Lymphocyte Parameters to Identify Overlap Syndrome among Patients. J Clin Med 2023; 12:jcm12030936. [PMID: 36769584 PMCID: PMC9917600 DOI: 10.3390/jcm12030936] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023] Open
Abstract
Little is known about the distribution of etiology in obstructive sleep apnea (OSA) combined with chronic breathlessness. A significant portion of patients in this group have so-called "overlap syndrome (OVS)", characterized by chronic obstructive pulmonary disease (COPD). OVS has more complications and a poorer prognosis compared to patients with either OSA or COPD alone, which makes it important to identify OVS early in OSA. The current study was a retrospective cross-sectional analysis of consecutive adult patients who were diagnosed with OSA (n = 1062), of whom 275 were hospitalized due to chronic breathlessness. Respiratory and cardiac diseases accounted for the vast majority of causes, followed by gastrointestinal and renal disorders. The final study population comprised 115 patients with OSA alone (n = 64) and OVS (n = 51), who had chronic breathlessness as the primary complaint, not secondary as one of many other complaints. Lymphocytes, CD4 counts, neutrophil-to-lymphocyte ratio (NLR), and PLR were differently expressed between the OSA-alone group and OVS group. The NLR, lymphocytes, and CD4 counts had a moderate diagnostic value for OVS in OSA patients, with AUCs of 0.708 (95% CI, 0.614-0.802), 0.719 (95% CI, 0.624-0.813), and 0.744 (95% CI, 0.653-0.834), respectively. The NLR had the highest AUC for predicting a 6-month re-admission of OVS, with a cut-off of 3.567 and a moderate prognostic value. The sensitivity and specificity were 0.8 and 0.732, respectively. In the animal model, the spleen hematoxylin- and eosin-stained, electron microscopy images showed germinal-center damage, chromatin activation, and mitochondrial swelling under the overlapping effect of intermittent hypoxia and cigarette smoke exposure. OSA with chronic breathlessness cannot be overstated. A significant proportion of patients with COPD in this group had poor lung function at initial diagnosis. The NLR is a useful biomarker to differentiate OVS among OSA patients combined with chronic breathlessness.
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Affiliation(s)
- Dan Liu
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhiding Wang
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Yan Zhuang
- Department of Respiratory Medicine, Tianjin Medical University Second Hospital, Tianjin 300052, China
| | - Yan Wang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jing Zhang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Rui Wang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jie Cao
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
- Correspondence: (J.C.); (J.F.)
| | - Jing Feng
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
- Correspondence: (J.C.); (J.F.)
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Pesola GR, Rataul H. POCUS is Already Here in 2019! Chest 2020; 157:476-477. [PMID: 32033654 DOI: 10.1016/j.chest.2019.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/29/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Gene R Pesola
- Department of Medicine, Section of Pulmonary/Critical Care, Columbia University, New York, NY.
| | - Harseerat Rataul
- Department of Medicine, Section of Pulmonary/Critical Care, Harlem Hospital Center, New York, NY
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Affiliation(s)
- Gene R Pesola
- Gene R. Pesola is with the Department of Medicine, Harlem Hospital/Columbia University, New York, NY. Allana T. Forde is a doctoral student in epidemiology, Mailman School of Public Health, Columbia University. Habibul Ahsan is with the Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Allana T Forde
- Gene R. Pesola is with the Department of Medicine, Harlem Hospital/Columbia University, New York, NY. Allana T. Forde is a doctoral student in epidemiology, Mailman School of Public Health, Columbia University. Habibul Ahsan is with the Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Habibul Ahsan
- Gene R. Pesola is with the Department of Medicine, Harlem Hospital/Columbia University, New York, NY. Allana T. Forde is a doctoral student in epidemiology, Mailman School of Public Health, Columbia University. Habibul Ahsan is with the Department of Public Health Sciences, University of Chicago, Chicago, IL
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Parvez F, Lauer FT, Factor-Litvak P, Liu X, Santella RM, Islam T, Eunus M, Alam N, Sarwar G, Rahman M, Ahsan H, Graziano J, Burchiel SW. Assessment of arsenic and polycyclic aromatic hydrocarbon (PAH) exposures on immune function among males in Bangladesh. PLoS One 2019; 14:e0216662. [PMID: 31095595 PMCID: PMC6522035 DOI: 10.1371/journal.pone.0216662] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/25/2019] [Indexed: 01/01/2023] Open
Abstract
Arsenic and polycyclic aromatic hydrocarbons (PAH) are environmental pollutants to which people around the world are exposed through water, food and air. In mouse and in vitro studies of human cells, both of these chemicals have been shown to modulate the immune system. In some experimental studies, a synergistic disruption of immune function was observed by a combined exposure to arsenic and PAH. However, a joint effect of arsenic and PAH on immune function has not been studied in humans. We have conducted an epidemiological investigation to examine effects of chronic arsenic and PAH exposures on immune function. We assessed T-cell proliferation (TCP) and cytokine production of anti-CD3/anti-CD28 stimulated lymphocytes in human peripheral blood mononuclear cells (HPBMC) among 197 healthy men enrolled to the Health Effects of Arsenic Longitudinal (HEALS) cohort in Bangladesh. By design, approximately half were active smokers and the rest were never smokers. Our analyses demonstrated that IL-1b, IL-2, IL-4 and IL-6 were significantly stimulated as a function of urinary arsenic levels in models adjusted for age, body mass index (BMI), smoking status and PAH-DNA adducts. After correcting for false detection rate (FDR), only IL-1b remained statistically significant. We found a U-shaped dose response relationship between urinary arsenic and IL-1b. On the other hand, PAH-DNA adducts were associated with an inhibition of TCP and appeared as an inverted U-shape curve. Dose response curves were non-monotonic for PAH-DNA adduct exposures and suggested that cytokine secretion of IFNg, IL-1b, IL-2, IL-10 and IL17A followed a complex pattern. In the majority of donors, there was a trend towards a decrease in cytokine associated with PAH-DNA adducts. We did not observe any interaction between urinary arsenic and PAH-DNA adducts on immune parameters. Our results indicate that long-term exposures to arsenic and PAH have independent, non-monotonic associations with TCP and cytokine production.
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Affiliation(s)
- Faruque Parvez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Fredine T. Lauer
- University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, Albuquerque, NM, United States of America
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Xinhua Liu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Regina M. Santella
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Tariqul Islam
- University of Chicago Field Research Office, Bangladesh
| | | | - Nur Alam
- University of Chicago Field Research Office, Bangladesh
| | - Golam Sarwar
- University of Chicago Field Research Office, Bangladesh
| | | | - Habibul Ahsan
- Department of Health Studies, University of Chicago, Chicago, IL, United States of America
| | - Joseph Graziano
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Scott W. Burchiel
- University of New Mexico College of Pharmacy, Department of Pharmaceutical Sciences, Albuquerque, NM, United States of America
- * E-mail:
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Affiliation(s)
- Gene R Pesola
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Section of Pulmonary/Critical Care Medicine, Department of Medicine, Harlem Hospital, Columbia University, New York, NY, USA
| | - Vikhyath Terla
- Section of Pulmonary/Critical Care Medicine, Department of Medicine, Harlem Hospital, Columbia University, New York, NY, USA
| | - Nasir Malik
- Section of Pulmonary/Critical Care Medicine, Department of Medicine, Harlem Hospital, Columbia University, New York, NY, USA
| | - Habibul Ahsan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
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Bousquet J, Dinh-Xuan AT, Similowski T, Malva J, Ankri J, Barbagallo M, Fabbri L, Humbert M, Mercier J, Robalo-Cordeiro C, Rodriguez-Manas L, Vellas B. Should we use gait speed in COPD, FEV1 in frailty and dyspnoea in both? Eur Respir J 2018; 48:315-9. [PMID: 27478189 DOI: 10.1183/13993003.00633-2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/30/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Jean Bousquet
- MACVIA-LR, Contre les Maladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon, Languedoc-Roussillon, France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France INSERM, VIMA: Ageing and chronic diseases, Epidemiological and public health approaches, U1168, Paris, France UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
| | - Anh Tuan Dinh-Xuan
- Service de physiologie respiratoire, Hôpital Cochin, Université Paris-Descartes, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Thomas Similowski
- UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France
| | - João Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joël Ankri
- Gerontology Center, Site Sainte Périne, Université de Versailles St Quentin, Paris, France
| | - Mario Barbagallo
- Dept of Internal Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Leonardo Fabbri
- Dept of Metabolic Medicine, University of Modena and Reggio Emilia, Sant'Agostino Estense Hospital, Modena, Italy
| | - Marc Humbert
- Université Paris-Sud, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Jacques Mercier
- Dept of Physiology, CHRU, University Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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