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Park H, Lee HJ, Lee JK, Park TY, Jin KN, Heo EY, Kim DK, Lee HW. Diffusing capacity as an independent predictor of acute exacerbations in chronic obstructive pulmonary disease. Sci Rep 2024; 14:2936. [PMID: 38316813 PMCID: PMC10844620 DOI: 10.1038/s41598-024-51593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/07/2024] [Indexed: 02/07/2024] Open
Abstract
A weak correlation between diffusing capacity of the lung for carbon monoxide (DLCO) and emphysema has been reported. This study investigated whether impaired DLCO in chronic obstructive pulmonary disease (COPD) is associated with increased risk of acute exacerbation independent of the presence or extent of emphysema. This retrospective cohort study included patients with COPD between January 2004 and December 2019. The participants were divided into four groups based on visually detected emphysema and impaired DLCO. Among 597 patients with COPD, 8.5% had no emphysema and impaired DLCO whereas 36.3% had emphysema without impaired DLCO. Among the four groups, patients with impaired DLCO and emphysema showed a higher risk of moderate-to-severe or severe exacerbation than those with normal DLCO. Impaired DLCO was an independent risk factor for severe exacerbation (hazard ratio, 1.524 [95% confidence interval 1.121-2.072]), whereas the presence of emphysema was not. The risk of moderate-to-severe or severe exacerbation increases with the severity of impaired DLCO. After propensity-score matching for the extent of emphysema, impaired DLCO was significantly associated with a higher risk of moderate-to-severe (p = 0.041) or severe exacerbation (p = 0.020). In patients with COPD and heterogeneous parenchymal abnormalities, DLCO can be considered an independent biomarker of acute exacerbation.
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Affiliation(s)
- Heemoon Park
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyo Jin Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jung-Kyu Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Yun Park
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Young Heo
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Deog Kyeom Kim
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Woo Lee
- Division of Respiratory and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
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2
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D'Cruz J, Neder-Serafini I, Zapotichny A, Neder JA. Exposing the Roots of Restriction: When the Transfer Coefficient Makes the Difference. Ann Am Thorac Soc 2024; 21:343-350. [PMID: 38299918 DOI: 10.1513/annalsats.202305-484cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/27/2023] [Indexed: 02/02/2024] Open
Affiliation(s)
- Jennifer D'Cruz
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Faculty of Health Sciences, and
| | - Igor Neder-Serafini
- Department of Biology, Faculty of Arts and Science, Queen's University, Kingston, Ontario, Canada; and
| | - Angie Zapotichny
- Pulmonary Function Laboratory, Hotel Dieu Hospital, Kingston Health Science Center, Kingston, Ontario, Canada
| | - J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Faculty of Health Sciences, and
- Pulmonary Function Laboratory, Hotel Dieu Hospital, Kingston Health Science Center, Kingston, Ontario, Canada
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3
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Steinbeis F, Knape P, Mittermaier M, Helbig ET, Tober-Lau P, Thibeault C, Lippert LJ, Xiang W, Müller-Plathe M, Steinbrecher S, Meyer HJ, Ring RM, Ruwwe-Glösenkamp C, Alius F, Li Y, Müller-Redetzky H, Uhrig A, Lingscheid T, Grund D, Temmesfeld-Wollbrück B, Suttorp N, Sander LE, Kurth F, Witzenrath M, Zoller T. Functional limitations 12 months after SARS-CoV-2 infection correlate with initial disease severity: An observational study of cardiopulmonary exercise capacity testing in COVID-19 convalescents. Respir Med 2022; 202:106968. [PMID: 36081267 PMCID: PMC9420203 DOI: 10.1016/j.rmed.2022.106968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
Background Cardiopulmonary Exercise Testing (CPET) provides a comprehensive assessment of pulmonary, cardiovascular and musculosceletal function. Reduced CPET performance could be an indicator for chronic morbidity after COVID-19. Methods Patients ≥18 years with confirmed PCR positive SARS-CoV-2 infection were offered to participate in a prospective observational study of clinical course and outcomes of COVID-19. 54 patients completed CPET, questionnaires on respiratory quality of life and performed pulmonary function tests 12 months after SARS-CoV-2 infection. Results At 12 months after SARS-CoV-2 infection, 46.3% of participants had a peak performance and 33.3% a peak oxygen uptake of <80% of the predicted values, respectively. Further impairments were observed in diffusion capacity and ventilatory efficiency. Functional limitations were particularly pronounced in patients after invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. Ventilatory capacity was reduced <80% of predicted values in 55.6% of participants, independent from initial clinical severity. Patient reported dyspnea and respiratory quality of life after COVID-19 correlated with CPET performance and parameters of gas exchange. Risk factors for reduced CPET performance 12 months after COVID-19 were prior intensive care treatment (OR 5.58, p = 0.004), SGRQ outcome >25 points (OR 3.48, p = 0.03) and reduced DLCO (OR 3.01, p = 0.054). Conclusions Functional limitations causing chronic morbidity in COVID-19 survivors persist over 12 months after SARS-CoV-2 infection. These limitations were particularly seen in parameters of overall performance and gas exchange resulting from muscular deconditioning and lung parenchymal changes. Patient reported reduced respiratory quality of life was a risk factor for adverse CPET performance.
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4
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Steinbeis F, Thibeault C, Doellinger F, Ring RM, Mittermaier M, Ruwwe-Glösenkamp C, Alius F, Knape P, Meyer HJ, Lippert LJ, Helbig ET, Grund D, Temmesfeld-Wollbrück B, Suttorp N, Sander LE, Kurth F, Penzkofer T, Witzenrath M, Zoller T. Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: An observational longitudinal study over 12 months. Respir Med 2021; 191:106709. [PMID: 34871947 PMCID: PMC8632363 DOI: 10.1016/j.rmed.2021.106709] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Prospective and longitudinal data on pulmonary injury over one year after acute coronavirus disease 2019 (COVID-19) are sparse. We aim to determine reductions in pulmonary function and respiratory related quality of life up to 12 months after acute COVID-19. METHODS Patients with acute COVID-19 were enrolled into an ongoing single-centre, prospective observational study and prospectively examined 6 weeks, 3, 6 and 12 months after onset of COVID-19 symptoms. Chest CT-scans, pulmonary function and symptoms assessed by St. Georges Respiratory Questionnaire were used to evaluate respiratory limitations. Patients were stratified according to severity of acute COVID-19. RESULTS Median age of all patients was 57 years, 37.8% were female. Higher age, male sex and higher BMI were associated with acute-COVID-19 severity (p < 0.0001, 0.001 and 0.004 respectively). Also, pulmonary restriction and reduced carbon monoxide diffusion capacity was associated with disease severity. In patients with restriction and impaired diffusion capacity, FVC improved over 12 months from 61.32 to 71.82, TLC from 68.92 to 76.95, DLCO from 60.18 to 68.98 and KCO from 81.28 to 87.80 (percent predicted values; p = 0.002, 0.045, 0.0002 and 0.0005). The CT-score of lung involvement in the acute phase was associated with restriction and reduction in diffusion capacity in follow-up. Respiratory symptoms improved for patients in higher severity groups during follow-up, but not for patients with initially mild disease. CONCLUSION Severity of respiratory failure during COVID-19 correlates with the degree of pulmonary function impairment and respiratory quality of life in the year after acute infection.
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Affiliation(s)
- Fridolin Steinbeis
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Charlotte Thibeault
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Doellinger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Raphaela Maria Ring
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Mirja Mittermaier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Alius
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Philipp Knape
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Hans-Jakob Meyer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Lena Johanna Lippert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Elisa Theresa Helbig
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Grund
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrück
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Norbert Suttorp
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Leif Erik Sander
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Florian Kurth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, And Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20359, Hamburg, Germany
| | - Tobias Penzkofer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Witzenrath
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Thomas Zoller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; Swiss Tropical and Public Health Institute, Basel, Switzerland.
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5
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Kellerer C, Jörres RA, Schneider A, Alter P, Kauczor HU, Jobst B, Biederer J, Bals R, Watz H, Behr J, Kauffmann-Guerrero D, Lutter J, Hapfelmeier A, Magnussen H, Trudzinski FC, Welte T, Vogelmeier CF, Kahnert K. Prediction of lung emphysema in COPD by spirometry and clinical symptoms: results from COSYCONET. Respir Res 2021; 22:242. [PMID: 34503520 PMCID: PMC8427948 DOI: 10.1186/s12931-021-01837-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Lung emphysema is an important phenotype of chronic obstructive pulmonary disease (COPD), and CT scanning is strongly recommended to establish the diagnosis. This study aimed to identify criteria by which physicians with limited technical resources can improve the diagnosis of emphysema. Methods We studied 436 COPD patients with prospective CT scans from the COSYCONET cohort. All items of the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ), the modified Medical Research Council (mMRC) scale, as well as data from spirometry and CO diffusing capacity, were used to construct binary decision trees. The importance of parameters was checked by the Random Forest and AdaBoost machine learning algorithms. Results When relying on questionnaires only, items CAT 1 & 7 and SGRQ 8 & 12 sub-item 3 were most important for the emphysema- versus airway-dominated phenotype, and among the spirometric measures FEV1/FVC. The combination of CAT item 1 (≤ 2) with mMRC (> 1) and FEV1/FVC, could raise the odds for emphysema by factor 7.7. About 50% of patients showed combinations of values that did not markedly alter the likelihood for the phenotypes, and these could be easily identified in the trees. Inclusion of CO diffusing capacity revealed the transfer coefficient as dominant measure. The results of machine learning were consistent with those of the single trees. Conclusions Selected items (cough, sleep, breathlessness, chest condition, slow walking) from comprehensive COPD questionnaires in combination with FEV1/FVC could raise or lower the likelihood for lung emphysema in patients with COPD. The simple, parsimonious approach proposed by us might help if diagnostic resources regarding respiratory diseases are limited. Trial registration ClinicalTrials.gov, Identifier: NCT01245933, registered 18 November 2010, https://clinicaltrials.gov/ct2/show/record/NCT01245933. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01837-2.
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Affiliation(s)
- Christina Kellerer
- School of Medicine, Institute of General Practice and Health Services Research, Technische Universität München/Klinikum Rechts der Isar, Orleansstr. 47, 81667, Munich, Germany. .,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
| | - Antonius Schneider
- School of Medicine, Institute of General Practice and Health Services Research, Technische Universität München/Klinikum Rechts der Isar, Orleansstr. 47, 81667, Munich, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Bertram Jobst
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany.,Faculty of Medicine, University of Latvia, Raina bulvaris 19, Riga, 1586, Latvia.,Faculty of Medicine, Christian-Albrechts-Universität Zu Kiel, 24098, Kiel, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Henrik Watz
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Pulmonary Research Institute at LungenClinic Grosshansdorf, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Diego Kauffmann-Guerrero
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
| | - Johanna Lutter
- Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Institute of Epidemiology, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Alexander Hapfelmeier
- School of Medicine, Institute of General Practice and Health Services Research, Technische Universität München/Klinikum Rechts der Isar, Orleansstr. 47, 81667, Munich, Germany
| | - Helgo Magnussen
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Pulmonary Research Institute at LungenClinic Grosshansdorf, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Franziska C Trudzinski
- Translational Lung Research Centre Heidelberg (TLRC), Member of the German Center for Lung Research, Thoraxklinik-Heidelberg gGmbH, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, German Center for Lung Research, Ziemssenstr. 1, 80336, Munich, Germany
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6
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Franciosi AN, Carroll TP, McElvaney NG. SZ alpha-1 antitrypsin deficiency and pulmonary disease: more like MZ, not like ZZ. Thorax 2020; 76:298-301. [PMID: 32917839 DOI: 10.1136/thoraxjnl-2020-215250] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/04/2022]
Abstract
The ZZ genotype of alpha-1 antitrypsin deficiency (AATD) is associated with COPD regardless of smoking. Heterozygous MZ-AATD is recognised as a moderate deficiency state, increasing the risk of COPD only among smokers. The risk attributable to SZ-AATD remains debated. We compared 486 AATD-registry participants, to determine whether SZ-AATD was associated with pulmonary outcomes more comparable to MZ-AATD or ZZ-AATD. We found no significant differences between MZ and SZ individuals regardless of never-smoking/ever-smoking (p>0.05 for all). ZZ-AATD was associated with lower FEV1pp than SZ, regardless of never-smoking/ever-smoking, as well as an increased OR of lung-index status and visually defined emphysema on CT (p≤0.002 for all). In our registry cohort SZ-AATD is associated with a risk of lung disease comparable to MZ, not ZZ-AATD.
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Affiliation(s)
- Alessandro N Franciosi
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Medicine, Beaumont Hospital, Dublin, Ireland
| | - Tomás P Carroll
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland .,Alpha-1 Foundation Ireland, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G McElvaney
- Irish Centre for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Medicine, Beaumont Hospital, Dublin, Ireland
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7
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Franciosi AN, Hobbs BD, McElvaney OJ, Molloy K, Hersh C, Clarke L, Gunaratnam C, Silverman EK, Carroll TP, McElvaney NG. Clarifying the Risk of Lung Disease in SZ Alpha-1 Antitrypsin Deficiency. Am J Respir Crit Care Med 2020; 202:73-82. [PMID: 32197047 PMCID: PMC7530947 DOI: 10.1164/rccm.202002-0262oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale: The ZZ genotype of alpha-1 antitrypsin deficiency (AATD) is associated with chronic obstructive pulmonary disease (COPD), even among never-smokers. The SZ genotype is also considered severe; yet, its effect on lung health remains unclear.Objectives: To determine the effect of SZ-AATD on spirometry compared with a normal-risk population and to determine the effect of smoking cessation in this genotype.Methods: We prospectively enrolled 166 related individuals, removing lung index cases to reduce bias, and compared spirometry between 70 SZ and 46 MM/MS individuals (control subjects). The effect of AAT concentrations on outcomes was assessed in 82 SZ individuals (including lung index cases). Subsequently, we analyzed retrospective SZ registry data to determine the effect of smoking cessation on spirometry decline (n = 60) and plasma anti-neutrophil elastase capacity (n = 20).Measurements and Main Results: No difference between SZ and control never-smokers was seen. Ever smoking was associated with a lower FEV1% predicted (-14.3%; P = 0.0092) and a lower FEV1/FVC ratio (-0.075; P = 0.0041) in SZ-AATD. No association was found between AAT concentration and outcomes for SZ-AATD. Longitudinal analysis of 60 SZ individuals demonstrated that COPD at baseline, but not former smoking or AAT concentrations, predicted greater spirometry decline. Finally, anti-neutrophil elastase capacity did not differ between former smokers and never-smokers (P = 0.67).Conclusions: SZ never-smokers demonstrated no increased risk of COPD, regardless of AAT concentration. Smoking interacts with SZ-AATD to significantly increase airflow obstruction. Former smoking alone is not associated with greater spirometry decline in SZ-AATD, suggesting that cessation attenuates the obstructive process. We found no evidence that the putative protective threshold or AAT concentrations predict risk within the SZ genotype, raising further doubts over the need for intravenous AAT augmentation in this cohort.
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Affiliation(s)
| | - Brian D. Hobbs
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Kevin Molloy
- Irish Centre for Genetic Lung Disease and
- Department of Medicine and
| | - Craig Hersh
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Louise Clarke
- Department of Pulmonary Physiology, Beaumont Hospital, Dublin, Ireland; and
| | | | - Edwin K. Silverman
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tomás P. Carroll
- Irish Centre for Genetic Lung Disease and
- Alpha-1 Foundation Ireland, Royal College of Surgeons in Ireland, Dublin, Ireland
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8
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Neder JA, Berton DC, O'Donnell DE. The Lung Function Laboratory to Assist Clinical Decision-making in Pulmonology: Evolving Challenges to an Old Issue. Chest 2020; 158:1629-1643. [PMID: 32428514 DOI: 10.1016/j.chest.2020.04.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/17/2022] Open
Abstract
The lung function laboratory frequently provides relevant information to the practice of pulmonology. Clinical interpretation of pulmonary function and exercise tests, however, has been complicated more recently by temporal changes in demographic characteristics (higher life expectancy), anthropometric attributes (increased obesity prevalence), and the surge of polypharmacy in a sedentary population with multiple chronic degenerative diseases. In this narrative review, we concisely discuss some key challenges to test interpretation that have been affected by these epidemiologic shifts: (a) the confounding effects of advanced age and severe obesity, (b) the contemporary controversies in the diagnosis of obstruction (including asthma and/or COPD), (c) the importance of considering the diffusing capacity of the lung for carbon monoxide (Dlco)/"accessible" alveolar volume (carbon monoxide transfer coefficient) in association with Dlco to uncover the causes of impaired gas exchange, and (d) the modern role of the pulmonary function laboratory (including cardiopulmonary exercise testing) in the investigation of undetermined dyspnea. Following a Bayesian perspective, we suggest interpretative algorithms that consider the pretest probability of abnormalities as indicated by additional clinical information. We, therefore, adopt a pragmatic approach to help the practicing pulmonologist to apply the information provided by the lung function laboratory to the care of individual patients.
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Affiliation(s)
- J Alberto Neder
- Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada.
| | - Danilo C Berton
- Division of Respirology, Department of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Denis E O'Donnell
- Pulmonary Function Laboratory and Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Kingston Health Science Center, Queen's University, Kingston, ON, Canada
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Barberan-Garcia A, Navarro-Ripoll R, Sánchez-Lorente D, Moisés-Lafuente J, Boada M, Messaggi-Sartor M, González-Vallespí L, Montané-Muntané M, Alsina-Restoy X, Campero B, Lopez-Baamonde M, Romano-Andrioni B, Guzmán R, López A, Arguis MJ, Roca J, Martinez-Palli G. Cost-effectiveness of a technology-supported multimodal prehabilitation program in moderate-to-high risk patients undergoing lung cancer resection: randomized controlled trial protocol. BMC Health Serv Res 2020; 20:207. [PMID: 32164687 PMCID: PMC7068871 DOI: 10.1186/s12913-020-05078-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients’ functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality are needed to clarify the benefits of prehabilitation. The main aim of the current protocol is to evaluate the cost-effectiveness of a multimodal prehabilitation program supported by information and communication technologies in moderate-to-high risk lung cancer patients undergoing thoracic surgery. Methods A Quadruple Aim approach will be adopted, assessing the prehabilitation program at the following levels: i) Patients’ and professionals’ experience outcomes (by means of standardized questionnaires, focus groups and structured interviews); ii) Population health-based outcomes (e.g. hospital length of stay, number and severity of postoperative complications, peak oxygen uptake and levels of systemic inflammation); and, iii) Healthcare costs. Discussion This study protocol should contribute not only to increase the scientific basis on prehabilitation but also to detect the main factors modulating service adoption. Trial registration NCT04052100 (August 9, 2019).
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Affiliation(s)
- Anael Barberan-Garcia
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain. .,Biomedical Networking Research Centre on Respiratory Diseases (CIBERES), Barcelona, Spain.
| | - Ricard Navarro-Ripoll
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Jorge Moisés-Lafuente
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Marc Boada
- Thoracic Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Monique Messaggi-Sartor
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain
| | | | - Mar Montané-Muntané
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Xavier Alsina-Restoy
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain
| | - Betina Campero
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Manuel Lopez-Baamonde
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Rudith Guzmán
- Thoracic Surgery Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio López
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Jose Arguis
- Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Roca
- Respiratory Medicine Department, Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Catalonia, Spain.,August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain.,Biomedical Networking Research Centre on Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Graciela Martinez-Palli
- August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona (UB), Barcelona, Spain.,Anaesthesia and Intensive Care Department, Hospital Clínic de Barcelona, Barcelona, Spain
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Neder JA, Berton DC, Muller PT, O'Donnell DE. Incorporating Lung Diffusing Capacity for Carbon Monoxide in Clinical Decision Making in Chest Medicine. Clin Chest Med 2020; 40:285-305. [PMID: 31078210 DOI: 10.1016/j.ccm.2019.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lung diffusing capacity for carbon monoxide (Dlco) remains the only noninvasive pulmonary function test to provide an integrated picture of gas exchange efficiency in human lungs. Due to its critical dependence on the accessible "alveolar" volume (Va), there remains substantial misunderstanding on the interpretation of Dlco and the diffusion coefficient (Dlco/Va ratio, Kco). This article presents the physiologic and methodologic foundations of Dlco measurement. A clinically friendly approach for Dlco interpretation that takes those caveats into consideration is outlined. The clinical scenarios in which Dlco can effectively assist the chest physician are discussed and illustrative clinical cases are presented.
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Affiliation(s)
- J Alberto Neder
- Laboratory of Clinical Exercise Physiology, Division of Respirology and Sleep Medicine, Department of Medicine, Kingston Health Science Center, Queen's University, Richardson House, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada.
| | - Danilo C Berton
- Division of Respirology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo T Muller
- Division of Respirology, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology and Sleep Medicine, Kingston Health Science Center & Queen's University, Kingston, Ontario, Canada
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