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Silva MGS, Carvalho TL, de Azevedo Vieira JE, da Costa LR, da Silva DLO, Costa ALB, dos Anjos HPS, Lopes AJ. Evaluating performance on the Glittre-ADL test in men with long COVID 3 years after a SARS-CoV-2 infection. J Exerc Sci Fit 2024; 22:271-277. [PMID: 38601317 PMCID: PMC11002684 DOI: 10.1016/j.jesf.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/08/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Background/objective Many COVID-19 survivors, especially those who have been hospitalized, have been suffering numerous complications that limit their activities of daily living, although changes that persist 3 years after infection are still not known. We aimed to investigate the impact of long COVID on the Glittre-ADL test (TGlittre) 3 years after acute infection in men who needed hospitalization and explore whether the performance on the TGlittre is associated with impairments in lung function, muscle strength, physical function and quality of life (QoL). Methods Cross-sectional study with 42 men with long COVID who took the TGlittre. They underwent pulmonary function tests and measurements of handgrip strength and quadriceps strength (QS). Additionally, they also completed the Saint George Respiratory Questionnaire (SGRQ) and Functional Independence Measure (FIM). Results The mean age was 52 ± 10.6 years, while the mean time after diagnosis of COVID-19 was 37 ± 3.5 months. The mean TGlittre time was 3.3 (3.1-4.1) min, which was 10% greater than the time expected for normal individuals to complete it. The TGlittre time was correlated significantly with the QS (rs = -0.397, p = 0.009), pulmonary diffusion (rs = - 0.364, p = 0.017), FIM (rs = -0.364, p = 0.017) and the "activity" domain score of the SGRQ (rs = 0.327, p = 0.034). Conclusion Functional capacity on exertion as measured by the TGlittre time is normal in most men with long COVID 3 years after hospitalization. However, this improvement in functional capacity does not seem to be reflected in muscle strength or QoL, requiring continued monitoring even after 3 years.
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Affiliation(s)
- Mayra Gomes Soares Silva
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | - Thiago Lemos Carvalho
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
| | | | | | | | | | | | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Program, Augusto Motta University Center (UNISUAM), Rio de Janeiro, Brazil
- Medical Sciences Post-Graduation Program, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Zhao LM, Lancaster AC, Patel R, Zhang H, Duong TQ, Jiao Z, Lin CT, Healey T, Wright T, Wu J, Bai HX. Association of clinical and imaging characteristics with pulmonary function testing in patients with Long-COVID. Heliyon 2024; 10:e31751. [PMID: 38845871 PMCID: PMC11153179 DOI: 10.1016/j.heliyon.2024.e31751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose The purpose of this study is to identify clinical and imaging characteristics associated with post-COVID pulmonary function decline. Methods This study included 22 patients recovering from COVID-19 who underwent serial spirometry pulmonary function testing (PFT) before and after diagnosis. Patients were divided into two cohorts by difference between baseline and post-COVID follow-up PFT: Decline group (>10 % decrease in FEV1), and Stable group (≤10 % decrease or improvement in FEV1). Demographic, clinical, and laboratory data were collected, as well as PFT and chest computed tomography (CT) at the time of COVID diagnosis and follow-up. CTs were semi-quantitatively scored on a five-point severity scale for disease extent in each lobe by two radiologists. Mann-Whitney U-tests, T-tests, and Chi-Squared tests were used for comparison. P-values <0.05 were considered statistically significant. Results The Decline group had a higher proportion of neutrophils (79.47 ± 4.83 % vs. 65.45 ± 10.22 %; p = 0.003), a higher absolute neutrophil count (5.73 ± 2.68 × 109/L vs. 3.43 ± 1.74 × 109/L; p = 0.031), and a lower proportion of lymphocytes (9.90 ± 4.20 % vs. 21.21 ± 10.97 %; p = 0.018) compared to the Stable group. The Decline group also had significantly higher involvement of ground-glass opacities (GGO) on follow-up chest CT [8.50 (4.50, 14.50) vs. 3.0 (1.50, 9.50); p = 0.032] and significantly higher extent of reticulations on chest CT at time of COVID diagnosis [6.50 (4.00, 9.00) vs. 2.00 (0.00, 6.00); p = 0.039] and follow-up [5.00 (3.00, 13.00) vs. 2.00 (0.00, 5.00); p = 0.041]. ICU admission was higher in the Decline group than in the Stable group (71.4 % vs. 13.3 %; p = 0.014). Conclusions This study provides novel insight into factors influencing post-COVID lung function, irrespective of pre-existing pulmonary conditions. Our findings underscore the significance of neutrophil counts, reduced lymphocyte counts, pulmonary reticulation on chest CT at diagnosis, and extent of GGOs on follow-up chest CT as potential indicators of decreased post-COVID lung function. This knowledge may guide prediction and further understanding of long-term sequelae of COVID-19 infection.
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Affiliation(s)
- Lin-Mei Zhao
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andrew C. Lancaster
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ritesh Patel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen Zhang
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Zhicheng Jiao
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Cheng Ting Lin
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terrance Healey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Thaddeus Wright
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Harrison X. Bai
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tan DJ, Lodge CJ, Walters EH, Bui DS, Pham J, Lowe AJ, Bowatte G, Vicendese D, Erbas B, Johns DP, James AL, Frith P, Hamilton GS, Thomas PS, Wood-Baker R, Han MK, Washko GR, Abramson MJ, Perret JL, Dharmage SC. Can We Use Lung Function Thresholds and Respiratory Symptoms to Identify Pre-Chronic Obstructive Pulmonary Disease? A Prospective, Population-based Cohort Study. Am J Respir Crit Care Med 2024; 209:1431-1440. [PMID: 38236192 DOI: 10.1164/rccm.202212-2330oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
Rationale: The term "pre-chronic obstructive pulmonary disease" ("pre-COPD") refers to individuals at high risk of developing COPD who do not meet conventional spirometric criteria for airflow obstruction. New approaches to identifying these individuals are needed, particularly in younger populations. Objectives: To determine whether lung function thresholds and respiratory symptoms can be used to identify individuals at risk of developing COPD. Methods: The Tasmanian Longitudinal Health Study comprises a population-based cohort first studied in 1968 (at age 7 yr). Respiratory symptoms, pre- and post-bronchodilator (BD) spirometry, diffusing capacity, and static lung volumes were measured in a subgroup at age 45, and the incidence of COPD was assessed at age 53. For each lung function measure, z-scores were calculated using Global Lung Function Initiative references. The optimal threshold for best discrimination of COPD incidence was determined by the unweighted Youden index. Measurements and Main Results: Among 801 participants who did not have COPD at age 45, the optimal threshold for COPD incidence by age 53 was pre-BD FEV1/FVC z-score less than -1.264, corresponding to the lowest 10th percentile. Those below this threshold had a 36-fold increased risk of developing COPD over an 8-year follow-up period (risk ratio, 35.8; 95% confidence interval, 8.88 to 144), corresponding to a risk difference of 16.4% (95% confidence interval, 3.7 to 67.4). The sensitivity was 88%, and the specificity was 87%. Positive and negative likelihood ratios were 6.79 and 0.14, respectively. Respiratory symptoms, post-BD spirometry, diffusing capacity, and static lung volumes did not improve on the classification achieved by pre-BD FEV1/FVC alone. Conclusions: This is the first study, to our knowledge, to evaluate the discriminatory accuracy of spirometry, diffusing capacity, and static lung volume thresholds for COPD incidence in middle-aged adults. Our findings support the inclusion of pre-BD spirometry in the physiological definition of pre-COPD and indicate that pre-BD FEV1/FVC at the 10th percentile accurately identifies individuals at high risk of developing COPD in community-based settings.
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Pham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Don Vicendese
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Engineering and Mathematical Science and
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| | - David P Johns
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter Frith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences, and
| | - Paul S Thomas
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia; and
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Mustafina M, Silantyev A, Krasovskiy S, Chernyak A, Naumenko Z, Suvorov A, Gognieva D, Abdullaev M, Bektimirova A, Bykova A, Dergacheva V, Betelin V, Kopylov P. Exhaled breath analysis in adult patients with cystic fibrosis by real-time proton mass spectrometry. Clin Chim Acta 2024; 560:119733. [PMID: 38777246 DOI: 10.1016/j.cca.2024.119733] [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: 01/08/2024] [Revised: 03/07/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Proton-transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS) is a promising tool for a rapid online determination of exhaled volatile organic compounds (eVOCs) profiles in patients with cystic fibrosis (CF). OBJECTIVE To detect VOC breath signatures specific to adult patients with CF compared with controls using PTR-TOF-MS. METHODS 102 CF patients (54 M/48, mean age 25.6 ± 7.8 yrs) and 97 healthy controls (56 M/41F, mean age 25.8 ± 6.0 yrs) were examined. Samples from normal quiet breathing and forced expiratory maneuvers were analyzed with PTR-TOF-MS (Ionicon, Austria) to obtain VOC profiles listed as ions at various mass-to-charge ratios (m/z). RESULTS PTR-TOF-MS analysis was able to detect 167 features in exhaled breath from CF patients and healthy controls. According to cluster analysis and LASSO regression, patients with CF and controls were separated. The most significant VOCs for CF were indole, phenol, dimethyl sulfide, and not indicated: m/z = 297.0720 ([C12H13N2O7 and C17H13O5]H + ), m/z = 281.0534 ([C19H7NO2, C12H11NO7 and C16H9O5]H + ) during five-fold cross-validation both in forced expiratory maneuver and in normal quiet breathing. CONCLUSION PTR-TOF-MS is a promising method for determining the molecular composition of exhaled air specific to CF.
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Affiliation(s)
- Malika Mustafina
- Department of Cardiology, Functional and Ultrasound Diagnostics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; Pulmonology Research Institute Under Federal Medical and Biological Agency of Russia, 115682 Moscow, Russia; Research Institute for Systemic Analysis of the Russian Academy of Sciences, 117218 Moscow, Russia.
| | - Artemiy Silantyev
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Stanislav Krasovskiy
- Pulmonology Research Institute Under Federal Medical and Biological Agency of Russia, 115682 Moscow, Russia
| | - Alexander Chernyak
- Pulmonology Research Institute Under Federal Medical and Biological Agency of Russia, 115682 Moscow, Russia
| | - Zhanna Naumenko
- Pulmonology Research Institute Under Federal Medical and Biological Agency of Russia, 115682 Moscow, Russia
| | - Aleksandr Suvorov
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Daria Gognieva
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; Research Institute for Systemic Analysis of the Russian Academy of Sciences, 117218 Moscow, Russia
| | - Magomed Abdullaev
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; Research Institute for Systemic Analysis of the Russian Academy of Sciences, 117218 Moscow, Russia
| | - Alina Bektimirova
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Aleksandra Bykova
- Department of Cardiology, Functional and Ultrasound Diagnostics, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; Research Institute for Systemic Analysis of the Russian Academy of Sciences, 117218 Moscow, Russia
| | - Vasilisa Dergacheva
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Vladimir Betelin
- Research Institute for Systemic Analysis of the Russian Academy of Sciences, 117218 Moscow, Russia
| | - Philipp Kopylov
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; Research Institute for Systemic Analysis of the Russian Academy of Sciences, 117218 Moscow, Russia
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5
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Abdesslem M, Ben Saad H. Isolated low FEV1 in pediatric spirometry: A reflection on recent findings. Pediatr Pulmonol 2024. [PMID: 38874189 DOI: 10.1002/ppul.27141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/25/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Mariem Abdesslem
- Farhat HACHED Hospital, Laboratory of Physiology and Functional Explorations, University of Sousse, Sousse, Tunisia
| | - Helmi Ben Saad
- Farhat HACHED Hospital, Heart Failure (LR12SP09) Research Laboratory, University of Sousse, Sousse, Tunisia
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McCormack M, Kaminsky DA. Beyond Diagnostics - Removing Race from Lung-Function Test Interpretation. N Engl J Med 2024; 390:2122-2123. [PMID: 38767237 DOI: 10.1056/nejme2403770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Meredith McCormack
- From the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore (M.M.); and the Division of Pulmonary Disease and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington (D.A.K.)
| | - David A Kaminsky
- From the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore (M.M.); and the Division of Pulmonary Disease and Critical Care Medicine, University of Vermont Larner College of Medicine, Burlington (D.A.K.)
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Alfaro E, Díaz-García E, García-Tovar S, Galera R, Casitas R, Torres-Vargas M, López-Fernández C, Añón JM, García-Río F, Cubillos-Zapata C. Endothelial dysfunction and persistent inflammation in severe post-COVID-19 patients: implications for gas exchange. BMC Med 2024; 22:242. [PMID: 38867241 PMCID: PMC11170912 DOI: 10.1186/s12916-024-03461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/30/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Understanding the enduring respiratory consequences of severe COVID-19 is crucial for comprehensive patient care. This study aims to evaluate the impact of post-COVID conditions on respiratory sequelae of severe acute respiratory distress syndrome (ARDS). METHODS We examined 88 survivors of COVID-19-associated severe ARDS six months post-intensive care unit (ICU) discharge. Assessments included clinical and functional evaluation as well as plasma biomarkers of endothelial dysfunction, inflammation, and viral response. Additionally, an in vitro model using human umbilical vein endothelial cells (HUVECs) explored the direct impact of post-COVID plasma on endothelial function. RESULTS Post-COVID patients with impaired gas exchange demonstrated persistent endothelial inflammation marked by elevated ICAM-1, IL-8, CCL-2, and ET-1 plasma levels. Concurrently, systemic inflammation, evidenced by NLRP3 overexpression and elevated levels of IL-6, sCD40-L, and C-reactive protein, was associated with endothelial dysfunction biomarkers and increased in post-COVID patients with impaired gas exchange. T-cell activation, reflected in CD69 expression, and persistently elevated levels of interferon-β (IFN-β) further contributed to sustained inflammation. The in vitro model confirmed that patient plasma, with altered levels of sCD40-L and IFN-β proteins, has the capacity to alter endothelial function. CONCLUSIONS Six months post-ICU discharge, survivors of COVID-19-associated ARDS exhibited sustained elevation in endothelial dysfunction biomarkers, correlating with the severity of impaired gas exchange. NLRP3 inflammasome activity and persistent T-cell activation indicate on going inflammation contributing to persistent endothelial dysfunction, potentially intensified by sustained viral immune response.
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Affiliation(s)
- Enrique Alfaro
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Elena Díaz-García
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Sara García-Tovar
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Raúl Galera
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Raquel Casitas
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - María Torres-Vargas
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina López-Fernández
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain
| | - José M Añón
- Department of Intensive Medicine, La Paz University Hospital, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
| | - Carolina Cubillos-Zapata
- Respiratory Diseases Group, Respiratory Service, La Paz University Hospital, IdiPAZ, Paseo de La Castellana 261, 28046, Madrid, Spain.
- Biomedical Research Networking Centre On Respiratory Diseases (CIBERES), Madrid, Spain.
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8
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Diao JA, He Y, Khazanchi R, Nguemeni Tiako MJ, Witonsky JI, Pierson E, Rajpurkar P, Elhawary JR, Melas-Kyriazi L, Yen A, Martin AR, Levy S, Patel CJ, Farhat M, Borrell LN, Cho MH, Silverman EK, Burchard EG, Manrai AK. Implications of Race Adjustment in Lung-Function Equations. N Engl J Med 2024; 390:2083-2097. [PMID: 38767252 DOI: 10.1056/nejmsa2311809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. METHODS We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. RESULTS Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. CONCLUSIONS The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).
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Affiliation(s)
- James A Diao
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Yixuan He
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Rohan Khazanchi
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Max Jordan Nguemeni Tiako
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Jonathan I Witonsky
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Emma Pierson
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Pranav Rajpurkar
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Jennifer R Elhawary
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Luke Melas-Kyriazi
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Albert Yen
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Alicia R Martin
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Sean Levy
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Chirag J Patel
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Maha Farhat
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Luisa N Borrell
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Michael H Cho
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Edwin K Silverman
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Esteban G Burchard
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
| | - Arjun K Manrai
- From the Department of Biomedical Informatics, Harvard Medical School (J.A.D., P.R., L.M.-K., C.J.P., M.F., A.K.M.), the Computational Health Informatics Program, Boston Children's Hospital (J.A.D., A.K.M.), the Analytic and Translational Genetics Unit (Y.H., A.R.M.) and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.F.), Massachusetts General Hospital, Harvard Internal Medicine-Pediatrics Combined Residency Program, Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (R.K.), the François-Xavier Bagnoud Center for Health and Human Rights, Harvard University (R.K.), the Department of Medicine (M.J.N.T.) and the Channing Division of Network Medicine and the Division of Pulmonary and Critical Care Medicine, Department of Medicine (M.H.C., E.K.S.), Brigham and Women's Hospital, and the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center (S.L.), Boston, and the Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge (Y.H., A.R.M.) - all in Massachusetts; the Departments of Pediatrics (J.I.W.), Medicine (J.R.E., E.G.B.), and Bioengineering and Therapeutic Sciences (J.R.E., E.G.B.), University of California, San Francisco, San Francisco; the Department of Computer Science, Cornell University, Ithaca (E.P.), and the Department of Population Health Sciences, Weill Cornell Medical College (E.P.), and the Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (L.N.B.), New York - all in New York; the Department of Engineering Science, University of Oxford, Oxford, United Kingdom (L.M.-K.); and the Medical Scientist Training Program, University of Illinois at Chicago, Chicago (A.Y.)
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9
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Guo X, Ren H, Sun P, Ding E, Fang J, Fang K, Ma X, Li C, Li C, Xu Y, Cao K, Lin EZ, Guo P, Pollitt KJG, Tong S, Tang S, Shi X. Personal Exposure to Airborne Organic Pollutants and Lung Function Changes among Healthy Older Adults. ENVIRONMENTAL RESEARCH 2024:119411. [PMID: 38876423 DOI: 10.1016/j.envres.2024.119411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
Epidemiological evidence on the impact of airborne organic pollutants on lung function among the elderly is limited, and their underlying biological mechanisms remain largely unexplored. Herein, a longitudinal panel study was conducted in Jinan, Shandong Province, China, involving 76 healthy older adults monitored over a span of five months repetitively. We systematically evaluated personal exposure to a diverse range of airborne organic pollutants using a wearable passive sampler and their effects on lung function. Participants' pulmonary function indicators were assessed, complemented by comprehensive multi-omics analyses of blood and urine samples. Leveraging the power of interaction analysis, causal inference test (CIT), and integrative pathway analysis (IPA), we explored intricate relationships between specific organic pollutants, biomolecules, and lung function deterioration, elucidating the biological mechanisms underpinning the adverse impacts of these pollutants. We observed that bis (2-chloro-1-methylethyl) ether (BCIE) was significantly associated with negative changes in the forced vital capacity (FVC), with glycerolipids mitigating this adverse effect. Additionally, 31 canonical pathways [e.g., high mobility group box 1 (HMGB1) signaling, phosphatidylinositol 3-kinase (PI3K)/AKT pathway, epithelial mesenchymal transition, and heme and nicotinamide adenine dinucleotide (NAD) biosynthesis] were identified as potential mechanisms. These findings may hold significant implications for developing effective strategies to prevent and mitigate respiratory health risks arising from exposure to such airborne pollutants. However, due to certain limitations of the study, our results should be interpreted with caution.
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Affiliation(s)
- Xiaojie Guo
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Huimin Ren
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, China Medical University, Shenyang, Liaoning 110001, China
| | - Peijie Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, China Medical University, Shenyang, Liaoning 110001, China
| | - Enmin Ding
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianlong Fang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Ke Fang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Xiao Ma
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, Shandong University, Jinan, Shandong 250100, China
| | - Chenfeng Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Chenlong Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, Shandong University, Jinan, Shandong 250100, China
| | - Yibo Xu
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, China Medical University, Shenyang, Liaoning 110001, China
| | - Kangning Cao
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Elizabeth Z Lin
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA
| | - Pengfei Guo
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA
| | - Shilu Tong
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane 4001, Australia
| | - Song Tang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, China; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
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10
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Leung CC. Use of spirometry to detect airflow obstruction. Respirology 2024; 29:443-444. [PMID: 38438271 DOI: 10.1111/resp.14699] [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: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
See related article
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Affiliation(s)
- Chi Chiu Leung
- Hong Kong Tuberculosis, Chest and Heart Diseases Association, Hong Kong, China
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11
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Yadav H, Torghabeh MH, Hoskote SS, Pennington KM, Lim KG, Scanlon PD, Niven AS, Hogan WJ. Adjusting diffusing capacity for anemia in patients undergoing allogeneic HCT: a comparison of two methodologies. Curr Res Transl Med 2024; 72:103432. [PMID: 38244276 PMCID: PMC11102530 DOI: 10.1016/j.retram.2023.103432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Diffusing capacity (DLCO) measurements are affected by hemoglobin. Two adjustment equations are used: Cotes (recommended by ATS/ERS) and Dinakara (used in the hematopoietic stem cell transplantation comorbidity index [HCT-CI]). It is unknown how these methods compare, and which is better from a prognostication standpoint. STUDY DESIGN This is a retrospective cohort of 1273 adult patients who underwent allogeneic HCT, completed a pre-transplant DLCO and had a concurrent hemoglobin measurement. Non-relapse mortality was measured using competing risk analysis. RESULTS Patients had normal spirometry (FEV1 99.7% [IQR: 89.4-109.8%; FVC 100.1% [IQR: 91.0-109.6%] predicted), left ventricular ejection fraction (57.2[6.7]%) and right ventricular systolic pressure (30.1[7.0] mmHg). Cotes-DLCO was 85.6% (IQR: 76.5-95.7%) and Dinakara-DLCO was 103.6% (IQR: 90.7-117.2%) predicted. For anemic patients (Hb<10g/dL), Cotes-DLCO was 84.2% (IQR: 73.9-94.1%) while Dinakara-DLCO 111.0% (97.3-124.7%) predicted. Cotes-DLCO increased HCT-CI score for 323 (25.4%) and decreased for 4 (0.3%) patients. Cotes-DLCO was superior for predicting non-relapse mortality: for both mild (66-80% predicted, HR 1.55 [95%CI: 1.26-1.92, p < 0.001]) and moderate (<65% predicted, HR 2.11 [95%CI: 1.55-2.87, p<0.001]) impairment. In contrast, for Dinakara-DLCO, only mild impairment (HR 1.69 [95%CI 1.26-2.27, p < 0.001]) was associated with lower survival while moderate impairment was not (HR 1.44 [95%CI: 0.64-3.21, p = 0.4]). In multivariable analyses, after adjusting for demographics, hematologic variables, cardiac function and FEV1, Cotes-DLCO was predictive of overall survival at 1-year (OR 0.98 [95%CI: 0.97-1.00], p = 0.01), but Dinakara-DLCO was not (OR 1.00 [95%CI: 0.98-1.00], p = 0.20). CONCLUSION The ERS/ATS recommended Cotes method likely underestimates DLCO in patients with anemia, whereas the Dinakara (used in the HCT-CI score) overestimates DLCO. The Cotes method is superior to the Dinakara method score in predicting overall survival and relapse-free survival in patients undergoing allogeneic HCT.
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Affiliation(s)
- Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States.
| | - Mehrdad Hefazi Torghabeh
- Division of Pulmonary and Critical Care Medicine, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, United States
| | - Sumedh S Hoskote
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - Kelly M Pennington
- Division of Hematology, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, United States
| | - Kaiser G Lim
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - Paul D Scanlon
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - Alexander S Niven
- Division of Pulmonary and Critical Care Medicine, Pulmonary Function Laboratory, Mayo Clinic, Rochester, United States
| | - William J Hogan
- Division of Pulmonary and Critical Care Medicine, William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, United States
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12
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Williams ZJ, Orton CM, Garner JL, Chan LT, Tana A, Shah PL, Polkey MI, Semple T, Hull JH. Feasibility of continuous bronchoscopy during exercise in the assessment of large airway movement in healthy subjects. J Appl Physiol (1985) 2024; 136:1429-1439. [PMID: 38660727 DOI: 10.1152/japplphysiol.00746.2023] [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: 10/19/2023] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
Excessive dynamic airway collapse (EDAC) is a recognized cause of exertional dyspnea arising due to invagination of the trachea and/or main bronchi. EDAC is typically assessed by evaluating large airway movement with forced expiratory maneuvers. This differs from the respiratory response to exercise hyperpnea. We aimed to evaluate large airway movement during physical activity, with continuous bronchoscopy during exercise (CBE), in healthy subjects and compare findings with resting bronchoscopic maneuvers and imaging techniques. Twenty-eight individuals were recruited to complete two visits including treadmill-based CBE, to voluntary exhaustion, and cine magnetic resonance imaging (MRI) with forced expiratory maneuvers at rest. Twenty-five subjects [aged 29 (26-33) yr, 52% female] completed the study (n = 2 withdrew before bronchoscopy, and one was unable to tolerate insertion of bronchoscope). The majority (76%) achieved a peak heart rate of >90% predicted during CBE. The procedure was prematurely terminated in five subjects (n = 3; elevated blood pressure and n = 2; minor oxygen desaturation). The CBE assessment enabled adequate tracheal visualization in all cases. Excessive dynamic airway collapse (tracheal collapse ≥50%) was identified in 16 subjects (64%) on MRI, and in six (24%) individuals during resting bronchoscopy, but in no cases with CBE. No serious adverse events were reported, but minor adverse events were evident. The CBE procedure permits visualization of large airway movement during physical activity. In healthy subjects, there was no evidence of EDAC during strenuous exercise, despite evidence during forced maneuvers on imaging, thus challenging conventional approaches to diagnosis.NEW & NOTEWORTHY This study demonstrates that large airway movement can be visualized with bronchoscopy undertaken during vigorous exercise. This approach does not require sedation and permits characterization of the behavior of the large airways and the tendency toward collapse during upright, ambulatory exercise. In healthy individuals, the response pattern of the large airways during exercise appears to differ markedly from the pattern of airway closure witnessed during forced expiratory maneuvers, assessed via imaging.
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Affiliation(s)
- Zander J Williams
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Christopher M Orton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Justin L Garner
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ley T Chan
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Anand Tana
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Pallav L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Michael I Polkey
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Thomas Semple
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom
| | - James H Hull
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
- Division of Surgery and Interventional Science, Institute of Sport, Exercise and Health (ISEH), University College London, London, United Kingdom
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13
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Phillips DB, James MD, Vincent SG, Elbehairy AF, Neder JA, Kirby M, Ora J, Day AG, Tan WC, Bourbeau J, O'Donnell DE. Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2024; 209:1314-1327. [PMID: 38170674 DOI: 10.1164/rccm.202307-1184oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/03/2024] [Indexed: 01/05/2024] Open
Abstract
Rationale: It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. Objectives: Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. Methods: We completed a cross-sectional analysis of the CanCOLD (Canadian Cohort Obstructive Lung Disease) population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV1 < 80% predicted and FEV1/FVC ⩾ 0.7), 264 control participants, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing. Measurements and Main Results: Individuals with PRISm had lower total lung, vital, and inspiratory capacities than healthy controls (all P < 0.05) and minimal small airway, pulmonary gas exchange, and radiographic parenchymal lung abnormalities. Compared with healthy controls, individuals with PRISm had higher dyspnea/[Formula: see text]o2 ratio at peak exercise (4.0 ± 2.2 vs. 2.9 ± 1.9 Borg units/L/min; P < 0.001) and lower [Formula: see text]o2peak (74 ± 22% predicted vs. 96 ± 25% predicted; P < 0.001). At standardized submaximal work rates, individuals with PRISm had greater Vt/inspiratory capacity (Vt%IC; P < 0.001), reflecting inspiratory mechanical constraint. In contrast to participants with PRISm, those with COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas exchange abnormalities. Despite these physiological differences among the three groups, the relationship between increasing dyspnea and Vt%IC during cardiopulmonary exercise testing was similar. Resting IC significantly correlated with [Formula: see text]o2peak (r = 0.65; P < 0.001) in the entire sample, even after adjusting for airflow limitation, gas trapping, and diffusing capacity. Conclusions: In individuals with PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates. Clinical trial registered with www.clinicaltrials.gov (NCT00920348).
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Affiliation(s)
- Devin B Phillips
- School of Kinesiology and Health Science, Faculty of Health, and
- Muscle Health Research Center, York University, Toronto, Ontario, Canada
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity, and Respiratory Medicine, The University of Manchester, and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - J Alberto Neder
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Josuel Ora
- Division of Respiratory Medicine, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; and
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, and
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Department of Medicine, Queen's University and Kingston Health Sciences Centre Kingston General Hospital Site, Kingston, Ontario, Canada
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Ramalho SHR, de Albuquerque ALP. Chronic Obstructive Pulmonary Disease in Heart Failure: Challenges in Diagnosis and Treatment for HFpEF and HFrEF. Curr Heart Fail Rep 2024; 21:163-173. [PMID: 38546964 DOI: 10.1007/s11897-024-00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is common in heart failure (HF), and it has a significant impact on the prognosis and quality of life of patients. Additionally, COPD is independently associated with lower adherence to first-line HF therapies. In this review, we outline the challenges of identifying and managing HF with preserved (HFpEF) and reduced (HFrEF) ejection fraction with coexisting COPD. RECENT FINDINGS Spirometry is necessary for COPD diagnosis and prognosis but is underused in HF. Therefore, misdiagnosis is a concern. Also, disease-modifying drugs for HF and COPD are usually safe but underprescribed when HF and COPD coexist. Patients with HF-COPD are poorly enrolled in clinical trials. Guidelines recommend that HF treatment should be offered regardless of COPD presence, but modern registries show that undertreatment persists. Treatment gaps could be attenuated by ensuring an accurate and earlier COPD diagnosis in patients with HF, clarifying the concerns related to pharmacotherapy safety, and increasing the use of non-pharmacologic treatments. Acknowledging the uncertainties, this review aims to provide key clinical resources to support better physician-patient co-decision-making and improve collaboration between health professionals.
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Affiliation(s)
- Sergio Henrique Rodolpho Ramalho
- Clinical Research Center, Hospital Brasília/DASA, Brasília, DF, Brazil.
- School of Medicine, UniCeub, Centro Universitário de Brasília, Brasília, DF, Brazil.
| | - André Luiz Pereira de Albuquerque
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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15
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Spekman JA, Israëls J, de Vreede I, Los M, Geelhoed MJ, van Zwet EW, Haak MC, Roest AA, van Klink JM, Lopriore E, Groene SG. Reduced lung function during childhood in identical twins with discordant fetal growth: a cohort study. EClinicalMedicine 2024; 72:102600. [PMID: 38633574 PMCID: PMC11019090 DOI: 10.1016/j.eclinm.2024.102600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
Background Fetal growth restriction (FGR) can negatively affect lung development, leading to increased respiratory morbidity and reduced lung function later in life. Studies regarding the impact of FGR on lung function in singletons are influenced by genetic, obstetric, and maternal factors. To overcome these confounding factors, we aim to investigate lung function in identical twins with selective FGR (sFGR). Methods Lung function assessments were performed in identical twins with sFGR born in our centre between March 1, 2002, and December 31, 2017, aged between 5 and 17 years. sFGR was defined as birthweight discordance ≥20%. Outcome measures consisted of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and transfer factor for carbon monoxide (DLCO) and were compared between the smaller and larger twin. Findings Thirty-nine twin pairs performed spirometry of sufficient quality. Median gestational age at birth was 34.3 (interquartile range (IQR) 32.1-36.0) weeks with median birthweights of 1500 (IQR 1160-1880) grams and 2178 (IQR 1675-2720) grams for the smaller and larger twin, respectively. Smaller twins had significantly lower z-scores for FEV1 (-0.94 versus -0.41, p = 0.0015), FVC (-0.56 versus -0.06, p < 0.0001) and DLCO (-0.50 versus 0.00, p < 0.0001) compared to larger co-twins. Interpretation Although being genetically identical, sFGR in identical twins is associated with a reduction in static and dynamic lung volume and a reduction in lung diffusion, even when taking the reduced lung volume into account. This indicates that adverse growth conditions in utero negatively affect lung development and function, potentially contributing to an increase in respiratory morbidities later in life. Funding The Dutch Heart Foundation and The Bontius Foundation.
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Affiliation(s)
- Jip A. Spekman
- Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Joël Israëls
- Pediatric Pulmonology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ilja de Vreede
- Pediatric Pulmonology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Mady Los
- Department of Pulmonology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Miranda J.J. Geelhoed
- Department of Pulmonology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Erik W. van Zwet
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Monique C. Haak
- Fetal Therapy, Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Arno A.W. Roest
- Pediatric Cardiology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jeanine M.M. van Klink
- Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Enrico Lopriore
- Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sophie G. Groene
- Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, the Netherlands
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Wyatt ML, Sokolow AG, Brown RF, Kaslow JA, Tolle JJ, Weiner DJ, Rosas-Salazar C. Prevalence, stability, and clinical significance of an isolated low FEV 1 spirometry pattern in children. Pediatr Pulmonol 2024; 59:1747-1756. [PMID: 38558514 DOI: 10.1002/ppul.26987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES In adults, an isolated low FEV1 pattern (an FEV1 below the lower limit of normal with a preserved FVC and FEV1/FVC) has been associated with the risk of developing airway obstruction. Our objective was to examine the prevalence, stability, and clinical significance of an isolated low FEV1 pattern in the pediatric population. METHODS We conducted a retrospective study of spirometries from children ages 6-21 years and categorized tests into spirometry patterns according to published guidelines and recent literature. In a subgroup of tests with an isolated low FEV1 pattern, we evaluated spirometry technique. We also examined the association of having a test with an isolated low FEV1 pattern with clinical markers of disease severity in a subgroup of children with cystic fibrosis (CF). RESULTS The isolated low FEV1 pattern was uncommon across the 29,979 tests included (n = 645 [2%]). In the 263 children with an isolated low FEV1 pattern who had a follow-up test performed, the most frequent spirometry pattern at last test was normal (n = 123 [47%]). A primary diagnosis of CF was associated with increased odds of having at least one test with an isolated low FEV1 pattern (OR = 8.37, 95% CI = 4.70-15.96, p < .001). The spirometry quality in a subgroup of tests with an isolated low FEV1 pattern (n = 50) was satisfactory. In the subgroup of children with CF (n = 102), those who had a test with an isolated low FEV1 pattern had higher odds of using oral antibiotics in the last 12 months than those who had a normal pattern (OR = 3.50, 95% CI = 1.15-10.63, p = .03). CONCLUSIONS The isolated low FEV1 pattern can occur repeatedly over time, usually transitions to a normal pattern, is not due to a poor spirometry technique, and could be clinically relevant in children with chronic lung diseases.
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Affiliation(s)
- MacKenzie L Wyatt
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Andrew G Sokolow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekah F Brown
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacob A Kaslow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James J Tolle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel J Weiner
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Houdouin V, Dubus JC, Crepon SG, Rialland F, Bruno B, Jubert C, Reix P, Pasquet M, Paillard C, Adjaoud D, Schweitzer C, Le Bourgeois M, Pages J, Yacoubi A, Dalle JH, Bergeron A, Delclaux C. Late-onset pulmonary complications following allogeneic hematopoietic cell transplantation in pediatric patients: a prospective multicenter study. Bone Marrow Transplant 2024; 59:858-866. [PMID: 38454132 DOI: 10.1038/s41409-024-02258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
The primary objective of our multicenter prospective study was to describe the incidence of late-onset non-infectious pulmonary complications (LONIPCs) in children undergoing hematopoietic cell transplantation (HCT) using sensitive criteria for pulmonary function test (PFT) abnormalities including the non-specific pattern of airflow obstruction. Secondary objectives were to assess the factors associated with LONIPC occurrence and the sensitivity of the 2014 NIH-Consensus Criteria of bronchiolitis obliterans syndrome (BOS). PFT and clinical assessment were performed prior to HCT and at 6, 12, 24, and 36 months post-HCT. LONIPC diagnosis was validated by an Adjudication Committee. The study comprised 292 children from 12 centers. Thirty-two individuals (11%, 95% CI: 8-15%) experienced 35 LONIPCs: 25 BOS, 4 interstitial lung diseases, 4 organizing pneumonia and 2 pulmonary veno-occlusive diseases. PFT abnormalities were obstructive defects (FEV1/FVC z-score < -1.645; n = 12), restrictive defects (TLC < 80% predicted, FEV1 and FVC z-scores < -1.645; n = 7) and non-specific pattern (FEV1 and FVC z-score< -1.645, FEV1/FVC z-score > -1.645, and TLC > 80% predicted; n = 8). HCT for malignant disease was the only factor associated with LONIPC (P = 0.04). The 2014 NIH-Consensus Criteria would only diagnose 8/25 participants (32%) as having BOS. In conclusion, 11% of children experienced a LONIPC in a prospective design. Clinical Trials.gov identifier (NCT number): NCT02032381.
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Affiliation(s)
- Véronique Houdouin
- Université de Paris Cité, AP-HP, Hôpital Robert Debré, Service de Pneumopédiatrie, RESPIRARE, INSERM U976, Paris, France.
| | - Jean Christophe Dubus
- Université Aix-Marseille, AP-HM, Hôpital universitaire Timone-Enfants, Service de Pneumopédiatrie, MEPHI, Méditerranée-Infection, Marseille, France
| | - Sophie Guilmin Crepon
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC-EC 1426, Paris, France
| | - Fanny Rialland
- Hôpital de la mère et l'enfant, Service d'hématologie pédiatrique, Nantes, France
| | - Bénedicte Bruno
- Hôpital Jeanne de Flandre, Service d'hématologie pédiatrique, Lille, France
| | - Charlotte Jubert
- Centre hospitalo-universitaire de Bordeaux, Service d'hématologie pédiatrique, Bordeaux, France
| | - Philippe Reix
- Université Lyon 1, Hôpital Femme Mère Enfant, Service de pneumologie, allergologie, mucoviscidose, CNRS, Laboratoire de Biométrie et biologie Evolutive UMR, 5558, Villeurbanne, France
| | - Marlène Pasquet
- Centre hospitalo-universitaire de Toulouse Purpan, Hôpital des enfants, Service d'immuno-hémato-oncologie pédiatrique, INSERM U1037, Toulouse, France
| | - Catherine Paillard
- Centre hospitalo-universitaire de Strasbourg, Service d'hématologie pédiatrique, Strasbourg, France
| | - Dalila Adjaoud
- Centre hospitalo-universitaire de Grenoble, Service d'hématologie pédiatrique, Grenoble, France
| | - Cyril Schweitzer
- Centre hospitalo-universitaire de Nancy, Service de Physiologie respiratoire Pédiatrique, Nancy, France
| | - Muriel Le Bourgeois
- AP-HP, Hôpital Necker Enfants Malades, Service de pneumologie pédiatrique, Paris, France
| | - Justine Pages
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC-EC 1426, Paris, France
| | - Adyla Yacoubi
- AP-HP, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Inserm, CIC-EC 1426, Paris, France
| | - Jean Hugues Dalle
- Université de Paris Cité, AP-HP, Hôpital Robert Debré, Service d'hématologie pédiatrique, Paris, France
| | - Anne Bergeron
- Université de Genève, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Christophe Delclaux
- Université de Paris Cité, AP-HP, Hôpital Robert Debré, Service de Physiologie Pédiatrique -Centre du Sommeil, INSERM NeuroDiderot, Paris, France
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18
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Böger R, Hannemann J. Defining the role of exertional hypoxemia and pulmonary vasoconstriction on lung function decline, morbidity, and mortality in patients with chronic obstructive lung disease - the PROSA study: rationale and study design. BMC Pulm Med 2024; 24:262. [PMID: 38816826 PMCID: PMC11137990 DOI: 10.1186/s12890-024-03074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Chronic obstructive lung disease (COPD) has diverse molecular pathomechanisms and clinical courses which, however, are not fully mirrored by current therapy. Intermittent hypoxemia is a driver of lung function decline and poor outcome, e.g., in patients with concomitant obstructive sleep apnea. Transient hypoxemia during physical exercise has been suggested to act in a similar manner. The PROSA study is designed to prospectively assess whether the clinical course of COPD patients with or without exertional desaturation differs, and to address potential pathophysiological mechanisms and biomarkers. METHODS 148 COPD patients (GOLD stage 2-3, groups B or C) will undergo exercise testing with continuous pulse oximetry. They will be followed for 36 months by spirometry, echocardiography, endothelial function testing, and biomarker analyses. Exercise testing will be performed by comparing the 6-min walk test (6MWT), bicycle ergometry, and a 15-sec breath-hold test. Exertional desaturation will be defined as SpO2 < 90% or delta-SpO2 ≥ 4% during the 6MWT. The primary endpoint will be the rate of decline of FEV1(LLN) between COPD patients with and without exertional desaturation. DISCUSSION The PROSA Study is an investigator-initiated prospective study that was designed to prove or dismiss the hypothesis that COPD patients with exertional desaturation have a significantly more rapid rate of decline of lung function as compared to non-desaturators. A 20% difference in the primary endpoint was considered clinically significant; it can be detected with a power of 90%. If the primary endpoint will be met, exercise testing with continuous pulse oximetry can be used as a ubiquitously available, easy screening tool to prospectively assess the risk of rapid lung function decline in COPD patients at an early disease stage. This will allow to introduce personalized, risk-adapted therapy to improve COPD outcome in the long run. PROSA is exclusively funded by public funds provided by the European Research Council through an ERC Advanced Grant. Patient recruitment is ongoing; the PROSA results are expected to be available in 2028. TRIAL REGISTRATION The PROSA Study has been prospectively registered at clinicaltrials.gov (register no. NCT06265623, dated 09.02.2024).
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Affiliation(s)
- Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Hamburg, Germany.
| | - Juliane Hannemann
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and its Health Sequelae, Hamburg, Germany
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19
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Pleasants RA, Shaikh A, Henderson AG, Bayer V, Drummond MB. Changes in Peak Inspiratory Flow After Acute Bronchodilation: An Observational Study of Patients with Stable Chronic Obstructive Pulmonary Disease. J Aerosol Med Pulm Drug Deliv 2024. [PMID: 38814000 DOI: 10.1089/jamp.2023.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Introduction: Identifying factors influencing peak inspiratory flow (PIF) is essential for aerosol drug delivery in stable patients with chronic obstructive pulmonary disease. While a minimum PIF for dry powder inhalers (DPIs) is established, acute bronchodilator (BD) effects on PIF remain unknown. Materials and Methods: An inspiratory flow meter (In-Check™ DIAL) was used to measure PIF in stable patients during a 24-week observational cross-sectional study. Additionally, bronchodilator responsiveness (BDR) was determined using the In-Check DIAL device and spirometry. Patients received four puffs of albuterol, and pre- and post-BD PIF, forced expiratory volume in one second (FEV1), and forced vital capacity were measured. Sixty-three patients completed acute BDR data collection from July 31, 2019, to November 9, 2021. Primary endpoints were pre- and post-BD spirometry and PIF. Statistical analyses included PIF correlations with FEV1. BD change was assessed according to inhaler resistance and sex (subgroup analysis). Results: Median patient age was 64.8 years, 85.7% were non-Hispanic White, and 57.1% were female. The median increase in absolute PIF (In-Check DIAL) was 5.0 L/min, and the % PIF change was 8.9%. With albuterol, 57.1% experienced a PIF BD change >5.0%, whereas 49.2% experienced a change >10.0%. Similarly, 55.6% experienced an FEV1 BD change >5.0% and 28.6% had a >10.0% FEV1 BD change with albuterol. PIF was weakly correlated with FEV1 BD change (absolute; % PIF; r = 0.28 [p = 0.02]; r = 0.21 [p = 0.11]). Pre- and post-BD median PIF were 75.5 and 83.5 L/min for low-to-medium-resistance DPI and 45.0 and 52.0 L/min for high-resistance, respectively. The median increases in pre- and post-BD PIF were 9.0 L/min in males and 4.5 L/min in females. In contrast to when using the In-Check DIAL device, we observed no consistent bronchodilatory effects on PIF measured by spirometry. Conclusions: Using the In-Check DIAL device, ∼50% of patients experienced >10% PIF increase after acute BD, potentially enhancing medication lung deposition. Further research is required to understand PIF's impact on medication delivery. ClinicalTrials.gov Identifier: NCT04168775.
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Affiliation(s)
- Roy A Pleasants
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Asif Shaikh
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | - Ashley G Henderson
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Valentina Bayer
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
| | - M Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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20
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Casitas R, Galera R, Torres-Vargas M, Garcia-Tovar S, Alfaro E, Díaz-Garcia E, Martinez-Cerón E, Garcia-Garcia M, Torres I, Núñez-Fernández M, Fernández-Villar A, Fernández-Velilla M, Añón JM, Cubillos-Zapata C, García-Río F. Medium-Term Disability and Long-Term Functional Impairment Persistence in Survivors of Severe COVID-19 ARDS: Clinical and Physiological Insights. Arch Bronconeumol 2024:S0300-2896(24)00185-6. [PMID: 38853119 DOI: 10.1016/j.arbres.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Although the medium- and long-term sequelae of survivor of acute respiratory distress syndrome (ARDS) of any cause have been documented, little is known about the way in which COVID-19-induced ARDS affects functional disability and exercise components. Our aims were to examine the medium-term disability in severe COVID-19-associated ARDS survivors, delineate pathophysiological changes contributing to their exercise intolerance, and explore its utility in predicting long-term functional impairment persistence. METHODS We studied 108 consecutive subjects with severe COVID-19 ARDS who remained alive 6 months after intensive care unit (ICU) discharge. Lung morphology was assessed with chest non-contrast CT scans and CT angiography. Functional evaluation included spirometry, plethysmography, muscle strength, and diffusion capacity, with assessment of gas exchange components through diffusing capacity of nitric oxide. Disability was assessed through an incremental exercise test, and measurements were repeated 12 and 24 months later in patients with functional impairments. RESULTS At 6 months after ICU discharge, a notable dissociation between morphological and clinical-functional sequelae was identified. Moderate-severe disability was present in 47% of patients and these subjects had greater limitation of ventilatory mechanics and gas exchange, as well as greater symptomatic perception during exercise and a probable associated cardiac limitation. Female sex, hypothyroidism, reduced membrane diffusion component, lower functional residual capacity, and high-attenuation lung volume were independently associated with the presence of moderate-severe functional disability, which in turn was related to higher frequency and greater intensity of dyspnea and worse quality of life. Out of the 71 patients with reduced lung volumes or diffusion capacity at 6 months post-ICU discharge, only 19 maintained a restrictive disorder associated with gas exchange impairment at 24 months post-discharge. In these patients, 6-month values for diffusion membrane component, maximal oxygen uptake, ventilatory equivalent for CO2, and dead space to tidal volume ratio were identified as independent risk factors for persistence of long-term functional sequelae. CONCLUSIONS Less than half of survivors of COVID-19 ARDS have moderate-severe disability in the medium term, identifying several risk factors. In turn, diffusion membrane component and exercise tolerance at 6-month ICU discharge are independently associated with the persistence of long-term functional sequelae.
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Affiliation(s)
- Raquel Casitas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Spain
| | - Raúl Galera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - María Torres-Vargas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Sara Garcia-Tovar
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Enrique Alfaro
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Elena Díaz-Garcia
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Elisabet Martinez-Cerón
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Miguel Garcia-Garcia
- Departamento de Análisis Económico y Economía Cuantitativa, Universidad Complutense de Madrid, Spain
| | - Isabel Torres
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Marta Núñez-Fernández
- Servicio de Neumología, Complejo Hospitalario Universitario de Vigo, Spain; NeumoVigo I+i, Galicia Sur Health Research Institute (IIGS), Vigo, Spain
| | - Alberto Fernández-Villar
- Servicio de Neumología, Complejo Hospitalario Universitario de Vigo, Spain; NeumoVigo I+i, Galicia Sur Health Research Institute (IIGS), Vigo, Spain
| | | | - José Manuel Añón
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain.
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Castilho T, Ribeiro JD, Wamosy RMG, Cardoso J, Ducati GC, Schivinski CIS. Bronchodilator response assessment through impulse oscillometry system and spirometry in children and adolescents with cystic fibrosis. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023162. [PMID: 38808869 PMCID: PMC11135897 DOI: 10.1590/1984-0462/2024/42/2023162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To investigate the effect of bronchodilator on the respiratory mechanics and pulmonary function of children and adolescents with cystic fibrosis. METHODS Cross-sectional study on clinically stable children and adolescents with cystic fibrosis aged from six to 15 years. Participants underwent impulse oscillometry and spirometry evaluations before and 15 minutes after bronchodilator inhalation. The Kolmogorov-Smirnov test was applied to verify the sample distribution, and the Student's t-test and Wilcoxon test were used to compare the data before and after bronchodilator inhalation. RESULTS The study included 54 individuals with a mean age of 9.7±2.8 years. The analysis showed a statistically significant improvement in impulse oscillometry and spirometry parameters after bronchodilator inhalation. However, according to the American Thoracic Society (ATS) and European Respiratory Society (ERS) recommendations (2020 and 2021), this improvement was not sufficient to classify it as a bronchodilator response. CONCLUSIONS The use of bronchodilator medication improved respiratory mechanics and pulmonary function parameters of children and adolescents with cystic fibrosis; however, most patients did not show bronchodilator response according to ATS/ERS recommendations.
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Affiliation(s)
| | | | | | - Juliana Cardoso
- Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil
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22
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Koussé JND, Ilboudo S, Ouédraogo AR, Ouédraogo JCRP, Hunsmann M, Ouédraogo GG, Ouédraogo M, Semdé R, Ouédraogo S. Pulmonary function assessment among conventional and organic cotton farmers exposed to pesticides in the Central-West region of Burkina Faso. Int Arch Occup Environ Health 2024:10.1007/s00420-024-02075-x. [PMID: 38777924 DOI: 10.1007/s00420-024-02075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Respiratory diseases have been associated with the exposure of populations to some environmental pollutants such as pesticides. To assess effects of pesticides on farmers' respiratory health, this study aimed to evaluate the pulmonary function of cotton farmers exposed to synthetic and natural pesticides in the Central-West region of Burkina Faso. METHODS A cross-sectional study was conducted from June to July 2022 among 281 conventional and 189 organic cotton farmers. After collecting information on pesticide use conditions, pulmonary function tests (PFTs) were performed on each farmer according to the American Thoracic Society/European Respiratory Society guidelines, in order to assess chronic respiratory effects among cotton producers. Binary logistic regression was used to assess factors associated with the occurrence of ventilatory changes. RESULTS Both conventional and organic cotton farmers reported similar chronic respiratory symptoms in different proportions. The main reported were rhinitis (54.45% conventional vs. 34.92% organic), chest pains (41.28% conventional vs. 23.81% organic), cough (33.45% conventional, 24.34% organic), breathlessness (31.67% conventional, 4.23% organic) (p<0.05). 16.18% and 27.50% of conventional male and female cotton farmers, respectively, had a restrictive defect. Among organic cotton farmers, 15.85% and 18.69%, respectively, of males and females had a restrictive defect. Furthermore, a significant increase in the predicted average percentage of FEV1/FVC ratio was observed among organic cotton farmers after salbutamol's use (p = 0.039). The type of cultivated cotton was not associated with ventilatory changes neither in the univariate analysis, nor in the multivariate analysis. Other factors such as farmers' age, BMI and insecticides use frequency per year were also important. Farmers who used insecticides more than 6 times per season had an increased risk of developing an obstructive defect (OR = 1.603; 95%CI: 0.484-5.309) compared to those who used them 6 times or less. CONCLUSION Chronic respiratory signs and ventilatory impairments were found among conventional and, to our knowledge, for the first time among organic cotton producers. However, these health effects were more prevalent among conventional cotton farmers than organic ones.
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Affiliation(s)
- Jean Noël Dado Koussé
- Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique (IRSS/CNRST), Ouagadougou 03, 03 BP 7047, Burkina Faso.
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso.
| | - Sylvain Ilboudo
- Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique (IRSS/CNRST), Ouagadougou 03, 03 BP 7047, Burkina Faso
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso
- International Research Laboratory - Environnement, Santé, Sociétés, (IRL 3189, ESS) CNRST/CNRS/UCAD/UGB/USTTB, Ouagadougou, Burkina Faso
| | - Abdoul Risgou Ouédraogo
- Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO (UFR-SDS/UJKZ), Ouagadougou 03, BP 7021, Burkina Faso
- Service de Pneumologie, Centre Hospitalier Universitaire de Tengandogo (CHU-Tengandogo), 11 BP 104 CMS, Ouagadougou 01, Burkina Faso
| | - Jean Claude Romaric Pingdwindé Ouédraogo
- Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique (IRSS/CNRST), Ouagadougou 03, 03 BP 7047, Burkina Faso
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso
- International Research Laboratory - Environnement, Santé, Sociétés, (IRL 3189, ESS) CNRST/CNRS/UCAD/UGB/USTTB, Ouagadougou, Burkina Faso
| | - Moritz Hunsmann
- Centre Norbert Elias (UMR 8562), Centre National de la Recherche Scientifique, Marseille / Avignon, France
| | - Geoffroy Gueswindé Ouédraogo
- Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique (IRSS/CNRST), Ouagadougou 03, 03 BP 7047, Burkina Faso
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso
- International Research Laboratory - Environnement, Santé, Sociétés, (IRL 3189, ESS) CNRST/CNRS/UCAD/UGB/USTTB, Ouagadougou, Burkina Faso
| | - Moussa Ouédraogo
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso
- Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO (UFR-SDS/UJKZ), Ouagadougou 03, BP 7021, Burkina Faso
| | - Rasmané Semdé
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso
- Unité de Formation et de Recherche en Sciences de la Santé, Université Joseph KI-ZERBO (UFR-SDS/UJKZ), Ouagadougou 03, BP 7021, Burkina Faso
| | - Sylvin Ouédraogo
- Institut de Recherche en Sciences de la Santé, Centre National de la Recherche Scientifique et Technologique (IRSS/CNRST), Ouagadougou 03, 03 BP 7047, Burkina Faso
- Laboratoire de Développement du Médicament, Centre d'Excellence Africain de Formation, de Recherche et d'Expertises en Sciences du Médicament, Université Joseph KI-ZERBO (LADME/CEA-CFOREM/UJKZ), Ougadougou 03, BP 7021, Burkina Faso
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Mohamed BME, Laz N, Saeed H, Abdelrahim MEA, Rabea H. Efficacy-based comparison between adults and children regarding using advanced counseling for asthma. J Asthma 2024:1-7. [PMID: 38742886 DOI: 10.1080/02770903.2024.2356004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/12/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Asthma advanced counseling using smartphone applications has recently become one of the most effective and commonly used methods among adults and children with asthma. OBJECTIVES We aimed to compare the advanced counseling effectiveness between adults and children with asthma. METHODS A cohort prospective parallel study was performed on a group of adults and children nonsmoking patients with asthma, using a pressurized metered dose inhaler (pMDI). The patients were divided into two groups namely adults with asthma with ages ranging from 19 to 60 years and Children with asthma with ages ranging from 11 to 18 years, the two groups received a 2-month course of advanced counseling using "Asthma software" and "Asthma Dodge" smartphone applications, during which the two groups were monitored using the forced expiratory volume in the first second to the forced vital capacity (FEV1/FVC) ratio and asthma control test (ACT). The study has obtained ethical approval with the serial number REC-H-PhBSU-23002, adhering to the principles outlined in The Declaration of Helsinki, from the Ethical Approval Committee of Beni-Suef University Faculty of Pharmacy. RESULTS With a total of 60 patients with asthma (N = 60), 31 adults (N = 31), and 29 children (N = 29), We found that starting from the first-month visit of counseling the children group showed superiority over the adult group in terms of the pulmonary function improvement p = .006. Also, regarding ACT scores the children group showed a superiority over the adult group this significance started from the first-month visit and continued to the second-month visit with p values = .032 and .011, respectively. CONCLUSION The advanced counseling achieved better asthma control and pulmonary function improvement in children and adults; however, the improvement was much better in children with asthma than adults with asthma.
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Affiliation(s)
- Basma M E Mohamed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Nabila Laz
- Department of Chest, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Haitham Saeed
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed E A Abdelrahim
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Hoda Rabea
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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24
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Gie A, Goussard P. The challenge of interpreting diminished mid-expiratory flow in the presence of normal FEV 1 and FVC. Respirology 2024. [PMID: 38773902 DOI: 10.1111/resp.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 05/24/2024]
Abstract
See related article
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Affiliation(s)
- Andre Gie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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25
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Nayır Büyükşahin H, Emiralioğlu N, Yalçın E, Şen V, Selimoğlu Şen H, Arslan H, Başkan AK, Çakır FB, Koray CF, Yılmaz Aİ, Ercan F, Altıntaş DU, Serbes M, Keskin Ö, Arık E, Gülen F, Barlık M, Karcıoğlu O, Damadoğlu E, Köse M, Ersoy A, Bingöl A, Başaran E, Çakır EP, Aslan AT, Canıtez Y, Korkmaz M, Özdemir A, Harmancı K, Soydaş ŞS, Hangül M, Yüksel H, Özcan G, Korkmaz P, Kılıç M, Gayretli Aydın ZG, Çaltepe G, Can D, Doğru S, Kartal Öztürk G, Süleyman A, Topal E, Özsezen B, Hızal M, Demirdöğen E, Ogun H, Börekçi Ş, Yazan H, Çakır E, Şişmanlar Eyüboğlu T, Çobanoğlu N, Cinel G, Pekcan S, Özçelik U, Doğru D. Comparison of clinical features of cystic fibrosis patients eligible but not on CFTR modulators to ineligible for CFTR modulators. Pediatr Pulmonol 2024. [PMID: 38771207 DOI: 10.1002/ppul.27051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/28/2024] [Accepted: 04/27/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs target the underlying defect and improve CFTR function. They are a part of standard care in many countries, but not all patients are eligible for these drugs due to age and genotype. Here, we aimed to determine the characteristics of non-eligible patients for CFTR modulators in the CF registry of Turkey (CFRT) to highlight their clinical needs. METHODS This retrospective cohort study included CF patient data from the CFRT in 2021. The decision of eligibility for the CFTR modulator was determined according to the 'Vertex treatment-Finder' on the Vertex® website. Demographic and clinical characteristics of patients were compared between eligible (group 1) and ineligible (group 2) groups for CFTR modulators. RESULTS Among the study population (N = 1527), 873 (57.2%) were in group 1 and 654 (42.8%) were in group 2. There was no statistical difference between groups regarding sex, meconium ileus history, diagnoses via newborn screening, FEV1 z-score, CF-associated complications, organ transplant history, and death. Patients in group 2 had a higher incidence of pancreatic insufficiency (87.7% vs. 83.2%, p = .010), lower median height z-scores (-0.87 vs. -0.55, p < .001), lower median body mass index z-scores (-0.65 vs. -0.50, p < .001), longer days receiving antibiotics due to pulmonary exacerbation (0 [interquartile range, IQR: 0-2] vs. 0 [IQR: 0-7], p = 0.001), and more non-invasive ventilation support (2.6% vs. 0.9%, p = 0.008) than patients in group 1. CONCLUSION The ineligible group had worse clinical outcomes than the eligible group. This highlights their need for life-changing drugs to improve clinical outcomes.
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Affiliation(s)
- Halime Nayır Büyükşahin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioğlu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalçın
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Velat Şen
- Division of Pulmonology, Department of Pediatrics, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Hadice Selimoğlu Şen
- Department of Pulmonology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Hüseyin Arslan
- Division of Pediatric Allergy and Pulmonology, Department of Pediatrics, Cerrahpaşa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Azer Kılıç Başkan
- Division of Pediatric Allergy and Pulmonology, Department of Pediatrics, Cerrahpaşa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Fatma Betül Çakır
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Cem Fırat Koray
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Aslı İmran Yılmaz
- Division of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Fatih Ercan
- Division of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Derya Ufuk Altıntaş
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Mahir Serbes
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Özlem Keskin
- Division of Pediatric Allergy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Elif Arık
- Division of Pediatric Allergy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Figen Gülen
- Division of Pulmonology, Department of Pediatrics, Ege University Faculty of Medicine, Diyarbakır, Turkey
| | - Meral Barlık
- Division of Pulmonology, Department of Pediatrics, Ege University Faculty of Medicine, Diyarbakır, Turkey
| | - Oğuz Karcıoğlu
- Department of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Damadoğlu
- Department of Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Köse
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Ersoy
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ayşen Bingöl
- Division of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Erdem Başaran
- Division of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Eylül Pınar Çakır
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe Tana Aslan
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yakup Canıtez
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Merve Korkmaz
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Ali Özdemir
- Division of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Koray Harmancı
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Şule Selin Soydaş
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Melih Hangül
- Division of Pediatric Pulmonology, Gaziantep Cengiz Gökçek Maternity and Children Hospital, Gaziantep, Turkey
| | - Hasan Yüksel
- Division of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Gizem Özcan
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pervin Korkmaz
- Department of Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mehmet Kılıç
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Zeynep Gökçe Gayretli Aydın
- Division of Pediatric Infectious Disease, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gönül Çaltepe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Demet Can
- Division of Pediatric Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Sibel Doğru
- Department of Pulmonology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Gökçen Kartal Öztürk
- Division of Pediatric Pulmonology, Dr.Behçet Uz Children's Hospital, Izmir, Turkey
| | - Ayşe Süleyman
- Division of Pediatric Allergy and Immunology, Istanbul University/Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erdem Topal
- Division of Pediatric Allergy and Immunology, Inönü University Faculty of Medicine, Malatya, Turkey
| | - Beste Özsezen
- Division of Pediatric Pulmonology, Şanliurfa Training and Research Hospital, Şanliurfa, Turkey
| | - Mina Hızal
- Division of Pediatric Pulmonology, Dr Sami Ulus Maternity and Children Training and Research Hospital, Ankara, Turkey
| | - Ezgi Demirdöğen
- Department of Pulmonology, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey
| | - Hamza Ogun
- Department of Pulmonology, Faculty of Medicine, Bezmialem University, İstanbul, Turkey
| | - Şermin Börekçi
- Department of Pulmonology, Cerrahpaşa Medicine Faculty, Istanbul University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Istanbul Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Erkan Çakır
- Division of Pediatric Pulmonology, Faculty of Medicine, İstinye University, İstanbul, Turkey
| | | | - Nazan Çobanoğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Güzin Cinel
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Uğur Özçelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Shepherd AI, James TJ, Gould AAM, Mayes H, Neal R, Shute J, Tipton MJ, Massey H, Saynor ZL, Perissiou M, Montgomery H, Sturgess C, Makaronidis J, Murray AJ, Grocott MPW, Cummings M, Young-Min S, Rennell-Smyth J, McNarry MA, Mackintosh KA, Dent H, Robson SC, Corbett J. Impact of nocturnal hypoxia on glycaemic control, appetite, gut microbiota and inflammation in adults with type 2 diabetes mellitus: A single-blind cross-over trial. J Physiol 2024. [PMID: 38769692 DOI: 10.1113/jp285322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
High altitude residents have a lower incidence of type 2 diabetes mellitus (T2DM). Therefore, we examined the effect of repeated overnight normobaric hypoxic exposure on glycaemic control, appetite, gut microbiota and inflammation in adults with T2DM. Thirteen adults with T2DM [glycated haemoglobin (HbA1c): 61.1 ± 14.1 mmol mol-1; aged 64.2 ± 9.4 years; four female] completed a single-blind, randomised, sham-controlled, cross-over study for 10 nights, sleeping when exposed to hypoxia (fractional inspired O2 [F I O 2 ${{F}_{{\mathrm{I}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ] = 0.155; ∼2500 m simulated altitude) or normoxic conditions (F I O 2 ${{F}_{{\mathrm{I}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ = 0.209) in a randomised order. Outcome measures included: fasted plasma [glucose]; [hypoxia inducible factor-1α]; [interleukin-6]; [tumour necrosis factor-α]; [interleukin-10]; [heat shock protein 70]; [butyric acid]; peak plasma [glucose] and insulin sensitivity following a 2 h oral glucose tolerance test; body composition; appetite indices ([leptin], [acyl ghrelin], [peptide YY], [glucagon-like peptide-1]); and gut microbiota diversity and abundance [16S rRNA amplicon sequencing]. During intervention periods, accelerometers measured physical activity, sleep duration and efficiency, whereas continuous glucose monitors were used to assess estimated HbA1c and glucose management indicator and time in target range. Overnight hypoxia was not associated with changes in any outcome measure (P > 0.05 with small effect sizes) except fasting insulin sensitivity and gut microbiota alpha diversity, which exhibited trends (P = 0.10; P = 0.08 respectively) for a medium beneficial effect (d = 0.49; d = 0.59 respectively). Ten nights of overnight moderate hypoxic exposure did not significantly affect glycaemic control, gut microbiome, appetite, or inflammation in adults with T2DM. However, the intervention was well tolerated and a medium effect-size for improved insulin sensitivity and reduced alpha diversity warrants further investigation. KEY POINTS: Living at altitude lowers the incidence of type 2 diabetes mellitus (T2DM). Animal studies suggest that exposure to hypoxia may lead to weight loss and suppressed appetite. In a single-blind, randomised sham-controlled, cross-over trial, we assessed the effects of 10 nights of hypoxia (fractional inspired O2 ∼0.155) on glucose homeostasis, appetite, gut microbiota, inflammatory stress ([interleukin-6]; [tumour necrosis factor-α]; [interleukin-10]) and hypoxic stress ([hypoxia inducible factor 1α]; heat shock protein 70]) in 13 adults with T2DM. Appetite and inflammatory markers were unchanged following hypoxic exposure, but an increased insulin sensitivity and reduced gut microbiota alpha diversity were associated with a medium effect-size and statistical trends, which warrant further investigation using a definitive large randomised controlled trial. Hypoxic exposure may represent a viable therapeutic intervention in people with T2DM and particularly those unable or unwilling to exercise because barriers to uptake and adherence may be lower than for other lifestyle interventions (e.g. diet and exercise).
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Affiliation(s)
- Anthony I Shepherd
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Thomas J James
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Alex A M Gould
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Harry Mayes
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Rebecca Neal
- Department of Rehabilitation and Sport Sciences, Bournemouth University, Poole, UK
| | - Janis Shute
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Michael J Tipton
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Heather Massey
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Zoe L Saynor
- Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Maria Perissiou
- Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, Dept Medicine, University College London, London, UK
| | - Connie Sturgess
- Centre for Human Health and Performance, Dept Medicine, University College London, London, UK
| | - Janine Makaronidis
- Centre for Obesity Research, University College London, London, UK
- National Institute for Health and Care Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Andrew J Murray
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton & University of Southampton, Southampton, UK
| | - Michael Cummings
- Diabetes and Endocrinology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Steven Young-Min
- Rheumatology Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Janet Rennell-Smyth
- Clinical Health and Rehabilitation Team, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Patient and public involvement member
| | - Melitta A McNarry
- School of Biological Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Kelly A Mackintosh
- School of Biological Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Hannah Dent
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Institute of Life Sciences and Healthcare, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Samuel C Robson
- School of Pharmacy and Biomedical Sciences, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, School of Sport and Exercise Sciences, Swansea University, Swansea, UK
- Institute of Life Sciences and Healthcare, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
| | - Jo Corbett
- Extreme Environments Laboratory, School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, Portsmouth, UK
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27
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Soriano JB, Polverino F. Sexual activity and respiratory disease: A systematic review. Respir Med 2024; 228:107665. [PMID: 38768665 DOI: 10.1016/j.rmed.2024.107665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/03/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
CONTEXT Sex and gender are related concepts, but they have distinct meanings and implications. Respiratory diseases are a major driver of morbi-mortality. It is frequent that respirologists, primary care doctors, or other specialists, when dealing with respiratory patients, and aiming for a holistic management of their patients, they all skip any question or matter associated with sexual activity or behavior. OBJECTIVES To review how sexual activity is explored in respiratory patients. METHODS To conduct this review, we endorse PRISMA guidance for reporting systematic reviews, and also the sex and gender equity in research (SAGER) guidelines. RESULTS Compared to other conditions such as heart disease, mental disorders, Alzheimer's, or even COVID-19, to date there is no review focused on sexual activity and respiratory health and disease. Asthma, COPD and other respiratory patients can have their sexual activity and behaviors affected by their disease, but also limitations in sex might be the sentinel event of an incident respiratory disease. Asking on sexual desire and related sex issues should not be considered taboo in any respiratory consultation. Importantly, any marketed stereotypes on cigarettes after any sexual activity should be counteracted. Many clinical trials of respiratory drugs keep recruiting few or no women, so research on women's sexual desire and satisfaction lags behind that of men's. By using the available objective tools and validated questionnaires summarized in this review, these important domains of respiratory patients and their partners can be properly identified and managed. CONCLUSIONS Sexual activity, depending on age and individual specific conditions, is a fundamental driver of overall health, and therefore of lung health.
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Affiliation(s)
- Joan B Soriano
- Facultat de Medicina, Universitat de les Illes Balears, Palma de Mallorca, Spain; Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Francesca Polverino
- Pulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA.
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Dimiene I, Hoppenot D, Vajauskas D, Padervinskiene L, Rimkunas A, Zemaitis M, Barkauskiene D, Lapinskas T, Ereminiene E, Miliauskas S. Systemic Manifestations of COPD and the Impact of Dual Bronchodilation with Tiotropium/Olodaterol on Cardiac Function and Autonomic Integrity. J Clin Med 2024; 13:2937. [PMID: 38792478 PMCID: PMC11121926 DOI: 10.3390/jcm13102937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) has significant systemic manifestations, including cardiovascular morbidity. The main aim of our study was to evaluate the effect of short-term COPD treatment with tiotropium/olodaterol (TIO/OLO) 5/5 μg on cardiac function and autonomic integrity. Methods: Twenty-nine patients with newly diagnosed moderate-to-severe COPD were enrolled. We performed pulmonary function tests, cardiac magnetic resonance, cardiac 123I-metaiodobenzylguanidine (123I-MIBG) imaging and analysis of blood biomarkers on our study subjects. The correlations between the tests' results were evaluated at baseline. The changes in pulmonary and cardiac parameters from baseline through 12 weeks were assessed. Results: Significant associations between pulmonary function tests' results and high-sensitivity C-reactive protein (hs-CRP), as well as interleukin-22 (IL-22), were observed at baseline. Treatment with TIO/OLO significantly improved lung function as measured by spirometry and body plethysmography. Moreover, we found that the cardiac index increased from 2.89 (interquartile range (IQR) 1.09) to 3.21 L/min/m2 (IQR 0.78) (p = 0.013; N = 18) and the late heart-to-mediastinum ratio improved from 1.88 (IQR 0.37) to 2 (IQR 0.41) (p = 0.026; N = 16) after 12 weeks of treatment. Conclusions: Treatment with TIO/OLO improves lung function and positively impacts cardiac function and autonomic integrity, suggesting that dual bronchodilation might have a potential in decreasing the risk for cardiac events in COPD. Hs-CRP and IL-22 might be beneficial in determining the intensity of systemic inflammation in COPD. Further research with a larger cohort is needed to enhance the initial results of this study.
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Affiliation(s)
- Ieva Dimiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Deimante Hoppenot
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Donatas Vajauskas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.V.); (L.P.)
| | - Lina Padervinskiene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.V.); (L.P.)
| | - Airidas Rimkunas
- Laboratory of Pulmonology, Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Marius Zemaitis
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Diana Barkauskiene
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (E.E.)
| | - Egle Ereminiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (T.L.); (E.E.)
| | - Skaidrius Miliauskas
- Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (D.H.); (M.Z.); (D.B.); (S.M.)
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Min HJ, Payne SJ, Stride EP. Modelling Drug Delivery to the Small Airways: Optimization Using Response Surface Methodology. Pharm Res 2024:10.1007/s11095-024-03706-1. [PMID: 38755398 DOI: 10.1007/s11095-024-03706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024]
Abstract
AIM The aim of this in silico study was to investigate the effect of particle size, flow rate, and tidal volume on drug targeting to small airways in patients with mild COPD. METHOD Design of Experiments (DoE) was used with an in silico whole lung particle deposition model for bolus administration to investigate whether controlling inhalation can improve drug delivery to the small conducting airways. The range of particle aerodynamic diameters studied was 0.4 - 10 µm for flow rates between 100 - 2000 mL/s (i.e., low to very high), and tidal volumes between 40 - 1500 mL. RESULTS The model accurately predicted the relationship between independent variables and lung deposition, as confirmed by comparison with published experimental data. It was found that large particles (~ 5 µm) require very low flow rate (~ 100 mL/s) and very small tidal volume (~ 110 mL) to target small conducting airways, whereas fine particles (~ 2 µm) achieve drug targeting in the region at a relatively higher flow rate (~ 500 mL/s) and similar tidal volume (~ 110 mL). CONCLUSION The simulation results indicated that controlling tidal volume and flow rate can achieve targeted delivery to the small airways (i.e., > 50% of emitted dose was predicted to deposit in the small airways), and the optimal parameters depend on the particle size. It is hoped that this finding could provide a means of improving drug targeting to the small conducting airways and improve prognosis in COPD management.
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Affiliation(s)
- Hyunhong J Min
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
| | - Stephen J Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Institute of Applied Mechanics, National Taiwan University, Taipie, Taiwan
| | - Eleanor P Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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Cannon MF, Goldfarb DG, Zeig-Owens RA, Hall CB, Choi J, Cohen HW, Prezant DJ, Weiden MD. Normal Lung Function and Mortality in World Trade Center Responders and National Health and Nutrition Examination Survey III Participants. Am J Respir Crit Care Med 2024; 209:1229-1237. [PMID: 38163381 DOI: 10.1164/rccm.202309-1654oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
Rationale: Low FEV1 is a biomarker of increased mortality. The association of normal lung function and mortality is not well described. Objectives: To evaluate the FEV1-mortality association among participants with normal lung function. Methods: A total of 10,999 Fire Department of the City of New York (FDNY) responders and 10,901 Third National Health and Nutrition Examination Survey (NHANES III) participants, aged 18-65 years with FEV1 ⩾80% predicted, were analyzed, with FEV1 percent predicted calculated using Global Lung Function Initiative Global race-neutral reference equations. Mortality data were obtained from linkages to the National Death Index. Cox proportional hazards models estimated the association between FEV1 and all-cause mortality, controlling for age, sex, race/ethnicity, smoking history, and, for FDNY, work assignment. Cohorts were followed for a maximum of 20.3 years. Measurements and Main Results: We observed 504 deaths (4.6%) of 10,999 for FDNY and 1,237 deaths (9.4% [weighted]) of 10,901 for NHANES III. Relative to FEV1 ⩾120% predicted, mortality was significantly higher for FEV1 100-109%, 90-99%, and 80-89% predicted in the FDNY cohort. In the NHANES III cohort, mortality was significantly higher for FEV1 90-99% and 80-89% predicted. Each 10% higher predicted FEV1 was associated with 15% (hazard ratio, 0.85; 95% confidence interval, 0.80-0.91) and 23% (hazard ratio, 0.77; 95% confidence interval, 0.71-0.84) lower mortality for FDNY and NHANES III, respectively. Conclusions: In both cohorts, higher FEV1 is associated with lower mortality, suggesting higher FEV1 is a biomarker of better health. These findings demonstrate that a single cross-sectional measurement of FEV1 is predictive of mortality over two decades, even when FEV1 is in the normal range.
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Affiliation(s)
- Madeline F Cannon
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Rachel A Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Hillel W Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, New York
- New York University Grossman School of Medicine, New York, New York
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31
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Wang Z, Li Y, Tan L, Liu S, Wang Z, Zhang Q, Lin J, Huang J, Liang L, Gao Y, Zhong N, Zheng J. Prevalence, Medicaid use and mortality risk of low FEV 1 in adults aged 20-35 years old in the USA: evidence from a population-based retrospective cohort study. BMJ Open Respir Res 2024; 11:e001918. [PMID: 38749533 PMCID: PMC11097847 DOI: 10.1136/bmjresp-2023-001918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The prevalence, Medicaid use and mortality risk associated with low forced expiratory volume in 1 s (FEV1) among young adults aged 20-35 years are not well understood, despite its potential implications for the development of chronic pulmonary disease and overall prognosis. METHODS A retrospective cohort study was conducted among young adults aged 20-35 years old, using data from the National Health and Nutrition Examination Survey, National Death Index and Centers for Medicare & Medicaid Services. Participants were categorised into a low FEV1 group (pre-bronchodilator FEV1%pred <80%) and a normal FEV1 group (FEV1%pred ≥80%). Weighted logistic regression analysis was employed to identify the risk factors associated with low FEV1, while Cox proportional hazard models were used to calculate the hazard ratio (HR) for Medicaid use and the all-cause mortality between the two groups. RESULTS A total of 5346 participants aged 20-35 were included in the study, with 329 in the low FEV1 group and 5017 in the normal group. The weighted prevalence of low FEV1 among young adults was 7.1% (95% CI 6.0 to 8.2). Low body mass index (OR=3.06, 95% CI 1.79 to 5.24), doctor-diagnosed asthma (OR=2.25, 1.28 to 3.93), and wheezing or whistling (OR=1.57, 1.06 to 2.33) were identified as independent risk factors for low FEV1. Over a 15-year follow-up, individuals in the low FEV1 group exhibited a higher likelihood of Medicaid use compared with those in the normal group (HR=1.73, 1.07 to 2.79). However, there was no statistically significant increase in the risk of all-cause mortality over a 30-year follow-up period (HR=1.48, 1.00 to 2.19). CONCLUSIONS A considerable portion of young adults demonstrated low FEV1 levels, a characteristic that was associated with a higher risk of Medicaid use over a long-term follow-up, yet not linked to an augmented risk of all-cause mortality.
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Affiliation(s)
- Zihui Wang
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yun Li
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lunfang Tan
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuyi Liu
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhufeng Wang
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qing Zhang
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junfeng Lin
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinhai Huang
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lina Liang
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yi Gao
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nanshan Zhong
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinping Zheng
- Guangzhou Institute of Respiratory Disease, Guangzhou, Guangdong, China
- First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Freidkin L, Kramer MR, Rosengarten D, Izhakian S, Taieb S, Pertzov B. The acute effect of inhaled nitric oxide on the exercise capacity of patients with advanced interstitial lung disease: a randomized controlled trial. BMC Pulm Med 2024; 24:226. [PMID: 38724947 PMCID: PMC11084010 DOI: 10.1186/s12890-024-03051-4] [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: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Inhaled nitric oxide (iNO) selectively acts on the pulmonary vasculature of ventilated lung tissue by reducing pulmonary vascular resistance and intrapulmonary shunt. This effect may reduce ventilation/perfusion mismatch and decrease pulmonary hypertension in patients with interstitial lung disease. METHODS In a prospective, single-blinded, randomized, placebo-controlled trial, participants with advanced interstitial lung disease, underwent two separate six-minute walk tests (6MWT): one with iNO and the other with a placebo. The primary outcome measured the difference in meters between the distances covered in the two tests. Secondary outcomes included oxygen saturation levels, distance-saturation product, and Borg dyspnea score. A predefined subgroup analysis was conducted for patients with pulmonary hypertension. RESULTS Overall, 44 patients were included in the final analysis. The 6MWT distance was similar for iNO treatment and placebo, median 362 m (IQR 265-409) vs 371 m (IQR 250-407), respectively (p = 0.29). Subgroup analysis for patients with pulmonary hypertension showed no difference in 6MWT distance with iNO and placebo, median 339 (256-402) vs 332 (238-403) for the iNO and placebo tests respectively (P=0.50). No correlation was observed between mean pulmonary artery pressure values and the change in 6MWT distance with iNO versus placebo (spearman correlation Coefficient 0.24, P=0.33). CONCLUSION In patients with advanced interstitial lung disease, both with and without concurrent pulmonary hypertension, the administration of inhaled nitric oxide failed to elicit beneficial effects on the six-minute walk distance and oxygen saturation. The use of inhaled NO was found to be safe and did not lead to any serious side effects. TRIAL REGISTRATION (NCT03873298, MOH_2018-04-24_002331).
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Affiliation(s)
- Lev Freidkin
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St, Petach-Tikva, 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai R Kramer
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St, Petach-Tikva, 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Rosengarten
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St, Petach-Tikva, 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Izhakian
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St, Petach-Tikva, 4941492, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Taieb
- Internal medicine E, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Barak Pertzov
- Pulmonary Division, Rabin Medical Center, Beilinson Campus, 39 Jabotinski St, Petach-Tikva, 4941492, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Irusen EM, Meiring D, Koegelenberg CFN. Asthma-COPD overlap and asthma progressing to COPD: Are we using the right diagnostic approaches and pathways? Respirology 2024. [PMID: 38712599 DOI: 10.1111/resp.14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Elvis Malcolm Irusen
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Danica Meiring
- Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
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Palones E, Plaza V, Gonzalez-Quereda L, Segarra-Casas A, Querol L, Bertoletti F, Rodriguez MJ, Gallano P, Crespo-Lessmann A. Chronic Cough and Cerebellar Ataxia With Neuropathy and Bilateral Vestibular Areflexia Syndrome (CANVAS): Screening for Mutations in Replication Factor C Subunit 1 (RFC1). Arch Bronconeumol 2024:S0300-2896(24)00141-8. [PMID: 38755058 DOI: 10.1016/j.arbres.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/05/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION A common complaint in patients is chronic cough (CC), which may be refractory (RCC) or unexplained (UCC). Recent studies point, as a possible cause of CC, to the hereditary cerebellar ataxia with neuropathy and bilateral vestibular areflexia syndrome (CANVAS), with an estimated carrier prevalence of 1 in 20000. AIM In patients with CC, determine the prevalence of the biallelic (AAGGG)exp mutation in replication factor C subunit 1 (RFC1) responsible for CANVAS, test the usefulness of the Rydel-Seiffer fork test, and evaluate patient quality of life (QoL). METHODS Clinical and functional data were collected for the 33 included patients undergoing CC studies in our specialized unit. Performed were an etiological study of CC following European Respiratory Society recommendations, a genetic study of RFC1 mutations, and Rydel-Seiffer fork testing to detect possible peripheral vibratory sensitivity impairment. Administered to evaluate QoL were 4 questionnaires. RESULTS Prevalence of biallelic (AAGGG)exp in RFC1 was 6.1% (n=2) overall, increasing to 7.1% in the RCC subgroup, and to 33.3% in the Rydel-Seiffer fork altered results subgroup. Prevalence of monoallelic (AAGGG)exp in RFC1 was 18.2% (n=6) overall, rising to 50.0% (n=2) in the UCC subgroup. CONCLUSION Genetic screening for (AAGGG)exp in RFC1, and also use of the Rydel-Seiffer fork test, should be considered in specialized CC consultations for patients with RCC and UCC. Detecting possible CANVAS symptoms in CC studies would identify candidates for early genetic screening, of interest in reducing the disease burden for patients and health systems alike.
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Affiliation(s)
- Esther Palones
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Respiratory Medicine, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Vicente Plaza
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Respiratory Medicine, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Lidia Gonzalez-Quereda
- Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Barcelona, Spain; Genetics Department, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Segarra-Casas
- Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Barcelona, Spain; Genetics Department, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Luis Querol
- Neuromuscular Disease Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Federico Bertoletti
- Department of Digestive Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María José Rodriguez
- Genetics Department, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pía Gallano
- Genetics and Microbiology Department, Universitat Autònoma de Barcelona, Barcelona, Spain; Genetics Department, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Networked Biomedical Research Centre for Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Astrid Crespo-Lessmann
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Respiratory Medicine, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Cooper B, Stanojevic S. Is lung function in a race against time? Exp Physiol 2024. [PMID: 38699789 DOI: 10.1113/ep091490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Brendan Cooper
- Lung Function & Sleep Department, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Han HX, Su W, Tian X, Zhou DB, Li J, Cao XX. Clinical characteristics, radiological features and outcomes in pulmonary involvement of cryoglobulinemia. Orphanet J Rare Dis 2024; 19:185. [PMID: 38698461 PMCID: PMC11067141 DOI: 10.1186/s13023-024-03159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Cryoglobulinemia with pulmonary involvement is rare, and its characteristics, radiological findings, and outcomes are still poorly understood. METHODS Ten patients with pulmonary involvement of 491 cryoglobulinemia patients at Peking Union Medical College Hospital were enrolled in this retrospective study. We analyzed the characteristics, radiological features and management of pulmonary involvement patients, and compared with those of non-pulmonary involvement with cryoglobulinemia. RESULTS The 10 patients with pulmonary involvement (2 males; median age, 53 years) included three patients with type I cryoglobulinemia and seven patients with mixed cryoglobulinemia. All of 10 patients were IgM isotype cryoglobulinemia. All type I patients were secondary to B-cell non-Hodgkin lymphoma. Four mixed patients were essential, and the remaining patients were secondary to infections (n = 2) and systemic lupus erythematosus (n = 1), respectively. Six patients had additional affected organs, including skin (60%), kidney (50%), peripheral nerves (30%), joints (20%), and heart (20%). The pulmonary symptoms included dyspnea (50%), dry cough (30%), chest tightness (30%), and hemoptysis (10%). Chest computed tomography (CT) showed diffuse ground-glass opacity (80%), nodules (40%), pleural effusions (30%), and reticulation (20%). Two patients experienced life-threatening diffuse alveolar hemorrhage. Five patients received corticosteroid-based regimens, and four received rituximab-based regimens. All patients on rituximab-based regimens achieved clinical remission. The estimated two-year overall survival (OS) was 40%. Patients with pulmonary involvement had significantly worse OS and progression-free survival than non-pulmonary involvement patients of cryoglobulinemia (P < 0.0001). CONCLUSIONS A diagnosis of pulmonary involvement should be highly suspected for patients with cryoglobulinemia and chest CT-indicated infiltrates without other explanations. Patients with pulmonary involvement had a poor prognosis. Rituximab-based treatment may improve the outcome.
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Affiliation(s)
- Hong-Xiao Han
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, 100730, Beijing, China
| | - Wei Su
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, 100730, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, 100730, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xin-Xin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, 100730, Beijing, China.
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China.
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Meoli A, Trischler J, Hutter M, Dressler M, Esposito S, Blümchen K, Zielen S, Schulze J. Impulse oscillometry bronchodilator response in preschool children. Pediatr Pulmonol 2024; 59:1321-1329. [PMID: 38353391 DOI: 10.1002/ppul.26909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND In preschoolers, performing an acceptable spirometry and measuring bronchodilator response (BDR) is challenging; in this context, impulse oscillometry (IOS) represents a valid alternative. However, more studies on the standardization of BDR for IOS in young children are required. OBJECTIVE The objective of the study was to identify optimal thresholds to define a positive BDR test with IOS in preschoolers with suspected asthma. METHODS Children aged 3-6 years with suspected asthma and their lung function investigated with both IOS and spirometry pre- and post-BDR were retrospectively analyzed. The spirometric BDR was defined as positive when the change of FEV1 was ≥12% or ≥200 mL. The oscillometric BDR was defined as positive in case of change of at least -40% in R5, +50% in X5, and -80% in AX. RESULTS Among 72 patients, 36 (age 5.2 ± 1 years; 64% boys) were selected for the subsequent analysis according to ATS/ERS quality criteria of measurements; specifically, 19 patients did not meet IOS and 36 did not meet spirometry criteria. The spirometric BDR was found positive in seven subjects (19.4%); conversely, a positive oscillometric BDR was identified in four patients (11.1%). No patient presented a positive BDR response with both methods. In IOS, the mean decrease in R5 and AX was 19.9% ± 10% and 44% ± 22.1%, and the mean increase in X5 was 23.3% ± 17.8%, respectively. A decrease in R5 of 25.7% (AUC 0.77, p = .03) and an increase in X5 of 25.7% (AUC 0.75, p = .04) showed the best combination of sensitivity and specificity to detect an increase of FEV1 ≥ 12% and/or ≥200 mL. CONCLUSION The IOS represents a valid alternative to spirometry to measure BDR in preschool children and should be the gold standard in this age group. We are considering a decrease of 26% in R5 and an increase of 26% in X5 as diagnostic threshold for BDR.
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Affiliation(s)
- Aniello Meoli
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Jordis Trischler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Martin Hutter
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Melanie Dressler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Susanna Esposito
- Department of Medicine and Surgery, Pediatric Clinic, University Hospital of Parma, Parma, Italy
| | - Katharina Blümchen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Frankfurt am Main, Germany
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Curnow AC, Huang L, Fischl MA, Floris-Moore M, Morris A, Nouraie M, Reddy DB, Seaberg EC, Sheth AN, Tien PC, Wang RJ. Hepatitis C Virus Clearance and Diffusing Capacity for Carbon Monoxide in Women With and Without Human Immunodeficiency Virus. Open Forum Infect Dis 2024; 11:ofae251. [PMID: 38770208 PMCID: PMC11103618 DOI: 10.1093/ofid/ofae251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Hepatitis C virus (HCV) infection is associated with extrahepatic effects, including reduced diffusing capacity of the lungs. It is unknown whether clearance of HCV infection is associated with improved diffusing capacity. In this sample of women with and without human immunodeficiency virus, there was no association between HCV clearance and diffusing capacity.
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Affiliation(s)
- Andrew C Curnow
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Laurence Huang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michelle Floris-Moore
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mehdi Nouraie
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Divya B Reddy
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Eric C Seaberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Richard J Wang
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Westrupp N, Berry CD, Cole T, Shanthikumar S, Welsh L. Detection of Bronchiolitis Obliterans Syndrome Using Nitrogen Multiple Breath Washout in Children Posthemopoietic Stem Cell Transplant. Transplant Cell Ther 2024; 30:524.e1-524.e9. [PMID: 38360272 DOI: 10.1016/j.jtct.2024.02.013] [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: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Bronchiolitis obliterans syndrome (BOS) is a severe complication following hemopoietic stem cell transplantation (HSCT) and is often undetected until there is significant deterioration in pulmonary function. Lung clearance index (LCI2.5) derived from the nitrogen multiple breath washout (N2MBW) test may be more feasible and sensitive than spirometry, which is currently used for surveillance and detection of BOS. We aimed to examine the feasibility of performing surveillance N2MBW in children post-HSCT, and in an exploratory analysis, determine if LCI2.5 led to earlier detection of BOS when compared to spirometric indices. Participants aged 5 to 17 years were recruited prior to receiving HSCT into a prospective, single-center, feasibility study at the Royal Children's Hospital, Melbourne. N2MBW and spirometry were performed within the month prior to transplant and repeated at 3, 6, 9, and 12 months post-transplant. Data were also collected on the presence of graft-versus-host (GVHD) disease in any organ, including the lungs. Twenty-one (12 male) children with a mean age of 13.4 (range 9.2 to 17.1) years at recruitment participated in this study. Prior to HSCT, all participants had normal LCI2.5, while 16 (76%) demonstrated normal forced expiratory volume in 1 second (FEV1). Ninety-nine percent of N2MBW tests were technically acceptable, compared with 66% of spirometry tests. Three participants developed BOS, while 2 participants died of other respiratory complications. At 6 and 12 months post-transplant, the BOS group had increases in LCI2.5 ranging from 3 to 5 units and mean reductions in FEV1 % predicted of 40% to 53% relative to pre HSCT values, respectively. In those who developed BOS, post-HSCT LCI2.5 values were significantly worse when compared with the no BOS group (P < .001). Relative changes in LCI2.5 and FEV1 were both predictive of BOS at 6 months post HSCT. This study demonstrates that N2MBW is a more feasible test compared with spirometry in children post HSCT. However, in an exploratory analysis, LCI2.5 did not lead to earlier detection of BOS, when compared to spirometry.
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Affiliation(s)
- Nicole Westrupp
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Cassidy Du Berry
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Theresa Cole
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Liam Welsh
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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Betancor D, Barroso B, Valverde-Monge M, Gomez-Lopez A, Sastre J. The discrepancy in bronchodilator response between ATS/ERS 2021 and 1991 criteria. Respir Med 2024; 226:107609. [PMID: 38583814 DOI: 10.1016/j.rmed.2024.107609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Diana Betancor
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Blanca Barroso
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marcela Valverde-Monge
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Alicia Gomez-Lopez
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquin Sastre
- Allergy Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Wongwathanavikrom NB, Tovichien P, Udomittipong K, Palamit A, Tiamduangtawan P, Mahoran K, Charoensittisup P. Incidence and risk factors for long COVID in children with COVID-19 pneumonia. Pediatr Pulmonol 2024; 59:1330-1338. [PMID: 38353350 DOI: 10.1002/ppul.26910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 01/06/2024] [Accepted: 01/31/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND AND OBJECTIVE There are only a few reports of long COVID including pulmonary function in children after COVID-19 pneumonia. We determined the incidence of long COVID and abnormal pulmonary function in those children and identify risk factors. METHODS This cohort study enrolled children admitted with COVID-19 pneumonia during 2021-2022. We gathered clinical characteristics during admission and at follow-up 3 months after. RESULTS We determined the incidence of long COVID at 39.7% (95% confidence interval [CI]: 30.7%-49.1%). All severe pneumonia cases consistently reported persistent symptoms. Exercise intolerance, cough, and fatigue were the three most common persistent symptoms in 26 (22.4%), 21 (18.1%), and 18 (15.5%) of the patients, respectively. At the follow-up, 21 cases (18.1%) demonstrated persistent abnormal chest radiographs. Three cases (6.9%) demonstrated restrictive ventilatory defects. Among those, one case (2.3%) demonstrated concomitant diffusion defect. Three cases (6.0%) demonstrated exercise-induced hypoxemia after the 6-minute walk test. Comparing spirometry variables between children with long COVID and without revealed significant difference of FEF25-75 (z score) between two groups. Age [adjusted OR (95% CI): 1.13 (1.05-1.22), p value 0.002], allergic diseases [adjusted OR (95% CI): 4.05 (1.36-12.06), p value 0.012], and living in polluted areas [adjusted OR (95% CI): 2.73 (1.18-6.33), p value 0.019] were significantly associated with long COVID. CONCLUSION A significant percentage of children developed long COVID after COVID-19 pneumonia. We should give additional attention to those who have exercise intolerance, chronic cough, or fatigue, especially older children, severe cases, children with allergic diseases, and those living in polluted areas.
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Affiliation(s)
- Na-Bhadhra Wongwathanavikrom
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prakarn Tovichien
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokporn Udomittipong
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apinya Palamit
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pinyapach Tiamduangtawan
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khunphon Mahoran
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawinee Charoensittisup
- Department of Pediatrics, Division of Pulmonology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Nopsopon T, Barrett NA, Phipatanakul W, Laidlaw TM, Weiss ST, Akenroye A. Lung function trajectories in a cohort of patients with moderate-to-severe asthma on mepolizumab, omalizumab, or dupilumab. Allergy 2024; 79:1195-1207. [PMID: 38164813 PMCID: PMC11062846 DOI: 10.1111/all.16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Lung function is an independent predictor of mortality. We evaluated the lung function trajectories of a cohort of patients with asthma receiving biologic therapy. METHODS We identified 229 monoclonal antibody-naïve adult patients with moderate-to-severe asthma who initiated omalizumab, mepolizumab, or dupilumab between 2010 and 2022 in a large healthcare system in Boston, MA. Generalized additive mixed models were used to estimate the lung function trajectories during the 156 weeks following biologic initiation. Response was defined as an improvement in FEV1 or a decrease of ≤0.5% per year. The Kaplan-Meier estimator was used to assess time to no additional improvement in FEV1 in responders. All models were adjusted for age, sex, body mass index, smoking status, baseline exacerbation rate, and baseline blood eosinophil count. RESULTS Eighty-eight patients initiated mepolizumab, 76 omalizumab, and 65 dupilumab. Baseline eosinophil count was highest in the mepolizumab group (405 cells/mcL) and lowest for omalizumab (250 cells/mcL). Both FEV1 and FVC improved in the mepolizumab group (FEV1 + 20 mL/year; FVC +43 mL/year). For omalizumab, there was an initial improvement in the first year followed by decline with an overall FEV1 loss of -44 mL/year and FVC -32 mL/year. For dupilumab, both FEV1 (+61 mL/year) and FVC (+74 mL/year) improved over time. Fifty percent of the mepolizumab group, 58% omalizumab, and 72% of dupilumab were responders. The median time to no additional FEV1 improvement in responders was 24 weeks for omalizumab, 48 weeks for mepolizumab, and 57 weeks for dupilumab. CONCLUSION In this clinical cohort, mepolizumab, omalizumab, and dupilumab had beneficial effects on FEV1 and FVC with distinct post-initiation trajectories.
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Affiliation(s)
- Tanawin Nopsopon
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA
| | - Nora A. Barrett
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA
| | | | - Tanya M. Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA
| | - Scott T. Weiss
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
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Lei X, Lu T. Single-cell sequencing reveals lung cell fate evolution initiated by smoking to explore gene predictions of correlative diseases. Toxicol Mech Methods 2024; 34:369-384. [PMID: 38064719 DOI: 10.1080/15376516.2023.2293117] [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: 10/04/2023] [Accepted: 12/02/2023] [Indexed: 01/11/2024]
Abstract
Continuous smoking leads to adaptive regulation and physiological changes in lung tissue and cells, and is an inductive factor for many diseases, making smokers face the risk of malignant and nonmalignant diseases. The impact of research in this area is getting more and more in-depth, but the stimulant effect, mechanism of action and response mechanism of the main cells in the lungs caused by smoke components have not yet been fully elucidated, and the early diagnosis and identification of various diseases induced by smoke toxins have not yet formed a systematic relationship method. In this study, single-cell transcriptome data were generated from three lung samples of smokers and nonsmokers through scRNA-seq technology, revealing the influence of smoking on lung tissue and cells and the changes in immune response. The results show that: through UMAP cell clustering, 16 intermediate cell states of 23 cell clusters of the four main cell types in the lung are revealed, the differences of the main cell groups between smokers and nonsmokers are explained, and the human lung cells are clarified. Components and their marker genes, screen for new marker genes that can be used in the evolution of intermediate-state cells, and at the same time, the analysis of lung cell subgroups reveals the changes in the intermediate state of cells under smoke stimulation, forming a subtype intermediate state cell map. Pseudo-time ordering analysis, to determine the pattern of dynamic processes experienced by cells, differential expression analysis of different branch cells, to clarify the expression rules of cells at different positions, to clarify the evolution process of the intermediate state of cells, and to clarify the response of lung tissue and cells to smoke components mechanism. The development of this study provides new diagnosis and treatment ideas for early disease detection, identification, disease prevention and treatment of patients with smoking-related diseases, and lays a theoretical foundation based on cell and molecular regulation.
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Affiliation(s)
- Xu Lei
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Taiying Lu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Lytzen AA, Helt TW, Christensen J, Lund TK, Kalhauge A, Rönsholt FF, Podlekavera D, Arndal E, Lebech A, Hanel B, Katzenstein TL, Berg RMG, Mortensen J. Pulmonary diffusing capacity for carbon monoxide and nitric oxide after COVID-19: A prospective cohort study (the SECURe study). Exp Physiol 2024; 109:652-661. [PMID: 38532277 PMCID: PMC11061629 DOI: 10.1113/ep091757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
Many patients exhibit persistently reduced pulmonary diffusing capacity after coronavirus disease 2019 (COVID-19). In this study, dual test gas diffusing capacity for carbon monoxide and nitric oxide (DL,CO,NO) metrics and their relationship to disease severity and physical performance were examined in patients who previously had COVID-19. An initial cohort of 148 patients diagnosed with COVID-19 of all severities between March 2020 and March 2021 had a DL,CO,NO measurement performed using the single-breath method at 5.7 months follow-up. All patients with at least one abnormal DL,CO,NO metric (n = 87) were revaluated at 12.5 months follow-up. The DL,CO,NO was used to provide the pulmonary diffusing capacity for nitric oxide (DL,NO), the pulmonary diffusing capacity for carbon monoxide (DL,CO,5s), the alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume. At both 5.7 and 12.5 months, physical performance was assessed using a 30 s sit-to-stand test and the 6 min walk test. Approximately 60% of patients exhibited a severity-dependent decline in at least one DL,CO,NO metric at 5.7 months follow-up. At 12.5 months, both DL,NO and DL,CO,5s had returned towards normal but still remained abnormal in two-thirds of the patients. Concurrently, improvements in physical performance were observed, but with no apparent relationship to any DL,CO,NO metric. The severity-dependent decline in DL,NO and DL,CO observed at 5.7 months after COVID-19 appears to be reduced consistently at 12.5 months follow-up in the majority of patients, despite marked improvements in physical performance.
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Affiliation(s)
- Anna Agnes Lytzen
- Centre for Physical Activity ResearchCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Thora Wesenberg Helt
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Jan Christensen
- Department of Occupational Therapy and PhysiotherapyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Thomas Kromann Lund
- Department of Cardiology, Section for Lung TransplantationCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Anna Kalhauge
- Department of RadiologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | | | - Daria Podlekavera
- Department of Respiratory Medicine and Infectious DiseasesCopenhagen University Hospital—Bispebjerg HospitalCopenhagenDenmark
| | - Elisabeth Arndal
- Department of OtorhinolaryngologyCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Anne‐Mette Lebech
- Department of Infectious DiseasesCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Birgitte Hanel
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Terese L. Katzenstein
- Department of Infectious DiseasesCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
| | - Ronan M. G. Berg
- Centre for Physical Activity ResearchCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of Biomedical Sciences, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Neurovascular Research Laboratory, Faculty of Life Sciences and EducationUniversity of South WalesPontypriddUK
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear MedicineCopenhagen University Hospital—RigshospitaletCopenhagenDenmark
- Department of MedicineThe National HospitalTorshavnFaroe Islands
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
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Glover NA, Ivanova O, Sathar F, Riess F, Shambhu RR, Mekota AM, Zurba L, Menezes C, Alexandra van Blydenstein S, Kalla I, Hoelscher M, Saathoff E, Charalambous S, Rachow A. Lung outcomes and related risk factors in patients after SARS-CoV-2 infection: a hospitalised single-centre cohort from Johannesburg, South Africa. EClinicalMedicine 2024; 71:102588. [PMID: 38623400 PMCID: PMC11016864 DOI: 10.1016/j.eclinm.2024.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Background Sequelae post-SARS-CoV-2 infection, including lung and functional impairment, pose a significant challenge post-recovery. We explored the burden and risk factors for post-COVID-19 sequelae in an African population with prevalent comorbidities including tuberculosis (TB) and HIV. Methods We conducted an observational cohort study on hospitalised adults with confirmed SARS-CoV-2 infection from 20 March to 06 October 2021 at Chris Hani Baragwanath Academic Hospital, South Africa. We collected data on comorbidities, and COVID-19 severity using the World Health Organization (WHO) clinical progression scale. Prospectively, we followed up all participants within 40-days post-discharge to assess body mass index (BMI), COVID-19 symptoms and quality of life using St George's Respiratory Questionnaire (SGRQ), 6-min walking-test (6MWT), and spirometry. A subsequent in-depth visit assessed plethysmography, diffusing capacity for the lung for carbon monoxide (DLCO), and high-resolution chest-CT. Findings We followed up 111 participants, where 65.8% were female, median age 50.5 years, and predominantly black-African (92.8%). Relevant comorbidities included TB disease (18.9%) and HIV infection (36%). SGRQ total scores were elevated in 78.9%, median 6MWT distance was reduced at 300 m (IQR 210-400), and nearly half (49.5%) exhibited spirometry findings below the lower limit of normal (LLN). In-depth pulmonary assessment for 61 participants revealed abnormalities in total lung capacity (31.6% <80% predicted), DLCO (53.4% <80% predicted), and chest-CT (86.7% abnormal). Significant risk factors for individual abnormal outcomes, adjusted for age and sex, were TB disease, HIV with CD4 <200 cells/mm3, BMI <18.5 kg/m2 and >35 kg/m2, and initial COVID-19 severity. Interpretation This study demonstrates substantial lung and functional morbidity within the first weeks post-COVID-19, particularly in individuals with pre-existing comorbidities including TB, HIV, and low or high BMI. Chest-CT and DLCO show best early potential at reflecting COVID-19-related pathologies. Funding The Bavarian State Ministry of Science and Arts.
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Affiliation(s)
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | | | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | - Rekha Rao Shambhu
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | - Anna-Maria Mekota
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | | | - Colin Menezes
- University of the Witwatersrand, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Sarah Alexandra van Blydenstein
- University of the Witwatersrand, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Ismail Kalla
- University of the Witwatersrand, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany
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Gray DM, Githinji L, Brittain K, Franckling-Smith Z, Bateman L, Prins M, Baard CB, McFarlane D, Nicol MP, Workman L, Zar HJ. Lung function trajectories in South African children with pulmonary tuberculosis compared to those with non-TB lower respiratory tract infection: a prospective study. Eur Respir J 2024; 63:2400216. [PMID: 38782467 DOI: 10.1183/13993003.00216-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/05/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Joint first authors
| | - Leah Githinji
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Joint first authors
| | - Kirsty Brittain
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Zoe Franckling-Smith
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lindy Bateman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Margaretha Prins
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Cynthia B Baard
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - David McFarlane
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Mark P Nicol
- Marshall Centre for Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Lesley Workman
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and the SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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47
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Jankovic J, Milenkovic B, Simic A, Skrobic O, Valipour A, Ivanovic N, Buha I, Milin-Lazovic J, Djurdjevic N, Jandric A, Colic N, Stojkovic S, Stjepanovic M. Influence of Achalasia on the Spirometry Flow-Volume Curve and Peak Expiratory Flow. Diagnostics (Basel) 2024; 14:933. [PMID: 38732346 PMCID: PMC11083519 DOI: 10.3390/diagnostics14090933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Achalasia is an esophageal motor disorder characterized by aperistalsis and the failure of the relaxation of the lower esophageal sphincter. We want to find out whether external compression or recurrent micro-aspiration of undigested food has a functional effect on the airway. METHODS The aim of this research was to analyze the influence of achalasia on the peak expiratory flow and flow-volume curve. All of the 110 patients performed spirometry. RESULTS The mean diameter of the esophagus was 5.4 ± 2.1 cm, and nine of the patients had mega-esophagus. Seven patients had a plateau in the inspiratory part of the flow-volume curve, which coincides with the patients who had mega-esophagus. The rest of the patients had a plateau in the expiration part of the curve. The existence of a plateau in the diameter of the esophagus of more than 5 cm was significant (p 0.003). Statistical significance between the existence of a plateau and a lowered PEF (PEF < 80) has been proven (p 0.001). Also, a statistical significance between the subtype and diameter of more than 4 cm has been proved. There was no significant improvement in the PEF values after operation. In total, 20.9% of patients had a spirometry abnormality finding. The frequency of the improvement in the spirometry values after surgery did not differ significantly by achalasia subtype. The improvement in FEV1 was statistically significant compared to the FVC values. CONCLUSIONS Awareness of the influence of achalasia on the pulmonary parameters is important because low values of PEF with a plateau on the spirometry loop can lead to misdiagnosis. The recognition of various patterns of the spirometry loop may help in identifying airway obstruction caused by another non-pulmonary disease such as achalasia.
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Affiliation(s)
- Jelena Jankovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Branislava Milenkovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Aleksandar Simic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Ognjan Skrobic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Arschang Valipour
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Health Care Group, 1210 Vienna, Austria;
| | - Nenad Ivanovic
- Clinic for Digestive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Ivana Buha
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Jelena Milin-Lazovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Institute for Medical Statistics and Informatics, University of Belgrade, 11000 Belgrade, Serbia
| | - Natasa Djurdjevic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
| | - Aleksandar Jandric
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
| | - Nikola Colic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Stefan Stojkovic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Mihailo Stjepanovic
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.J.); (B.M.); (I.B.); (N.D.); (A.J.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia; (A.S.); (O.S.); (J.M.-L.); (N.C.)
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Perrotta F, D'Agnano V, Mariniello DF, Castaldo G, Vitale M, Cazzola M, Bianco A, Scialò F. Potential role of SIRT-1 and SIRT-3 as biomarkers for the diagnosis and prognosis of idiopathic pulmonary fibrosis. Respir Res 2024; 25:189. [PMID: 38678247 PMCID: PMC11056041 DOI: 10.1186/s12931-024-02796-0] [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: 03/08/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a debilitating and progressive lung disease of unknown aetiology, characterized by the relentless deposition of fibrotic tissue. Biomarkers may play a pivotal role as indicators of disease presence, progression, and treatment response. Sirtuins, a family of enzymes with ADP ribosyltransferase or deacetylase activity, have been implicated in several diseases, including pulmonary fibrosis. METHODS A cross-sectional, prospective, observational single-center study was conducted to investigate the potential role of serum SIRTs levels as biomarkers in patients with IPF. Demographic, clinical, and functional data and serological samples were collected from 34 patients with IPF followed at the Interstital Lung and Rare Diseases Outpatient Clinic of the Vanvitelli Pneumology Clinic, Monaldi Hospital, Naples, Italy and from 19 age-matched controls. RESULTS Serum SIRT-1 levels were significantly reduced in IPF patients compared to controls (median IPF 667 [435-858] pg/mL versus controls 925 [794-1173] pg/mL; p < 0.001 ). In contrast, serum SIRT-3 levels were significantly increased in IPF patients compared to controls (median IPF 338 [230-500] pg/mL versus controls 154 [99.8-246] pg/mL; p < 0.001). There were no statistically significant differences in serum SIRT-6 and SIRT-7 levels between IPF and controls. In addition, we found a significant positive correlation between SIRT-1 and lung function parameters such as FEV1% (ϱ=0.417;p = 0.016), FVC% (ϱ=0.449;p = 0.009) and DLCO% (ϱ=0.393;p = 0.024), while a significant negative correlation was demonstrated between SIR-1 and GAP score, demonstrating a significant reduction in SIRT-1 in advanced Gender-Age-Physiology (GAP) stages 2-3 compared to GAP stage 1 (p = 0.008). CONCLUSIONS This prospective, cross-sectional study showed that SIRT-1 was associated with lung function and IPF severity and that both SIRT-1 and SIRT-3 could be considered as potential biomarkers of IPF, whereas SIRT-6 and SIRT-7 were not associated with IPF.
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Affiliation(s)
- Fabio Perrotta
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy.
- U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, Naples, Italy.
| | - Vito D'Agnano
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, Naples, Italy
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples "Federico II", Naples, Italy
| | - Maria Vitale
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Naples, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- U.O.C. Clinica Pneumologica L. Vanvitelli, A.O. dei Colli, Monaldi Hospital, Naples, Italy
| | - Filippo Scialò
- Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Naples, Italy
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49
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Zhao Y, Zhao S, Lu J, Dong R, Wang Q, Song G, Hu Y. The status and influencing factors of lung ventilation function in employees exposed to dust in enterprises of the XPCC, China. Front Public Health 2024; 12:1370765. [PMID: 38737857 PMCID: PMC11082291 DOI: 10.3389/fpubh.2024.1370765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/01/2024] [Indexed: 05/14/2024] Open
Abstract
Background Occupational health is closely related to harmful factors in the workplace. Dust is the primary contributing factor causing impaired lung ventilation function among employees with dust exposure, and their lung ventilation function may also be influenced by other factors. We aimed at assessing the status and influencing factors of lung ventilation function among employees exposed to dust in the enterprises of the Eighth Division located in the Xinjiang Production and Construction Corps (XPCC), China. Methods Employees exposed to dust in enterprises of the Eighth Division located in the XPCC in 2023 were selected as the subjects of this cross-sectional study. Their lung ventilation function indicators were extracted from health examination records, and an on-site electronic questionnaire survey was conducted among them. Binary logistic regression analyses were conducted to evaluate the factors influencing lung ventilation function. Results According to the fixed value criteria, the abnormal rates of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were 31.6, 1.4, and 0.4%, respectively. The lower limit of normal (LLN) criteria could overestimate the rate of abnormal lung ventilation function. Several factors were related to impaired lung ventilation function, including gender, age, education level, marital status, body mass index (BMI), smoking status, physical activity, the type of dust, industry, enterprise scale, occupation, length of service, working shift, monthly income, and respiratory protection. Conclusions A relatively low abnormal rate of lung ventilation function was observed among employees exposed to dust in enterprises of the Eighth Division, XPCC, and their lung ventilation function was associated with various factors. Effective measures should be taken urgently to reduce the effects of adverse factors on lung ventilation function, thereby further protecting the health of the occupational population.
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50
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Ruiz-Rull C, Jaén-Moreno MJ, del Pozo GI, Gómez C, Montiel FJ, Alcántara M, Carrión L, Chauca GM, Feu N, Guler I, Rico-Villademoros F, Camacho-Rodríguez C, Gutierrez-Rojas L, Mannino D, Sarramea F. Low lung function in Bipolar Disorder and Schizophrenia: a hidden risk. Front Physiol 2024; 15:1335798. [PMID: 38737830 PMCID: PMC11084671 DOI: 10.3389/fphys.2024.1335798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/15/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction: People with serious mental illness (SMI), such as schizophrenia and bipolar disorder, have a higher risk of premature morbidity and mortality. In the general population, impaired lung function is associated with increased morbidity and mortality. We compared lung function between people with and without serious mental illnesses using a cross-sectional study in 9 community mental health units. Methods: Subjects aged 40-70 years with a diagnosis of schizophrenia or bipolar disorder were recruited consecutively. The controls had no psychiatric diagnosis and were not receiving any psychotropics. Spirometry was performed by a trained nurse. We used the 2021 American Thoracic Society/European Respiratory Society standards for the interpretation of the spirometry results. Results: We studied 287 subjects. People with SMI (n = 169) had lower spirometry values than those without a psychiatric diagnosis (n = 118). An abnormal spirometry pattern (36.1% vs 16.9%, p < 0.001), possible restriction or non-specific (Preserved Ratio Impaired Spirometry [PRISm]) pattern (17.8% vs 7.6%, p = 0.014), and pattern of airflow obstruction or possible mixed disorder (18.3% vs 9.3%, p = 0.033) were more frequent in people with SMI. Multivariate analyses showed that the PRISm pattern was associated with abdominal circumference (odds ratio [OR] 1.05, 95%CI 1.03-1.08) and that the pattern of airflow obstruction or possible mixed disorder was associated with smoking behavior (OR 5.15, 95%CI 2.06-15.7). Conclusion: People with SMI have impaired lung function, with up to one-third of them showing an abnormal spirometry pattern. This suggests that regular monitoring of lung function and addressing modifiable risk factors, such as tobacco use and obesity, in this population is of paramount importance.
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Affiliation(s)
- Cristina Ruiz-Rull
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Centro de Salud Cruz de Caravaca, Almería, Spain
| | - María José Jaén-Moreno
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Ciencias Morfológicas y Sociosanitarias, Universidad de Córdoba, Córdoba, Spain
| | - Gloria Isabel del Pozo
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Cristina Gómez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, Jaen, Spain
| | - Francisco Javier Montiel
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Complejo Hospitalario de Jaén, Jaen, Spain
| | - Montserrat Alcántara
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Laura Carrión
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Geli Marie Chauca
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Infanta Margarita, Cabra, Spain
| | - Nuria Feu
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Ipek Guler
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Área de Gestión de la Investigación, Córdoba, Spain
| | | | | | - Luis Gutierrez-Rojas
- Instituto de Neurociencias, Universidad de Granada, Granada, Spain
- Departamento de Psiquiatria, Universidad de Granada, Granada, Spain
| | - David Mannino
- University of Kentucky, Chief Medical Officer, COPD Foundation, Lexington, KY, United States
| | - Fernando Sarramea
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Departamento de Ciencias Morfológicas y Sociosanitarias, Universidad de Córdoba, Córdoba, Spain
- Unidad de Gestión Clínica de Salud Mental, Hospital Universitario Reina Sofía, Córdoba, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain
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