1
|
Siegfried JM. Sex and Gender Differences in Lung Cancer and Chronic Obstructive Lung Disease. Endocrinology 2022; 163:6470418. [PMID: 34927202 DOI: 10.1210/endocr/bqab254] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/19/2022]
Abstract
Two highly prevalent pulmonary diseases, lung cancer and chronic obstructive lung disease (COPD), show both sex and gender differences in their presentations and outcomes. Sex differences are defined as biological differences associated with the male vs female genotype, and gender differences are defined as behavioral or social differences that primarily arise because of gender identity. The incidence of both lung cancer and COPD has increased dramatically in women over the past 50 years, and both are associated with chronic pulmonary inflammation. Development of COPD is also a risk factor for lung cancer. In this review, the main differences in lung cancer and COPD biology observed between men and women will be summarized. Potential causative factors will be discussed, including the role of estrogen in promoting pro-growth and inflammatory phenotypes which may contribute to development of both lung cancer and COPD. Response of the innate and adaptive immune system to estrogen is a likely factor in the biology of both lung cancer and COPD. Estrogen available from synthesis by reproductive organs as well as local pulmonary estrogen synthesis may be involved in activating estrogen receptors expressed by multiple cell types in the lung. Estrogenic actions, although more pronounced in women, may also have importance in the biology of lung cancer and COPD in men. Effects of estrogen are also timing and context dependent; the multiple cell types that mediate estrogen action in the lungs may confer both positive and negative effects on disease processes.
Collapse
Affiliation(s)
- Jill M Siegfried
- Department of Pharmacology, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| |
Collapse
|
2
|
Nicolaou L, Checkley W. Differences between cigarette smoking and biomass smoke exposure: An in silico comparative assessment of particulate deposition in the lungs. ENVIRONMENTAL RESEARCH 2021; 197:111116. [PMID: 33823195 PMCID: PMC8187290 DOI: 10.1016/j.envres.2021.111116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 05/29/2023]
Abstract
Cigarette smoking and biomass smoke are the two main environmental risk factors of chronic obstructive pulmonary disease (COPD) worldwide. However, it remains unclear why these exposures result in two different disease phenotypes. In this study, we assessed the lung deposition from biomass and cigarette smoke exposures and examined whether differences due to inherently different particle size distributions and inhalation conditions may contribute to the differences between biomass- and tobacco-related COPD phenotypes. Using high-fidelity three-dimensional computational fluid-particle dynamics in a representative upper airway geometry, coupled to one-dimensional models of the lower airways, we computed total deposited doses and examined regional deposition patterns based on exposure data from a randomized control trial in Peru and from the literature for biomass and mainstream cigarette smoke, respectively. Our results showed that intrathoracic deposition was higher in cigarette smoking, with 36.8% of inhaled biomass smoke particles and 57.7% of cigarette smoke particles depositing in the intrathoracic airways. We observed higher fractions of cigarette smoke particles in the last few airway generations, which could explain why cigarette smoking is associated with more emphysema than biomass smoke exposure. Mean daily deposited dose was two orders of magnitude higher in cigarette smoking. Lobar distributions of the deposited dose also differed, with the left lower and right upper lobes receiving the highest doses of biomass and cigarette smoke particles, respectively. Our findings suggest that the differences between biomass- and tobacco-related COPD could, at least in part, be due to differences in total and regional lung deposition of biomass and cigarette smoke.
Collapse
Affiliation(s)
- Laura Nicolaou
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA.
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| |
Collapse
|
3
|
Senyurek VY, Imtiaz MH, Belsare P, Tiffany S, Sazonov E. A CNN-LSTM neural network for recognition of puffing in smoking episodes using wearable sensors. Biomed Eng Lett 2020; 10:195-203. [PMID: 32431952 DOI: 10.1007/s13534-020-00147-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 01/03/2023] Open
Abstract
A detailed assessment of smoking behavior under free-living conditions is a key challenge for health behavior research. A number of methods using wearable sensors and puff topography devices have been developed for smoking and individual puff detection. In this paper, we propose a novel algorithm for automatic detection of puffs in smoking episodes by using a combination of Respiratory Inductance Plethysmography and Inertial Measurement Unit sensors. The detection of puffs was performed by using a deep network containing convolutional and recurrent neural networks. Convolutional neural networks (CNN) were utilized to automate feature learning from raw sensor streams. Long Short Term Memory (LSTM) network layers were utilized to obtain the temporal dynamics of sensor signals and classify sequence of time segmented sensor streams. An evaluation was performed by using a large, challenging dataset containing 467 smoking events from 40 participants under free-living conditions. The proposed approach achieved an F1-score of 78% in leave-one-subject-out cross-validation. The results suggest that CNN-LSTM based neural network architecture sufficiently detect puffing episodes in free-living condition. The proposed model be used as a detection tool for smoking cessation programs and scientific research.
Collapse
Affiliation(s)
- Volkan Y Senyurek
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| | - Masudul H Imtiaz
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| | - Prajakta Belsare
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| | - Stephen Tiffany
- 2Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260 USA
| | - Edward Sazonov
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| |
Collapse
|
4
|
Senyurek VY, Imtiaz MH, Belsare P, Tiffany S, Sazonov E. A CNN-LSTM neural network for recognition of puffing in smoking episodes using wearable sensors. Biomed Eng Lett 2020. [PMID: 32431952 DOI: 10.3877/cma.j.issn.2095-1221.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A detailed assessment of smoking behavior under free-living conditions is a key challenge for health behavior research. A number of methods using wearable sensors and puff topography devices have been developed for smoking and individual puff detection. In this paper, we propose a novel algorithm for automatic detection of puffs in smoking episodes by using a combination of Respiratory Inductance Plethysmography and Inertial Measurement Unit sensors. The detection of puffs was performed by using a deep network containing convolutional and recurrent neural networks. Convolutional neural networks (CNN) were utilized to automate feature learning from raw sensor streams. Long Short Term Memory (LSTM) network layers were utilized to obtain the temporal dynamics of sensor signals and classify sequence of time segmented sensor streams. An evaluation was performed by using a large, challenging dataset containing 467 smoking events from 40 participants under free-living conditions. The proposed approach achieved an F1-score of 78% in leave-one-subject-out cross-validation. The results suggest that CNN-LSTM based neural network architecture sufficiently detect puffing episodes in free-living condition. The proposed model be used as a detection tool for smoking cessation programs and scientific research.
Collapse
Affiliation(s)
- Volkan Y Senyurek
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| | - Masudul H Imtiaz
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| | - Prajakta Belsare
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| | - Stephen Tiffany
- 2Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 14260 USA
| | - Edward Sazonov
- 1Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487 USA
| |
Collapse
|
5
|
Imtiaz MH, Ramos-Garcia RI, Wattal S, Tiffany S, Sazonov E. Wearable Sensors for Monitoring of Cigarette Smoking in Free-Living: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E4678. [PMID: 31661856 PMCID: PMC6864810 DOI: 10.3390/s19214678] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/28/2023]
Abstract
Globally, cigarette smoking is widespread among all ages, and smokers struggle to quit. The design of effective cessation interventions requires an accurate and objective assessment of smoking frequency and smoke exposure metrics. Recently, wearable devices have emerged as a means of assessing cigarette use. However, wearable technologies have inherent limitations, and their sensor responses are often influenced by wearers' behavior, motion and environmental factors. This paper presents a systematic review of current and forthcoming wearable technologies, with a focus on sensing elements, body placement, detection accuracy, underlying algorithms and applications. Full-texts of 86 scientific articles were reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines to address three research questions oriented to cigarette smoking, in order to: (1) Investigate the behavioral and physiological manifestations of cigarette smoking targeted by wearable sensors for smoking detection; (2) explore sensor modalities employed for detecting these manifestations; (3) evaluate underlying signal processing and pattern recognition methodologies and key performance metrics. The review identified five specific smoking manifestations targeted by sensors. The results suggested that no system reached 100% accuracy in the detection or evaluation of smoking-related features. Also, the testing of these sensors was mostly limited to laboratory settings. For a realistic evaluation of accuracy metrics, wearable devices require thorough testing under free-living conditions.
Collapse
Affiliation(s)
- Masudul H Imtiaz
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Raul I Ramos-Garcia
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Shashank Wattal
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| | - Stephen Tiffany
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, NY 12246, USA.
| | - Edward Sazonov
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA.
| |
Collapse
|
6
|
Wallace E, Guiu Hernandez E, Ang A, Hiew S, Macrae P. A systematic review of methods of citric acid cough reflex testing. Pulm Pharmacol Ther 2019; 58:101827. [PMID: 31326628 DOI: 10.1016/j.pupt.2019.101827] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This systematic review summarises and appraises methods of citric acid cough reflex testing (CRT) documented in published literature. METHODS Electronic databases, MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus were searched up to and including 11th February 2018. Studies reporting a method of citric acid CRT, published in peer-reviewed journals in English or Spanish, were assessed for the inclusion criteria. Of the selected studies, information on the instrumentation and CRT protocol was extracted. RESULTS A total of 129 studies were included. Instrumentation and protocols differed widely across studies. Reporting of methods of citric acid CRT was sub-standard, with many crucial methodological components omitted from published manuscripts, preventing their full replication. CONCLUSIONS Considerable methodological variability exists for citric acid CRT in published literature. The findings suggest that caution is warranted in comparing citric acid cough thresholds across studies. Full replication of previously published methods of citric acid CRT is limited due to crucial elements of the citric acid CRT protocol being omitted from published manuscripts. These findings have implications on the use of citric acid CRT in clinical and pharmaceutical studies to evaluate the effects of antitussive medications and cough therapies.
Collapse
Affiliation(s)
- Emma Wallace
- University of Canterbury, Rose Centre for Stroke Recovery and Research, Dept of Communication Disorders, Christchurch, New Zealand.
| | - Esther Guiu Hernandez
- University of Canterbury, Rose Centre for Stroke Recovery and Research, Dept of Communication Disorders, Christchurch, New Zealand
| | - Alicia Ang
- University of Canterbury, Rose Centre for Stroke Recovery and Research, Dept of Communication Disorders, Christchurch, New Zealand
| | - Sarah Hiew
- University of Canterbury, Rose Centre for Stroke Recovery and Research, Dept of Communication Disorders, Christchurch, New Zealand
| | - Phoebe Macrae
- University of Canterbury, Rose Centre for Stroke Recovery and Research, Dept of Communication Disorders, Christchurch, New Zealand
| |
Collapse
|
7
|
Gut-Gobert C, Cavaillès A, Dixmier A, Guillot S, Jouneau S, Leroyer C, Marchand-Adam S, Marquette D, Meurice JC, Desvigne N, Morel H, Person-Tacnet C, Raherison C. Women and COPD: do we need more evidence? Eur Respir Rev 2019; 28:28/151/180055. [PMID: 30814138 PMCID: PMC9488562 DOI: 10.1183/16000617.0055-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/21/2018] [Indexed: 01/20/2023] Open
Abstract
The increasingly female face of chronic obstructive pulmonary disease (COPD) prevalence among women has equalled that of men since 2008, due in part to increased tobacco use among women worldwide and exposure to biomass fuels. This finding is supported by a number of characteristics. There is evidence of susceptibility to smoking and other airborne contaminants, along with epidemiological and phenotypic manifestations. COPD has thus become the leading cause of death in women in the USA. The clinical presentation is characterised by increasingly pronounced dyspnoea with a marked tendency towards anxiety and depression, undernutrition, nonsmall cell lung cancer (especially adenocarcinoma) and osteoporosis. Quality of life is also more significantly impacted. The theories advanced to explain these differences involve the role played by oestrogens, impaired gas exchange in the lungs and smoking habits. While these differences require appropriate therapeutic responses (smoking cessation, pulmonary rehabilitation, long-term oxygen therapy), barriers to the treatment of women with COPD include greater under-diagnosis than in men, fewer spirometry tests and medical consultations. Faced with this serious public health problem, we need to update and adapt our knowledge to the epidemiological changes. The face of COPD is increasingly female. We need more evidence and a change in how the disease is managed. http://ow.ly/zueL30mWqlS
Collapse
Affiliation(s)
- Christophe Gut-Gobert
- G.E.T.B.O. (Groupe d'Etude de la Thrombose de Bretagne Occidentale), Université Européenne de Bretagne, Université de Brest, EA3878, IFR148, Hôpital La Cavale Blanche, Département de Médecine Interne et Pneumologie, Brest, France
| | - Arnaud Cavaillès
- Institut du Thorax, CHU de Nantes, Dept of Pulmonology, Nantes, France
| | - Adrien Dixmier
- Dept of Pulmonology, Orléans Regional Hospital, Orléans, France
| | - Stéphanie Guillot
- Unité d'Explorations Fonctionnelles Respiratoires, CHRU Rennes, Rennes, France
| | - Stéphane Jouneau
- Service de Pneumologie, Hôpital Pontchaillou, Rennes, France.,IRSET UMR 1085, Université de Rennes 1, Rennes, France
| | - Christophe Leroyer
- G.E.T.B.O. (Groupe d'Etude de la Thrombose de Bretagne Occidentale), Université Européenne de Bretagne, Université de Brest, EA3878, IFR148, Hôpital La Cavale Blanche, Département de Médecine Interne et Pneumologie, Brest, France
| | - Sylvain Marchand-Adam
- Université François Rabelais Faculté de Médecine de Tours, Inserm 1100, CHRU de Tours Service de Pneumologie, Tours, France
| | - David Marquette
- Dept of Pulmonary Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Jean-Claude Meurice
- Dept of Pulmonology Centre Hospitalier de l'Université de Poitiers, Poitiers, France
| | | | - Hugues Morel
- Dept of Pulmonology, Orléans Regional Hospital, Orléans, France
| | | | - Chantal Raherison
- Service des Maladies Respiratoires, CHU Bordeaux, Epicene U1219 Université de Bordeaux, Bordeaux, France
| |
Collapse
|
8
|
Development of a Multisensory Wearable System for Monitoring Cigarette Smoking Behavior in Free-Living Conditions. ELECTRONICS 2017; 6. [PMID: 29607211 PMCID: PMC5877467 DOI: 10.3390/electronics6040104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper presents the development and validation of a novel multi-sensory wearable system (Personal Automatic Cigarette Tracker v2 or PACT2.0) for monitoring of cigarette smoking in free-living conditions. The contributions of the PACT2.0 system are: (1) the implementation of a complete sensor suite for monitoring of all major behavioral manifestations of cigarette smoking (lighting events, hand-to-mouth gestures, and smoke inhalations); (2) a miniaturization of the sensor hardware to enable its applicability in naturalistic settings; and (3) an introduction of new sensor modalities that may provide additional insight into smoking behavior e.g., Global Positioning System (GPS), pedometer and Electrocardiogram(ECG) or provide an easy-to-use alternative (e.g., bio-impedance respiration sensor) to traditional sensors. PACT2.0 consists of three custom-built devices: an instrumented lighter, a hand module, and a chest module. The instrumented lighter is capable of recording the time and duration of all lighting events. The hand module integrates Inertial Measurement Unit (IMU) and a Radio Frequency (RF) transmitter to track the hand-to-mouth gestures. The module also operates as a pedometer. The chest module monitors the breathing (smoke inhalation) patterns (inductive and bio-impedance respiratory sensors), cardiac activity (ECG sensor), chest movement (three-axis accelerometer), hand-to-mouth proximity (RF receiver), and captures the geo-position of the subject (GPS receiver). The accuracy of PACT2.0 sensors was evaluated in bench tests and laboratory experiments. Use of PACT2.0 for data collection in the community was validated in a 24 h study on 40 smokers. Of 943 h of recorded data, 98.6% of the data was found usable for computer analysis. The recorded information included 549 lighting events, 522/504 consumed cigarettes (from lighter data/self-registered data, respectively), 20,158/22,207 hand-to-mouth gestures (from hand IMU/proximity sensor, respectively) and 114,217/112,175 breaths (from the respiratory inductive plethysmograph (RIP)/bio-impedance sensor, respectively). The proposed system scored 8.3 ± 0.31 out of 10 on a post-study acceptability survey. The results suggest that PACT2.0 presents a reliable platform for studying of smoking behavior at the community level.
Collapse
|
9
|
Sazonov E, Lopez-Meyer P, Tiffany S. A wearable sensor system for monitoring cigarette smoking. J Stud Alcohol Drugs 2014; 74:956-64. [PMID: 24172124 DOI: 10.15288/jsad.2013.74.956] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Available methods of smoking assessment (e.g., self-report, portable puff-topography instruments) do not permit the collection of accurate measures of smoking behavior while minimizing reactivity to the assessment procedure. This article suggests a new method for monitoring cigarette smoking based on a wearable sensor system (Personal Automatic Cigarette Tracker [PACT]) that is completely transparent to the end user and does not require any conscious effort to achieve reliable monitoring of smoking in free-living individuals. METHOD The proposed sensor system consists of a respiratory inductance plethysmograph for monitoring of breathing and a hand gesture sensor for detecting a cigarette at the mouth. The wearable sensor system was tested in a laboratory study of 20 individuals who performed 12 different activities including cigarette smoking. Signal processing was applied to evaluate the uniqueness of breathing patterns and their correlation with hand gestures. RESULTS The results indicate that smoking manifests unique breathing patterns that are highly correlated with hand-to-mouth cigarette gestures and suggest that these signals can potentially be used to identify and characterize individual smoke inhalations. CONCLUSIONS With the future development of signal processing and pattern-recognition methods, PACT can be used to automatically assess the frequency of smoking and inhalation patterns (such as depth of inhalation and smoke holding) throughout the day and provide an objective method of assessing the effectiveness of behavioral and pharmacological smoking interventions.
Collapse
Affiliation(s)
- Edward Sazonov
- Department of Electrical and Computer Engineering, The University of Alabama, Tuscaloosa, Alabama
| | | | | |
Collapse
|
10
|
Harvey BG, Strulovici-Barel Y, Vincent TL, Mezey JG, Raviram R, Gordon C, Salit J, Tilley AE, Chung A, Sanders A, Crystal RG. High correlation of the response of upper and lower lobe small airway epithelium to smoking. PLoS One 2013; 8:e72669. [PMID: 24039793 PMCID: PMC3767732 DOI: 10.1371/journal.pone.0072669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/18/2013] [Indexed: 01/15/2023] Open
Abstract
The distribution of lung disease induced by inhaled cigarette smoke is complex, depending on many factors. With the knowledge that the small airway epithelium (SAE) is the earliest site of smoking-induced lung disease, and that the SAE gene expression is likely sensitive to inhaled cigarette smoke, we compared upper vs. lower lobe gene expression in the SAE within the same cigarette smokers to determine if the gene expression patterns were similar or different. Active smokers (n = 11) with early evidence of smoking-induced lung disease (normal spirometry but low diffusing capacity) underwent bronchoscopy and brushing of the upper and lower lobe SAE in order to compare upper vs lower lobe genome-wide and smoking-responsive gene expression by microarray. Cluster and principal component analysis demonstrated that, for each individual, the expression of the known SAE smoking-responsive genes were highly correlated in upper and lower lobe pairs, although, as expected, there were differences in the smoking-induced changes in gene expression from individual to individual. These observations support the concept that the heterogeneity observed among smokers in the anatomic distribution of smoking-induced disease are not secondary to the topographic differences in the effects of cigarette smoke on the airway epithelium.
Collapse
Affiliation(s)
- Ben-Gary Harvey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Yael Strulovici-Barel
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Thomas L. Vincent
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Jason G. Mezey
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Biological Statistics and Computational Biology, Cornell University, Ithaca, New York, United States of America
| | - Ramya Raviram
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Cynthia Gordon
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Jacqueline Salit
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Ann E. Tilley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Augustine Chung
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Abraham Sanders
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Ronald G. Crystal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| |
Collapse
|
11
|
Raherison C, Biron E, Nocent-Ejnaini C, Taillé C, Tillie-Leblond I, Prudhomme A. Existe-t-il des spécificités chez les femmes atteintes de BPCO ? Rev Mal Respir 2010; 27:611-24. [DOI: 10.1016/j.rmr.2010.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 12/29/2009] [Indexed: 10/19/2022]
|
12
|
Abstract
Smoking is a well-known risk factor for perioperative complications. Smokers experience an increased incidence of respiratory complications during anaesthesia and an increased risk of postoperative cardiopulmonary complications, infections and impaired wound healing. Smokers have a greater risk of postoperative intensive care admission. Even passive smoking is associated with increased risk at operation. Preoperative smoking intervention 6-8 weeks before surgery can reduce the complications risk significantly. Four weeks of abstinence from smoking seems to improve wound healing. An intensive, individual approach to smoking intervention results in a significantly better postoperative outcome. Future research should focus upon the effect of a shorter period of preoperative smoking cessation. All smokers admitted for surgery should be informed of the increased risk, recommended preoperative smoking cessation, and offered a smoking intervention programme whenever possible.
Collapse
Affiliation(s)
- Ann Møller
- Department of Anaesthesiology, Herlev University Hospital, Herlev Ringvej, 2730 Herlev, Denmark.
| | | |
Collapse
|
13
|
Fontana GA, Lavorini F, Geri P, Zanasi A, Piumelli R. Cough in children with congenital central hypoventilation syndrome. Pulm Pharmacol Ther 2005; 17:425-9. [PMID: 15564086 DOI: 10.1016/j.pupt.2004.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 09/13/2004] [Indexed: 11/19/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS) is defined as failure of the chemical (autonomic) control of breathing causing alveolar hypoventilation in the absence of pulmonary, cardiac, neuromuscular or patent brainstem lesions. Hypoventilation is predominant in non-rapid-eye-movement sleep, during which breathing is primarily under chemical control. Failure of the central integration of chemosensory inputs is proposed as the putative defect. A genetic basis for CCHS is supported by lines of evidence. In some diseases of the central nervous system there is more or less complete depression of the cough reflex, whereas spontaneous ventilation is generally preserved. Little is known regarding cough in CCHS patients. Parents consistently report that their children cough 'normally' during airway infections; in contrast, experimental lines of evidence suggest that CCHS children lack a cough response following inhalation of a tussigenic agent. Although several factors may account for the discrepancy, the possibility of a weakened or even absent cough reflex remains to be fully ascertained. Conceivably, a defective cough reflex, in conjunction with the well established lack of perception of respiratory discomfort, might result in an increased risk of potentially serious respiratory complications in CCHS patients.
Collapse
Affiliation(s)
- Giovanni A Fontana
- Dipartimento di Area Critica Medico Chirurgica, Sezione di Malattie dell'Apparato Respiratorio, Università degli Sudi di Firenze, Viale G. B., Morgagni, 85, 50134 Firenze, Italy.
| | | | | | | | | |
Collapse
|
14
|
Stephens RE, Addington WR, Widdicombe JG. Effect of acute unilateral middle cerebral artery infarcts on voluntary cough and the laryngeal cough reflex. Am J Phys Med Rehabil 2003; 82:379-83. [PMID: 12704278 DOI: 10.1097/01.phm.0000064730.54787.f5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effect of acute unilateral middle cerebral artery (MCA) infarctions in right-handed subjects on their ability to elicit voluntary cough (VC), and separately to assess the laryngeal cough reflex using the reflex cough test. DESIGN This prospective, clinical study involved 30 right-handed, alert subjects with no previous history of stroke or asthma and with an infarction of the MCA distribution as seen on computed tomographic or magnetic resonance images. Subjects could follow verbal commands. A total of 16 subjects had right MCA infarcts and 14 had left MCA infarcts. VC responses and reflex cough test results were compared with the side of the infarct. The reflex cough test used nebulized tartaric acid. RESULTS The laryngeal cough reflex was normal in all 30 subjects, irrespective of side of MCA infarction, and none developed aspiration pneumonia. Eleven of the 14 subjects who had a left MCA infarct had an abnormal VC (78.6%) and showed cough apraxia. All 16 subjects with right infarcts produced a VC. Subjects with left infarcts were more likely to have an abnormal VC than those subjects with right lesions (P < 0.001). CONCLUSIONS VC is of limited use in screening subjects for aspiration pneumonia risk. A normal laryngeal cough reflex indicated a neurologically protected airway.
Collapse
Affiliation(s)
- Robert E Stephens
- Department of Anatomy, University of Health Sciences, Kansas City, Missouri 64106-1453, USA
| | | | | |
Collapse
|
15
|
Dicpinigaitis PV, Grimm DR, Lesser M. Baclofen-induced cough suppression in cervical spinal cord injury. Arch Phys Med Rehabil 2000; 81:921-3. [PMID: 10896005 DOI: 10.1053/apmr.2000.5612] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the effect of the GABA-agonist baclofen on cough reflex sensitivity in subjects with cervical spinal cord injury (C-SCI). Baclofen has been shown to inhibit the cough reflex in able-bodied volunteers. DESIGN Prospective, nonrandomized control trial. SETTING Veterans Affairs medical center with large outpatient SCI population. PARTICIPANTS Twelve adult males (11 outpatients) with C-SCI chronically maintained on oral baclofen for the treatment of muscle spasm. INTERVENTION Subjects underwent cough challenge testing with inhaled capsaicin. The concentrations (microM) of capsaicin inducing 2 or more (C2) and 5 or more (C5) coughs were determined. Mean values for log C2 and log C5 were compared with a control group of outpatients with C-SCI not receiving baclofen. RESULTS Subjects treated with baclofen had a significantly higher cough threshold (diminished cough reflex sensitivity) than control subjects. Mean (+/- standard error of the mean) values for log C2 in study subjects and controls were 1.28 +/- .16 and .65 +/- .15, respectively (p = .009). Mean values for log C5 in subjects receiving baclofen and in control subjects were 2.20 +/- .22 and 1.43 +/- .23, respectively (p = .024). Subjects and controls did not differ in terms of age, spirometric parameters, or duration of injury. CONCLUSIONS The results suggest that chronic therapy with baclofen diminishes cough reflex sensitivity in subjects with C-SCI. The clinical significance of this finding remains to be elucidated.
Collapse
Affiliation(s)
- P V Dicpinigaitis
- Department of Medicine, Albert Einstein College of Medicine, and the Spinal Cord Pulmonary Research Center, Veterans Affairs Medical Center, Bronx, NY, USA
| | | | | |
Collapse
|
16
|
Abstract
BACKGROUND Cough is an important symptom of patients with chronic obstructive pulmonary disease (COPD). The cough threshold to citric acid and capsaicin in patients with COPD and in normal volunteers was measured, as well as bronchial hyperresponsiveness to methacholine. METHODS Nineteen patients with COPD and 22 controls were recruited. Subjects underwent a methacholine bronchoprovocation test and a cough challenge to citric acid and capsaicin. RESULTS The log citric acid cough threshold D2 (concentration causing two coughs) was significantly lower in patients with COPD (mean 2.17 versus 2.56, mean difference (95% CI) 0.39 (0.04 to 0.74), p = 0.02) but not for capsaicin cough D2 (0.66 versus 0.8, p = 0.41). Sixteen patients with COPD had bronchial hyperresponsiveness which was correlated with baseline FEV1 (r = 0.6, p = 0.01, 95% CI 0.15 to 0.84). CONCLUSIONS Patients with COPD have a lower cough threshold to citric acid, possibly due to a differential effect of cigarette smoke on citric acid sensitive cough receptors.
Collapse
Affiliation(s)
- C H Wong
- Department of Medicine, Northern General Hospital, Sheffield, UK
| | | |
Collapse
|
17
|
Fujimura M, Kamio Y, Hashimoto T, Matsuda T. Airway cough sensitivity to inhaled capsaicin and bronchial responsiveness to methacholine in asthmatic and bronchitic subjects. Respirology 1998; 3:267-72. [PMID: 10201054 DOI: 10.1111/j.1440-1843.1998.tb00133.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to evaluate the effect of chronic airway inflammation on airway cough sensitivity and non-specific bronchial responsiveness, and the relationship between them. The capsaicin cough threshold, defined as the lowest concentration of capsaicin causing five or more coughs, and non-specific bronchial responsiveness, defined as the methacholine concentration causing a 20% fall in forced expiratory volume in 1 s (FEV1) (PC20-FEV1), were measured in 18 asthmatic, 13 bronchitic (sinobronchial syndrome) and 28 healthy non-atopic subjects. All subjects were non-smoking men. The geometric mean values (mumol) of the cough threshold were 18.9 (GSEM 1.29), 8.69 (GSEM 1.29) and 27.6 (GSEM 1.31) in asthmatic, bronchitic and normal subjects, respectively. The value in bronchitic subjects was significantly lower (P << 0.02) than that in normal subjects. The geometric mean value of PC20-FEV1 in asthmatic subjects (0.48 mg/ml (GSEM 1.38)) was significantly lower than that in bronchitic subjects (18.5 mg/ml (GSEM 1.75)) (P << 0.001). There was no correlation between cough threshold and PC20-FEV1 values (correlation coefficient (r) = 0.155). These results indicate that cough sensitivity is potentiated by chronic airway inflammation in bronchitis but not in asthma, and suggest that cough sensitivity and bronchial responsiveness may be independently potentiated by different mechanisms resulting from chronic airway inflammation.
Collapse
Affiliation(s)
- M Fujimura
- Third Department of Internal Medicine, Kanazawa University School of Medicine, Japan
| | | | | | | |
Collapse
|
18
|
Fujimura M, Sakamoto S, Kamio Y, Matsuda T. Sex difference in the inhaled tartaric acid cough threshold in non-atopic healthy subjects. Thorax 1990; 45:633-4. [PMID: 2402729 PMCID: PMC462649 DOI: 10.1136/thx.45.8.633] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The threshold for cough induced by inhaled tartaric acid was measured in 71 non-atopic healthy volunteers. The cough threshold was lower in women than in men, which may be relevant to previous reports that angiotensin converting enzyme inhibitors induce cough more frequently in women than in men.
Collapse
Affiliation(s)
- M Fujimura
- Third Department of Internal Medicine, Kanazawa University School of Medicine, Japan
| | | | | | | |
Collapse
|
19
|
Crofton SJ, Masironi R. Chronic Airways Disease. Chest 1989. [DOI: 10.1378/chest.96.3_supplement.349s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|