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Gaboli M, López Lobato M, Valverde Fernández J, Ferrand Ferri P, Rubio Pérez E, Andrade Ruiz HA, López-Puerta González JM, Madruga-Garrido M. Effect of Nusinersen on Respiratory and Bulbar Function in Children with Spinal Muscular Atrophy: Real-World Experience from a Single Center. Neuropediatrics 2024. [PMID: 39102865 DOI: 10.1055/a-2379-7069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
BACKGROUND Due to the limited data from clinical trials and real-world settings in the realm of nusinersen, there is a need for further evidence. This study seeks to assess the impact of nusinersen, when combined with standard care, on bulbar function, respiratory function, and the necessity for respiratory support among pediatric patients with spinal muscular atrophy (SMA). METHODS Prospective observational study, involving pediatric SMA patients (Types 1-3) undergoing nusinersen treatment at the Hospital Universitario Virgen del Rocío in Spain over at least 24 months. The cohort included 11 SMA type 1 patients, comprising 6 type 1b and 5 type 1c, 12 SMA type 2 patients, and 5 SMA type 3 patients. RESULTS Twenty-eight pediatric patients were enrolled with the majority being male (n = 20). Patients with type 1 were diagnosed and received treatment significantly earlier than those with types 2 and 3 (p < 0.001). Additionally, there was a longer period between diagnosis and the start of treatment in types 2 and 3 (p = 0.002). Follow-up revealed statistically improved functional and respiratory outcomes associated with earlier initiation of nusinersen treatment at 6, 12, and 24 months in all phenotypes. The ability to swallow and feed correctly remained unchanged throughout the study, with SMA type 1c patients maintaining oral feeding in contrast to patients with SMA type 1b. Notably, no deaths were recorded. CONCLUSIONS This study provides important insights into the real-world clinical progress of pediatric SMA patients and their response to nusinersen treatment, highlighting the significance of early intervention for better functional and respiratory outcomes.
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Affiliation(s)
- Mirella Gaboli
- Paediatric Pulmonology Unit, Department of Paediatrics, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Mercedes López Lobato
- Paediatric Neurology Unit, Department of Paediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Justo Valverde Fernández
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Department of Paediatrics, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Patricia Ferrand Ferri
- Paediatric Physical Medicine and Rehabilitation Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eloisa Rubio Pérez
- Methodological and Statistical Management Unit, Fundación para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Henry A Andrade Ruiz
- Methodological and Statistical Management Unit, Fundación para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - José María López-Puerta González
- Spine Surgery, Department of Orthopaedic Surgery and Traumatology, Universitary Hospital Virgen del Rocío, Networking Biomedical Research Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Sevilla, Spain
| | - Marcos Madruga-Garrido
- Neurología Pediátrica, Hospital Viamed Santa Angela de la Cruz and Neurolinkia, Sevilla, Spain
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Sönnerfors P, Jacobson PK, Andersson A, Behndig A, Bjermer L, Blomberg A, Blomqvist H, Erjefält J, Friberg M, Lamberg Lundström K, Lundborg A, Malinovschi A, Persson HL, Tufvesson E, Wheelock Å, Janson C, Sköld CM. The challenges of recruiting never-smokers with chronic obstructive pulmonary disease from the large population-based Swedish CArdiopulmonary bioImage study (SCAPIS) cohort. Eur Clin Respir J 2024; 11:2372903. [PMID: 39015382 PMCID: PMC11251440 DOI: 10.1080/20018525.2024.2372903] [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: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/18/2024] Open
Abstract
Background A substantial proportion of individuals with COPD have never smoked, and it is implied to be more common than previously anticipated but poorly studied. Aim To describe the process of recruitment of never-smokers with COPD from a population-based cohort (n = 30 154). Methods We recruited never-smokers with COPD, aged 50-75 years, from six University Hospitals, based on: 1) post broncho-dilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) < 0.70 and 2) FEV1 50-100% of predicted value and 3) being never-smokers (self-reported). In total 862 SCAPIS participants were identified, of which 652 were reachable and agreed to a first screening by telephone. Altogether 128 (20%) were excluded due to previous smoking or declined participation. We also applied a lower limit of normal (LLN) of FEV1/FVC (z-score<-1.64) according to the Global Lung Initiative to ensure a stricter definition of airflow obstruction. Results Data on respiratory symptoms, health status, and medical history were collected from 492 individuals, since 32 were excluded at a second data review (declined or previous smoking), prior to the first visit. Due to not matching the required lung function criteria at a second spirometry, an additional 334 (68%) were excluded. These exclusions were by reason of: FEV1/FVC ≥0.7 (49%), FEV1 > 100% of predicted (26%) or z-score ≥ -1,64 (24%). Finally, 154 never-smokers with COPD were included: 56 (36%) women, (mean) age 60 years, FEV1 84% of predicted, FEV1/FVC: 0.6, z-score: -2.2, Oxygen saturation: 97% and BMI: 26.8 kg/m2. Conclusions The challenges of a recruitment process of never-smokers with COPD were shown, including the importance of correct spirometry testing and strict inclusion criteria. Our findings highlight the importance of repeated spirometry assessments for improved accuracy in diagnosing COPD.
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Affiliation(s)
- Pernilla Sönnerfors
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Women´s Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petra Kristina Jacobson
- Department of Respiratory Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Andersson
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- COPD Center Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Anders Blomberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Heléne Blomqvist
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Erjefält
- Unit of Airway inflammation, Department of Experimental Medicine Sciences, Lund University, Lund, Sweden
| | - Maria Friberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kristina Lamberg Lundström
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anna Lundborg
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Hans Lennart Persson
- Department of Respiratory Medicine in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences, Respiratory medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Åsa Wheelock
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Carl Magnus Sköld
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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3
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Zhou GY, Cerrone D, Lewinter K, Masood I, Detterich J, Singh S, Shah P, Keens T, Sabati A, Kato R. The prevalence of abnormal spirometry in children with CHD. Cardiol Young 2023; 33:2548-2552. [PMID: 36999369 DOI: 10.1017/s1047951123000550] [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] [Indexed: 04/01/2023]
Abstract
BACKGROUND The burden of pulmonary disease in children with CHD remains under-recognised. Studies have examined children with single ventricle and two ventricle heart disease and documented a decreased forced vital capacity. Our study sought to further explore the pulmonary function of children with CHD. METHODS A retrospective review was performed of spirometry in CHD patients over a 3-year period. Spirometry data were corrected for size, age, and gender and analysed using z-scores. RESULTS The spirometry of 260 patients was analysed. About 31% had single ventricle (n = 80, 13.6 years (interquartile range 11.5-16.8)) and 69% had two ventricle circulation (n = 180, 14.4 years (interquartile range 12.0-17.3)). Single ventricle patients were found to have a lower median forced vital capacity z-score compared to two ventricle patients (p = 0.0133). The prevalence of an abnormal forced vital capacity was 41% in single ventricle patients and 29% in two ventricle patients. Two ventricle patients with tetralogy of Fallot and truncus arteriosus had similar low forced vital capacity comparable to single ventricle patients. The number of cardiac surgeries predicted an abnormal forced vital capacity in two ventricle patients except tetralogy of Fallot patients. CONCLUSION Pulmonary morbidity in patients with CHD is common with a decreased forced vital capacity noted in single ventricle and two ventricle patients. Forced vital capacity is lower in patients with single ventricle circulation; however, two ventricle patients with tetralogy of Fallot or truncus arteriosus have similar lung function in comparison to the single ventricle group. The number of surgical interventions was predictive of forced vital capacity z-score in some but not all two ventricle patients and not predictive in single ventricle patients suggesting a multifactorial to pulmonary disease in children with CHD.
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Affiliation(s)
- Geena Y Zhou
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Daniel Cerrone
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Katherine Lewinter
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Imran Masood
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sasha Singh
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Payal Shah
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Thomas Keens
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Arash Sabati
- Division of Cardiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Roberta Kato
- Division of Pediatric Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Guerreiro I, Bringard A, Nehme M, Guessous I, Benzakour L, Juillet De Saint Lager-Lucas A, Taboni A, Lador F. Exercise ventilatory response after COVID-19: comparison between ambulatory and hospitalized patients. Am J Physiol Lung Cell Mol Physiol 2023; 325:L756-L764. [PMID: 37874657 PMCID: PMC11068391 DOI: 10.1152/ajplung.00142.2023] [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: 05/01/2023] [Revised: 07/30/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023] Open
Abstract
Inefficient ventilatory response during cardiopulmonary exercise testing (CPET) has been suggested as a cause of post-COVID-19 dyspnea. It has been described in hospitalized patients (HOSP) with lung parenchymal sequelae but also after mild infection in ambulatory patients (AMBU). We hypothesize that AMBU and HOSP have different ventilatory responses to exercise, due to different etiologies. We analyzed CPET realized between July 2020 and May 2022 of patients with persisting respiratory symptoms 3 mo after COVID-19. Chest computed tomography (CT) scan, pulmonary function tests, quality of life, and respiratory questionnaires were collected. CPET data were specifically explored as a function of ventilation (V̇e) and time. Seventy-nine consecutive patients were included (42 AMBU and 37 HOSP, median: 54 [44-60] yr old, 57% female). Patients were hospitalized for a median of 20 [8-34] days, with pneumonia (41%) or acute respiratory distress syndrome (ARDS; 30%). Among HOSP, 12(32%) patients had abnormal values for spirometry and 18(51%) for carbon monoxide diffusing capacity (P < 0.001). CPET showed no differences between AMBU and HOSP in peak absolute O2 uptake (V̇o2) (1.59 [1.22-2.11] mL·min-1; P = 0.65). Tidal volume (VT) as a function of V̇e, was lower in AMBU than in HOSP (P < 0.01) toward the end of exercise. The slope of the V̇e-CO2 production was higher than normal in both groups (30.9 [26.1-34.3]; P = 0.96). In conclusion, the severity of COVID-19 did not influence the exercise capacity, but AMBU demonstrated a less efficient ventilatory response to exercise as compared with HOSP. CPET with exploration of data as a function of V̇e and throughout the exercise better unveil ventilatory inefficiency.NEW & NOTEWORTHY We evaluated the exercise ventilatory response in patients with persisting dyspnea after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We found that despite similar peak power and peak absolute O2 uptake, tidal volume as a function of ventilation was lower in ambulatory than in hospitalized patients toward the end of exercise, reflecting ventilatory inefficiency. We call for evaluation of minute ventilation with the exploration of data throughout the exercise and not only peak data to better unveil ventilatory inefficiency.
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Affiliation(s)
- Ivan Guerreiro
- Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Aurélien Bringard
- Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mayssam Nehme
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Lamyae Benzakour
- Liaison Psychiatry and Crisis Intervention Service, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | | | - Anna Taboni
- Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Lador
- Division of Pneumology, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Smith EF, Bradshaw TK, Urs RC, Evans DJ, Hemy NR, Hall GL, Wilson AC, Simpson SJ. Oscillometry and spirometry are not interchangeable when assessing the bronchodilator response in children and young adults born preterm. Pediatr Pulmonol 2023; 58:3122-3132. [PMID: 37539845 PMCID: PMC10947568 DOI: 10.1002/ppul.26632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The European Respiratory Society Oscillometry Taskforce identified that clinical correlates of bronchodilator responses are needed to advance oscillometry in clinical practice. The understanding of bronchodilator-induced oscillometry changes in preterm lung disease is poor. Here we describe a comparison of bronchodilator assessments performed using oscillometry and spirometry in a population born very preterm and explore the relationship between bronchodilator-induced changes in respiratory function and clinical outcomes. METHODS Participants aged 6-23 born ≤32 (N = 288; 132 with bronchopulmonary dysplasia) and ≥37 weeks' gestation (N = 76, term-born controls) performed spirometry and oscillometry. A significant bronchodilator response (BDR) to 400 μg salbutamol was classified according to published criteria. RESULTS A BDR was identified in 30.9% (n = 85) of preterm-born individuals via spirometry and/or oscillometry, with poor agreement between spirometry and oscillometry definitions (k = 0.26; 95% confidence interval [CI] 0.18-0.40, p < .001). Those born preterm with a BDR by oscillometry but not spirometry had increased wheeze (33% vs. 11%, p = .010) and baseline resistance (Rrs5 z-score mean difference (MD) = 0.86, 95% CI 0.07-1.65, p = .025), but similar baseline spirometry to the group without a BDR (forced expiratory volume in 1 s [FEV1 ] z-score MD = -0.01, 95% CI -0.66 to 0.68, p > .999). Oscillometry was more feasible than spirometry (95% success rate vs. 85% (FEV1 ), 69% (forced vital capacity) success rate, p < .001), however being born preterm did not affect test feasibility. CONCLUSION In the preterm population, oscillometry is a feasible and clinically useful supportive test to assess the airway response to inhaled salbutamol. Changes measured by oscillometry reflect related but distinct physiological changes to those measured by spirometry, and thus these tests should not be used interchangeably.
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Affiliation(s)
- Elizabeth F. Smith
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Tiffany K. Bradshaw
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Rhea C. Urs
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Denby J. Evans
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Naomi R. Hemy
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
| | - Graham L. Hall
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
| | - Andrew C. Wilson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
- Child and Adolescent Health ServicePerth Children's HospitalNedlandsAustralia
| | - Shannon J. Simpson
- Wal‐Yan Respiratory Research Centre, Telethon Kids InstitutePerth Children's HospitalNedlandsAustralia
- Curtin School of Allied HealthFaculty of Health SciencesBentleyAustralia
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Gochicoa-Rangel L, Martínez-Briseño D, Guerrero-Zúñiga S, Contreras-Morales J, Arias-Jiménez D, Del-Río-Hidalgo R, Hernández-Rocha FI, Ceballos-Zúñiga CO, Silva-Cerón M, Mora-Romero UDJ, Torre-Bouscoulet L, Fernández-Plata R, Pérez-Nieto JE, Vargas MH. Reference equations using segmented regressions for impulse oscillometry in healthy subjects aged 2.7-90 years. ERJ Open Res 2023; 9:00503-2023. [PMID: 38111542 PMCID: PMC10726221 DOI: 10.1183/23120541.00503-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/30/2023] [Indexed: 12/20/2023] Open
Abstract
Background Published reference equations for impulse oscillometry (IOS) usually encompass a specific age group but not the entire lifespan. This may lead to discordant predicted values when two or more non-coincident equations can be applied to the same person, or when a person moves from one equation to the next non-convergent equation as he or she gets older. Thus, our aim was to provide a single reference equation for each IOS variable that could be applied from infancy to old age. Methods This was an ambispective cross-sectional study in healthy nonsmokers, most of whom lived in Mexico City, who underwent IOS according to international standards. A multivariate piecewise linear regression, also known as segmented regression, was used to obtain reference equations for each IOS variable. Results In a population of 830 subjects (54.0% female) aged 2.7 to 90 years (54.8% children ≤12 years), segmented regression estimated two breakpoints for age in almost all IOS variables, except for R5-R20 in which only one breakpoint was detected. With this approach, multivariate regressions including sex, age, height and body mass index as independent variables were constructed, and coefficients for calculating predicted value, lower and upper limits of normal, percentage of predicted and z-score were obtained. Conclusions Our study provides IOS reference equations that include the major determinants of lung function, i.e. sex, age, height and body mass index, that can be easily implemented for subjects of almost any age.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- Pulmonary Function Test Laboratory, Institute for Development and Innovation in Respiratory Physiology (INFIRE), Mexico City, Mexico
- These authors contributed equally
| | - David Martínez-Briseño
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- These authors contributed equally
| | - Selene Guerrero-Zúñiga
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Dulce Arias-Jiménez
- Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Pachuca, Mexico
| | | | | | | | - Mónica Silva-Cerón
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Luis Torre-Bouscoulet
- Pulmonary Function Test Laboratory, Institute for Development and Innovation in Respiratory Physiology (INFIRE), Mexico City, Mexico
| | | | | | - Mario H. Vargas
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Schiffers C, Mraz T, Breyer MK, Hartl S, Breyer-Kohansal R, Wouters EFM. Restrictive Spirometry or PRISm: Does it Matter? Am J Respir Crit Care Med 2023; 208:905-907. [PMID: 37586047 DOI: 10.1164/rccm.202304-0765le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023] Open
Affiliation(s)
| | - Tobias Mraz
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, and
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, and
| | - Sylvia Hartl
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, and
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria; and
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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8
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Sandvik RM, Schmidt MN, Voldby CM, Buchvald FF, Olesen HV, Olsen J, Kragh MV, Rubak SL, Pressler T, Robinson PD, Gustafsson PM, Skov M, Nielsen KG. Nationwide lung function monitoring from infancy in newborn-screened children with cystic fibrosis. ERJ Open Res 2023; 9:00317-2023. [PMID: 37908398 PMCID: PMC10613974 DOI: 10.1183/23120541.00317-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/01/2023] [Indexed: 11/02/2023] Open
Abstract
Background Cystic fibrosis (CF) lung disease starts in infancy and can be assessed for structural lung abnormalities using computed tomography or magnetic resonance scans, or for lung function impairment using multiple breath washout (MBW). However, in infancy these two methods are not well correlated. Trajectories of CF lung disease assessed by MBW in infants and toddlers remain poorly described, which is why we aimed to 1) describe the trajectory of lung function, 2) explore risk factors for progression and 3) explore the real-life effect of lumacaftor/ivacaftor. Methods This was a nationwide observational cohort study (2018-2021) using data collected as part of the routine clinical surveillance programme (including MBW and monthly endo-laryngeal suction sampling for bacterial pathogens) in children born after implementation of newborn screening for CF (May 2016). Lumacaftor/ivacaftor commenced from age 2 years in children homozygous for F508del. Ventilation distribution efficiency (VDE), recently described to have advantages over lung clearance index (LCI), was reported as the primary MBW outcome after z-score calculations based on published reference data. Mixed effect linear regression models were the main statistical analyses performed in this study. Results 59 children, aged 2-45 months, contributed with 211 MBW occasions (median (interquartile range (IQR)) 3 (2-5) MBW occasions per child) with a median (IQR) follow-up time of 10.8 (5.2-22.3) months. An overall mean annual deterioration rate of -0.50 (95% CI -0.78- -0.22) z-VDE was observed, starting from an estimated mean z-VDE of -1.68 (95% CI -2.15- -1.22) at age 0.0 years (intercept). Pseudomonas aeruginosa "ever" (n=14, MBWs 50) had a significantly worse z-VDE trajectory versus P. aeruginosa "never" (mean difference 0.53 (95% CI 0.16-0.89) per year; p=0.0047) and lumacaftor/ivacaftor treatment (n=22, MBWs 46) significantly improved the trajectory of z-VDE (mean difference 1.72 (95% CI 0.79-2.66) per year; p=0.0004), leading to a stable mean z-VDE trajectory after start of treatment. Conclusions Infants and toddlers with CF demonstrated progressive deterioration in z-VDE over the first years of life. P. aeruginosa isolation "ever" was associated with an accelerated deterioration in lung function, while lumacaftor/ivacaftor therapy significantly improved and stabilised the trajectory.
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Affiliation(s)
- Rikke M. Sandvik
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Marika N. Schmidt
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Christian M. Voldby
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Frederik F. Buchvald
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Hanne V. Olesen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, CF Centre Aarhus, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus, Denmark
| | - Jørgen Olsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, CF Centre Aarhus, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus, Denmark
| | - Maja V. Kragh
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Sune L.M. Rubak
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, CF Centre Aarhus, Danish Centre of Paediatric Pulmonology and Allergology, Aarhus, Denmark
| | - Tacjana Pressler
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Paul D. Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, Australia
- Airway Physiology and Imaging Group, The Woolcock Medical Research Institute, Sydney, Australia
| | - Per M. Gustafsson
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Children and Young Persons – Medical Clinic, Skaraborg Hospital, Skövde, Sweden
| | - Marianne Skov
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
| | - Kim G. Nielsen
- Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Danish PCD and chILD Centre, CF Centre Copenhagen, Paediatric Pulmonary Service, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Shigdel R, Johannessen A, Lin H, Peddada S, Gómez Real F, Ringel-Kulka T, Svanes C, Bertelsen RJ. Oral bacterial composition associated with lung function and lung inflammation in a community-based Norwegian population. Respir Res 2023; 24:183. [PMID: 37438766 DOI: 10.1186/s12931-023-02491-6] [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: 06/25/2022] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND The oral cavity is the gateway to the bacteria community in the lung. Disruption of the symbiotic balance of the oral microbiota has been associated with respiratory diseases. However, little is known about the relationship between oral bacteria and respiratory outcomes in the general population. We aimed to describe the associations between oral bacteria, lung function, and lung inflammation in a community-based population. METHODS Oral (gingival) samples were collected concurrently with spirometry tests in 477 adults (47% males, median age 28 years) from the RHINESSA study in Bergen, Norway. Bacterial DNA from the 16S rRNA gene from gingival fluid were sequenced by Illumina®MiSeq. Lung function was measured using spirometry and measurement of fractional exhaled nitric oxide (FeNO) were performed to examine airway inflammation. Differential abundance analysis was performed using ANCOM-BC, adjusting for weight, education, and smoking. RESULTS The abundance of the genera Clostridiales, Achromobacter, Moraxella, Flavitalea and Helicobacter were significantly different among those with low FEV1 (< lower limit of normal (LLN)) as compared to normal FEV1 i.e. ≥ LLN. Twenty-three genera differed in abundance between among those with low FVC < LLN as compared to normal FEV1 ≥ LLN. The abundance of 27 genera from phyla Actinobacteria, Bacteroidetes, Firmicutes, Proteobacteria and Sacchribacteria differed significantly between elevated FeNO levels (≥ 50 ppb) compared to FeNO ≤ 25 ppb. CONCLUSION Oral bacterial composition was significantly different for those with low FEV or FVC as compared to those with normal lung function equal to or higher than LLN. Differential bacterial composition was also observed for elevated FeNO levels.
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Affiliation(s)
- Rajesh Shigdel
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway.
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Huang Lin
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Shyamal Peddada
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | - Tamar Ringel-Kulka
- UNC Gillings School of Global Public Health, Department of Maternal and Child Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Randi Jacobsen Bertelsen
- Department of Clinical Science, University of Bergen, P.O. Box 7804, N-5020, Bergen, Norway
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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10
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Rosser F, Balmes J. Ozone and childhood respiratory health: A primer for US pediatric providers and a call for a more protective standard. Pediatr Pulmonol 2023; 58:1355-1366. [PMID: 36815617 PMCID: PMC10121852 DOI: 10.1002/ppul.26368] [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: 10/20/2022] [Revised: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
Ground level ozone is a potent respiratory toxicant with decades of accumulated data demonstrating respiratory harms to children. Despite the ubiquity of ozone in the United States, impacting both urban and rural communities, the associated harms of exposure to this important air pollutant are often infrequently or inadequately covered during medical training including pulmonary specialization. Thus, many providers caring for children's respiratory health may have limited knowledge of the harms which may result in reduced discussion of ozone pollution during clinical encounters. Further, the current US air quality standard for ozone does not adequately protect children. In this nonsystematic review, we present basic background information for healthcare providers caring for children's respiratory health, review the US process for setting air quality standards, discuss the respiratory harms of ozone for healthy children and those with underlying respiratory disease, highlight the urgent need for a more protective ozone standard to adequately protect children's respiratory health, review impacts of climate change on ozone levels, and provide information for discussion in clinical encounters.
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Affiliation(s)
- Franziska Rosser
- Department of Pediatrics, Division of Pulmonary Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - John Balmes
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- School of Public Health, University of California, Berkeley, CA
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11
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Pendergrast C, Boyle T, Crockett AJ, Eston R, Johnston KN. Longitudinal lung function in urban firefighters: A group-based multi-trajectory modelling approach. Respirology 2023; 28:247-253. [PMID: 36180416 DOI: 10.1111/resp.14382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Urban firefighters are routinely exposed to both physical and chemical hazards that can negatively impact lung health, but it is unclear if firefighters experience accelerated decline in spirometry parameters due to chronic exposure and acute insults. This study aimed to describe sub-groups of firefighters with differing spirometry trajectories and examine the relationship between the identified trajectories and demographic, lifestyle and occupational characteristics. METHODS Data from six waves of the Respiratory Function Measurement and Surveillance for South Australian Metropolitan Fire Service Study (2007-2019) were used to identify spirometry parameter z-score trajectories, using group-based multi-trajectory modelling (GBMTM). Analysis of variance and chi-square statistics were used to assess trajectory group differences in baseline self-reported demographic, lifestyle and occupational characteristics. RESULTS In the 669 included firefighters, we identified five trajectories for the combination of Forced Expiratory Volume in the first second z-score (FEV1 z), Forced Vital Capacity z-score (FVCz) and the ratio of FEV1 and FVC z-score (FEV1 /FVCz). There were three stable trajectories of low, average and very high lung function and two declining trajectories of average and high lung function. Analysis of subgroup characteristics revealed no significant differences between expected and actual group proportions for the occupational characteristics of years of service and respiratory protection use. Significant differences were seen in respiratory health and body mass index. CONCLUSION GBMTM defined distinct, plausible spirometry trajectory sub-groups. Firefighter longitudinal spirometry trajectory group membership was associated with BMI and respiratory disease or symptoms but not with self-reported smoking history or occupational factors.
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Affiliation(s)
- Catherine Pendergrast
- Innovation, Implementation and Clinical Translation in Health (IIMPACT) Research Concentration, University of South Australia, Adelaide, South Australia, Australia
| | - Terry Boyle
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Alan J Crockett
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Roger Eston
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Kylie N Johnston
- Innovation, Implementation and Clinical Translation in Health (IIMPACT) Research Concentration, University of South Australia, Adelaide, South Australia, Australia
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12
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Liu J, Maleche-Obimbo E, Shanthikumar S, Graham SM. A scoping review of lung function in children and adolescents living with HIV in the era of antiretroviral treatment. Pediatr Pulmonol 2023; 58:1344-1354. [PMID: 36811157 DOI: 10.1002/ppul.26365] [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: 10/13/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) in children and adolescents remains an important health challenge in many countries and is commonly associated with lung disease. The introduction of antiretroviral therapy (ART) has greatly improved survival but chronic lung disease is a common ongoing challenge. We conducted a scoping review of studies that have reported lung function in school-aged children and adolescents living with HIV. METHODS A systematic literature search was performed by searching Medline, Embase, and PubMed databases, limited to articles published between 2011 and 2021 in English language. Inclusion criteria were studies involving participants living with HIV aged 5-18 years and having spirometry data. The primary outcome was lung function as measured by spirometry. RESULTS Twenty-one studies were included in the review. Most study participants were living in the sub-Saharan African region. The prevalence of reduced forced expiratory volume in 1 s (FEV1 ) ranged from 25.3% to 73% across studies, reduced forced vital capacity (FVC) ranged from 10% to 42% and reduced FEV1 /FVC ranged from 3% to 26%. The mean z-score of FEV1 ranged from -2.19 to -0.73, mean zFEV1 /FVC ranged from -0.74 to 0.2, and mean FVC ranged from -1.86 to -0.63. CONCLUSION There is a high prevalence of lung function impairment in children and adolescents living with HIV, which persists in the ART era. Further studies are needed of interventions that might improve lung function in these vulnerable populations.
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Affiliation(s)
- Jingbo Liu
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
| | | | | | - Stephen M Graham
- Department of Paediatrics, Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
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13
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Vukoja M, Kopitovic I, Lazic Z, Milenkovic B, Stankovic I, Tomic-Spiric V, Zvezdin B, Hromis S, Cekerevac I, Ilic A, Vukcevic M, Dimic-Janjic S, Stjepanovic M. Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement. Expert Rev Respir Med 2022; 16:1133-1144. [PMID: 36448775 DOI: 10.1080/17476348.2022.2153674] [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: 12/05/2022]
Abstract
INTRODUCTION Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings. AREAS COVERED In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers. EXPERT OPINION Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.
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Affiliation(s)
- Marija Vukoja
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Kopitovic
- Department for Respiratory Pathophysiology and Sleep Disordered Breathing, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zorica Lazic
- Pulmonary Department, University Clinical Centre Kragujevac, Kragujevac, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Branislava Milenkovic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Ivana Stankovic
- Department for Asthma and Chronic Obstructive Pulmonary Diseases, Clinic for Lung Diseases, University Clinical Centre of Nis, Nis, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Nis, Nis, Serbia
| | - Vesna Tomic-Spiric
- Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia.,Diagnostic-polyclinic Department, Clinic of Allergology and Immunology, University Clinical Center of Serbia
| | - Biljana Zvezdin
- Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.,Department for Allergy and Obstructive Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Sanja Hromis
- Department for Allergy and Obstructive Pulmonary Diseases, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.,Department of Nursing, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Cekerevac
- Pulmonary Department, University Clinical Centre Kragujevac, Kragujevac, Serbia.,Department of Internal Medicine, Faculty of Medicine, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Ilic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Miodrag Vukcevic
- Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia.,Pulmonary Department, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
| | - Mihailo Stjepanovic
- Department of Pneumonology Clinic for Pulmonology Diseases, University Clinical Centre of Serbia, Belgrade, Serbia.,Department of Internal Medicine, School of Medicine, University of Belgrade, Serbia
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14
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The Contribution of Anthropometry and Socioeconomic Status to Racial Differences in Measures of Lung Function. Chest 2022; 162:635-646. [DOI: 10.1016/j.chest.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/19/2022] Open
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15
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Steinbeis F, Knape P, Mittermaier M, Helbig ET, Tober-Lau P, Thibeault C, Lippert LJ, Xiang W, Müller-Plathe M, Steinbrecher S, Meyer HJ, Ring RM, Ruwwe-Glösenkamp C, Alius F, Li Y, Müller-Redetzky H, Uhrig A, Lingscheid T, Grund D, Temmesfeld-Wollbrück B, Suttorp N, Sander LE, Kurth F, Witzenrath M, Zoller T. Functional limitations 12 months after SARS-CoV-2 infection correlate with initial disease severity: An observational study of cardiopulmonary exercise capacity testing in COVID-19 convalescents. Respir Med 2022; 202:106968. [PMID: 36081267 PMCID: PMC9420203 DOI: 10.1016/j.rmed.2022.106968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
Background Cardiopulmonary Exercise Testing (CPET) provides a comprehensive assessment of pulmonary, cardiovascular and musculosceletal function. Reduced CPET performance could be an indicator for chronic morbidity after COVID-19. Methods Patients ≥18 years with confirmed PCR positive SARS-CoV-2 infection were offered to participate in a prospective observational study of clinical course and outcomes of COVID-19. 54 patients completed CPET, questionnaires on respiratory quality of life and performed pulmonary function tests 12 months after SARS-CoV-2 infection. Results At 12 months after SARS-CoV-2 infection, 46.3% of participants had a peak performance and 33.3% a peak oxygen uptake of <80% of the predicted values, respectively. Further impairments were observed in diffusion capacity and ventilatory efficiency. Functional limitations were particularly pronounced in patients after invasive mechanical ventilation and extracorporeal membrane oxygenation treatment. Ventilatory capacity was reduced <80% of predicted values in 55.6% of participants, independent from initial clinical severity. Patient reported dyspnea and respiratory quality of life after COVID-19 correlated with CPET performance and parameters of gas exchange. Risk factors for reduced CPET performance 12 months after COVID-19 were prior intensive care treatment (OR 5.58, p = 0.004), SGRQ outcome >25 points (OR 3.48, p = 0.03) and reduced DLCO (OR 3.01, p = 0.054). Conclusions Functional limitations causing chronic morbidity in COVID-19 survivors persist over 12 months after SARS-CoV-2 infection. These limitations were particularly seen in parameters of overall performance and gas exchange resulting from muscular deconditioning and lung parenchymal changes. Patient reported reduced respiratory quality of life was a risk factor for adverse CPET performance.
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16
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Sakic A, Ekström M, Sharma S, Nilsson PM. Can birth weight predict offspring's lung function in adult age? Evidence from two Swedish birth cohorts. Respir Res 2022; 23:348. [PMID: 36522741 PMCID: PMC9753232 DOI: 10.1186/s12931-022-02269-2] [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: 12/19/2021] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Associations between birth weight (BW) and adult lung function have been inconsistent and limited to early adulthood. We aimed to study this association in two population-based cohorts and explore if BW, adjusted for gestational age, predicts adult lung function. We also tested adult lung function impairment according to the mis-match hypothesis-small babies growing big as adults. METHODS We included 3495 individuals (aged 46.4 ± 5.4 years) from the Malmo Preventive Project (MPP), Sweden, born between 1921 and 1949, and 1401 young to middle-aged individuals (aged 28.6 ± 6.7 years) from the Malmo Offspring Study (MOS) with complete data on BW and gestational age. Adult lung function (forced vital capacity [FVC], forced expiratory volume in one second [FEV1] and the FEV1/FVC-ratio) were analysed as level of impairment (z-score), using multiple linear and logistic regressions. RESULTS BW (z-score) did not predict adult lung function in MPP, whereas BW was a significant (p = 0.003) predictor of FEV1 following full adjustment in MOS. For every additional unit increase in BW, children were 0.77 (95% CI 0.65-0.92) times less likely to have impaired adult lung function (FEV1). Moreover, adults born with lower BW (< 3510 g) showed improved lung function (FEV1 and FEV1/FVC in MOS and MPP, respectively) if they achieved higher adult body weight. CONCLUSIONS Adults born with lower birth weight, adjusted for gestational age, are more likely to have impaired lung function, seen in a younger birth cohort. Postnatal growth pattern may, however, compensate for low birth weight and contribute to better adult lung function.
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Affiliation(s)
- Aleksandra Sakic
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Magnus Ekström
- grid.4514.40000 0001 0930 2361Department of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Shantanu Sharma
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Peter M. Nilsson
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, and Department of Internal Medicine, Lund University, Skåne University Hospital, Jan Waldenströms Gata 15, 5th floor, 20502 Malmö, Sweden
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17
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Steinbeis F, Thibeault C, Doellinger F, Ring RM, Mittermaier M, Ruwwe-Glösenkamp C, Alius F, Knape P, Meyer HJ, Lippert LJ, Helbig ET, Grund D, Temmesfeld-Wollbrück B, Suttorp N, Sander LE, Kurth F, Penzkofer T, Witzenrath M, Zoller T. Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: An observational longitudinal study over 12 months. Respir Med 2022; 191:106709. [PMID: 34871947 PMCID: PMC8632363 DOI: 10.1016/j.rmed.2021.106709] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Prospective and longitudinal data on pulmonary injury over one year after acute coronavirus disease 2019 (COVID-19) are sparse. We aim to determine reductions in pulmonary function and respiratory related quality of life up to 12 months after acute COVID-19. METHODS Patients with acute COVID-19 were enrolled into an ongoing single-centre, prospective observational study and prospectively examined 6 weeks, 3, 6 and 12 months after onset of COVID-19 symptoms. Chest CT-scans, pulmonary function and symptoms assessed by St. Georges Respiratory Questionnaire were used to evaluate respiratory limitations. Patients were stratified according to severity of acute COVID-19. RESULTS Median age of all patients was 57 years, 37.8% were female. Higher age, male sex and higher BMI were associated with acute-COVID-19 severity (p < 0.0001, 0.001 and 0.004 respectively). Also, pulmonary restriction and reduced carbon monoxide diffusion capacity was associated with disease severity. In patients with restriction and impaired diffusion capacity, FVC improved over 12 months from 61.32 to 71.82, TLC from 68.92 to 76.95, DLCO from 60.18 to 68.98 and KCO from 81.28 to 87.80 (percent predicted values; p = 0.002, 0.045, 0.0002 and 0.0005). The CT-score of lung involvement in the acute phase was associated with restriction and reduction in diffusion capacity in follow-up. Respiratory symptoms improved for patients in higher severity groups during follow-up, but not for patients with initially mild disease. CONCLUSION Severity of respiratory failure during COVID-19 correlates with the degree of pulmonary function impairment and respiratory quality of life in the year after acute infection.
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Affiliation(s)
- Fridolin Steinbeis
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Charlotte Thibeault
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Doellinger
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Raphaela Maria Ring
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Mirja Mittermaier
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Alius
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Philipp Knape
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Hans-Jakob Meyer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Lena Johanna Lippert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Elisa Theresa Helbig
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Grund
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrück
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany
| | - Norbert Suttorp
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Leif Erik Sander
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Florian Kurth
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, And Department of Medicine I, University Medical Centre Hamburg-Eppendorf, 20359, Hamburg, Germany
| | - Tobias Penzkofer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiology, Augustenburger Platz 1, 13353, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Witzenrath
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Thomas Zoller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases and Respiratory Medicine, Charitéplatz 1, 10117, Berlin, Germany; Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Mussell GT, Marshall H, Smith LJ, Biancardi AM, Hughes PJC, Capener DJ, Bray J, Swift AJ, Rajaram S, Condliffe AM, Collier GJ, Johns CS, Weatherley ND, Wild JM, Sabroe I. Xenon ventilation MRI in difficult asthma: initial experience in a clinical setting. ERJ Open Res 2021; 7:00785-2020. [PMID: 34589542 PMCID: PMC8473920 DOI: 10.1183/23120541.00785-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hyperpolarised gas magnetic resonance imaging (MRI) can be used to assess ventilation patterns. Previous studies have shown the image-derived metric of ventilation defect per cent (VDP) to correlate with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1 in asthma. Objectives The aim of this study was to explore the utility of hyperpolarised xenon-129 (129Xe) ventilation MRI in clinical care and examine its relationship with spirometry and other clinical metrics in people seen in a severe asthma service. Methods 26 people referred from a severe asthma clinic for MRI scanning were assessed by contemporaneous 129Xe MRI and spirometry. A subgroup of 18 patients also underwent reversibility testing with spirometry and MRI. Quantitative MRI measures of ventilation were calculated, VDP and the ventilation heterogeneity index (VHI), and compared to spirometry, Asthma Control Questionnaire 7 (ACQ7) and blood eosinophil count. Images were reviewed by a multidisciplinary team. Results VDP and VHI correlated with FEV1, FEV1/FVC and forced expiratory flow between 25% and 75% of FVC but not with ACQ7 or blood eosinophil count. Discordance of MRI imaging and symptoms and/or pulmonary function tests also occurred, prompting diagnostic re-evaluation in some cases. Conclusion Hyperpolarised gas MRI provides a complementary method of assessment in people with difficult to manage asthma in a clinical setting. When used as a tool supporting clinical care in a severe asthma service, occurrences of discordance between symptoms, spirometry and MRI scanning indicate how MRI scanning may add to a management pathway. This article demonstrates the feasibility of using 129Xe MRI in clinical practice. Discordance between symptoms, spirometry and MRI can support the use of further treatment or suggest coexisting breathing control issues or laryngeal disorders.https://bit.ly/3ky4oXP
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Affiliation(s)
- Grace T Mussell
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Helen Marshall
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto M Biancardi
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David J Capener
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jody Bray
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alison M Condliffe
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Chris S Johns
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nick D Weatherley
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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McLeod C, Wood J, Tong A, Schultz A, Norman R, Smith S, Blyth CC, Webb S, Smyth AR, Snelling TL. The measurement properties of tests and tools used in cystic fibrosis studies: a systematic review. Eur Respir Rev 2021; 30:200354. [PMID: 33980667 PMCID: PMC9489019 DOI: 10.1183/16000617.0354-2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/26/2020] [Indexed: 11/05/2022] Open
Abstract
There is no consensus on how best to measure responses to interventions among children and adults with cystic fibrosis (CF). We have systematically reviewed and summarised the characteristics and measurement properties of tests and tools that have been used to capture outcomes in studies among people with CF, including their reliability, validity and responsiveness. This review is intended to guide researchers when selecting tests or tools for measuring treatment effects in CF trials. A consensus set of these tests and tools could improve consistency in how outcomes are captured and thereby facilitate comparisons and synthesis of evidence across studies.
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Affiliation(s)
- Charlie McLeod
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Nedlands, Australia
- Infectious Diseases Dept, Perth Children's Hospital, Nedlands, Australia
| | - Jamie Wood
- Physiotherapy Dept, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Dept of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, Australia
| | - Sherie Smith
- Evidence Based Child Health Group, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Christopher C Blyth
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Australia
- Division of Paediatrics, Faculty of Medicine, University of Western Australia, Nedlands, Australia
- Infectious Diseases Dept, Perth Children's Hospital, Nedlands, Australia
- Pathwest Laboratory Medicine WA, QEII Medical Centre, Nedlands, Australia
| | - Steve Webb
- St John of God Hospital, Subiaco, Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alan R Smyth
- Evidence Based Child Health Group, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Thomas L Snelling
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Australia
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20
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Marshall H, Kenworthy JC, Horn FC, Thomas S, Swift AJ, Siddiqui S, Brightling CE, Wild JM. Peripheral and proximal lung ventilation in asthma: Short-term variation and response to bronchodilator inhalation. J Allergy Clin Immunol 2020; 147:2154-2161.e6. [PMID: 33309743 DOI: 10.1016/j.jaci.2020.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 11/04/2020] [Accepted: 11/26/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The relative involvement of the large and small airways in asthma is not clear. Hyperpolarized gas magnetic resonance imaging (MRI) provides high-resolution 3-dimensional images of ventilation distribution that can be quantified by the ventilated volume percentage (VV%) of the lungs. OBJECTIVE Our aims were to (1) quantify the baseline reproducibility of VV%, (2) assess the ventilation distribution between the proximal and peripheral lungs, and (3) investigate regional ventilation response to bronchodilator inhalation in a cohort of patients with asthma. METHODS A total of 33 patients with poorly controlled, moderate-to-severe asthma were scanned with hyperpolarized 3He MRI. Two image data sets were acquired at baseline, and 1 image data set was acquired after bronchodilator inhalation. Images were divided into proximal and peripheral regions for analysis. RESULTS Bland-Altman analysis showed strong reproducibility of VV% (bias = 0.12%; LOA = -1.86% to 2.10%). VV% variation at baseline was greater in the periphery than in the proximal lung. The proximal lung was better ventilated than the peripheral lung. Ventilation increased significantly in response to bronchodilator inhalation, globally and regionally, and the ventilation increase in response to bronchodilator inhalation was greater in the peripheral lung than in the proximal lung. Hyperpolarized gas MRI was more sensitive to changes in response to bronchodilator inhalation (58%) than spirometry (33%). CONCLUSION The peripheral lung showed reduced ventilation and a greater response to bronchodilator inhalation than the proximal lung. The high level of baseline reproducibility and sensitivity of hyperpolarized gas MRI to bronchodilator reversibility suggests that it is suitable for low subject number studies of therapy response.
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Affiliation(s)
- Helen Marshall
- POLARIS, Academic Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
| | - J Chris Kenworthy
- POLARIS, Academic Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Felix C Horn
- POLARIS, Academic Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Steven Thomas
- British Columbia Cancer Board, Vancouver, British Columbia, Canada
| | - Andrew J Swift
- POLARIS, Academic Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Salman Siddiqui
- Institute for Lung Health and Leicester National Institute for Health Research Biomedical Research Centre (Respiratory Theme), Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Christopher E Brightling
- Institute for Lung Health and Leicester National Institute for Health Research Biomedical Research Centre (Respiratory Theme), Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | - Jim M Wild
- POLARIS, Academic Radiology, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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21
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New developments in respiratory medicine: a primary immunodeficiency perspective. Curr Opin Allergy Clin Immunol 2020; 20:549-556. [PMID: 32941317 DOI: 10.1097/aci.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To consider recent developments in respiratory medicine that are of relevance to clinicians caring for adults affected by primary immunodeficiency disorders. RECENT FINDINGS We consider impulse oscillometry, new bronchoscopic techniques for sampling, MRI and PET, the concept of the human airway microbiome, and new treatment approaches for bronchiectasis and interstitial lung disease to better understand the future of respiratory care for people with PID. SUMMARY New approaches to the diagnosis and management of respiratory manifestations of PID have been driven by better understanding of the lung in health and disease, progress in imaging and sampling modalities, and new therapeutics.
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22
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Ivanova O, Khosa C, Bakuli A, Bhatt N, Massango I, Jani I, Saathoff E, Hoelscher M, Rachow A. Lung Function Testing and Prediction Equations in Adult Population from Maputo, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124535. [PMID: 32599726 PMCID: PMC7344554 DOI: 10.3390/ijerph17124535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Background: Local spirometric prediction equations are of great importance for interpreting lung function results and deciding on the management strategies for respiratory patients, yet available data from African countries are scarce. The aim of this study was to collect lung function data using spirometry in healthy adults living in Maputo, Mozambique and to derive first spirometric prediction equations for this population. Methods: We applied a cross-sectional study design. Participants, who met the inclusion criteria, underwent a short interview, anthropometric measurements, and lung function testing. Different modelling approaches were followed for generating new, Mozambican, prediction equations and for comparison with the Global Lung Initiative (GLI) and South African equations. The pulmonary function performance of participants was assessed against the different reference standards. Results: A total of 212 males and females were recruited, from whom 155 usable spirometry results were obtained. The mean age of participants was 35.20 years (SD 10.99) and 93 of 155 (59.35%) were females. The predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and the FEV1/FVC ratio based on the Mozambican equations were lower than the South African—and the GLI-based predictions. Conclusions: This study provides first data on pulmonary function in healthy Mozambican adults and describes how they compare to GLI and South African reference values for spirometry.
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Affiliation(s)
- Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Correspondence:
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
| | - Nilesh Bhatt
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Isabel Massango
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Ilesh Jani
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, 80802 Munich, Germany
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, 80802 Munich, Germany
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23
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Vaz Fragoso CA, Leo-Summers LS, Gill TM, McAvay GJ. Re-evaluation of the Uplift Clinical Trial Using Age-Appropriate Spirometric Criteria. Chest 2020; 158:539-549. [PMID: 32278783 DOI: 10.1016/j.chest.2020.02.070] [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: 09/18/2019] [Revised: 01/13/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The clinical trial of tiotropium in COPD, UPLIFT, enrolled adults with a mean age of 65 years and moderate-to-severe airflow obstruction, based on criteria from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). For the UPLIFT cohort, however, GOLD-based criteria are not age-appropriate. RESEARCH QUESTION Will the use of more age-appropriate criteria for airflow obstruction from the Global Lung Function Initiative (GLI) modify the spirometric classification of the UPLIFT cohort and, in turn, the mortality effect of tiotropium in COPD? STUDY DESIGN AND METHODS Baseline spirometric classifications were first cross-tabulated by GLI- and GOLD-based criteria. Next, in GLI- and GOLD-based airflow obstruction, modified intention-to-treat analyses evaluated differences in time to death over 4 years, comparing tiotropium vs placebo. Because treatment response may differ by COPD severity, the mortality effect also was evaluated within stratum defined by GLI- and GOLD-based moderate and severe airflow obstruction. RESULTS Of 5,898 participants with GOLD-based airflow-obstruction, staged as moderate in 2,739 (46.4%) and severe in 3,156 (53.5%), GLI-based criteria established airflow obstruction in 5,750 (97.5%), staged as moderate in 795 (13.5%) and severe in 4,947 (83.9%). Relative to placebo, tiotropium yielded statistically nonsignificant adjusted hazard ratios (adjHRs) (95% CI) for death of 0.91 (0.80-1.04) and 0.91 (0.79-1.03) in GLI- and GOLD-based airflow obstruction, respectively. However, statistically significant effect modification was observed, but only in GLI-based moderate and severe airflow-obstruction, with tiotropium yielding adjHRs for death of 0.53 (0.34-0.81) and 0.99 (0.86-1.13), respectively. The P value for interaction was .007. INTERPRETATION Mortality reduction by tiotropium was only statistically significant in GLI-based moderate airflow-obstruction, a group that was underrepresented in UPLIFT because of severity misclassification by the original GOLD-based enrollment criteria.
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Affiliation(s)
- Carlos A Vaz Fragoso
- Veterans Affairs (VA) Connecticut Healthcare System, West Haven; Yale University School of Medicine, Department of Internal Medicine, New Haven, CT.
| | - Linda S Leo-Summers
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Thomas M Gill
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
| | - Gail J McAvay
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT
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24
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Martínez-Briseño D, Gochicoa-Rangel L, Torre-Bouscoulet L, Cid-Juárez S, Fernández-Plata R, Martínez-Valdeavellano L, Chapela-Lara S, Del Río-Hidalgo R, Pérez-Padilla R. Comparing Spirometric Reference Values From Childhood to Old Age Estimated by LMS and Linear Regression Models. Arch Bronconeumol 2020; 57:172-178. [PMID: 32127230 DOI: 10.1016/j.arbres.2019.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/25/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Proper reference values for lung function testing are essential for achieving adequate interpretations. The LMS procedure (lambda, mu, sigma) permits continuous analyses of entire populations avoiding gaps in the transition between childhood and adulthood. It also allows more precise calculations of average values, dispersion, and 5th percentiles, which are usually considered the lower limit of normality. The objective of this study was to compare our results fitted with the LMS method with standard multiple linear regression, and with those from international Global Lung Function Initiative (GLI) equations. METHODS Data from 9835 healthy residents of the metropolitan area of Mexico City aged 8-80 years were compiled from several studies: EMPECE, PLATINO, adult Mexican workers and two unpublished studies. The LMS procedure and multiple linear regression models were fit to obtain reference equations using R software. RESULTS Residuals from the LMS models had a median closer to zero, and smaller dispersion than those from the linear model, but differences although statistically significant were very small and of questionable practical relevance. For example, for females and ln(FEV1), median residual was -0.001 with p25 of -0.08 and p75 of 0.08 for LMS, compared with 0.004 (-0.08, 0.09) [p<0.05] for the linear model. Average spirometric values for a given height for our population, were higher than those predicted by the GLI study. CONCLUSION Continuous reference equations for the Mexican population calculated using the LMS technique showed slightly better fit than linear regression models.
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Affiliation(s)
- David Martínez-Briseño
- Department of Epidemiology and Social Sciences in Health, National Institute of Respiratory Diseases "Ismael Cosío Villegas", 4502 Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | | | - Silvia Cid-Juárez
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rosario Fernández-Plata
- Department of Epidemiology and Social Sciences in Health, National Institute of Respiratory Diseases "Ismael Cosío Villegas", 4502 Mexico City, Mexico
| | - Luisa Martínez-Valdeavellano
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Sofía Chapela-Lara
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rodrigo Del Río-Hidalgo
- Department of Respiratory Physiology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Department of Research in Smoking and COPD, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico.
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Wijnant SRA, De Roos E, Kavousi M, Stricker BH, Terzikhan N, Lahousse L, Brusselle GG. Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study. Eur Respir J 2020; 55:13993003.01217-2019. [PMID: 31601717 DOI: 10.1183/13993003.01217-2019] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/20/2019] [Indexed: 11/05/2022]
Abstract
Preserved ratio impaired spirometry (PRISm) is a heterogeneous condition but its course and disease progression remain to be elucidated. We aimed to examine its prevalence, trajectories and prognosis in the general population.In the Rotterdam Study (population-based prospective cohort) we examined prevalence, trajectories and prognosis of subjects with normal spirometry (controls; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7, FEV1 ≥80%), PRISm (FEV1/FVC ≥0.7, FEV1 <80%) and chronic obstructive pulmonary disease (COPD) (FEV1/FVC <0.7) at two study visits. Hazard ratios with 95% confidence intervals for mortality (until December 30, 2018) were adjusted for age, sex, body mass index, current smoking and pack-years.Of 5487 subjects (age 69.1±8.9 years; 7.1% PRISm), 1603 were re-examined after 4.5 years. Of the re-examined PRISm subjects, 15.7% transitioned to normal spirometry and 49.4% to COPD. Median lung function decline was highest in subjects with incident PRISm (FEV1 -92.8 mL·year-1, interquartile range (IQR) -131.9- -65.8 mL·year-1; FVC -93.3 mL·year-1, IQR -159.8- -49.1 mL·year-1), but similar in persistent PRISm (FEV1 -30.2 mL·year-1, IQR -67.9- -7.5 mL·year-1; FVC -20.1 mL·year-1, IQR -47.7-21.7 mL·year-1) and persistent controls (FEV1 -39.6 mL·year-1, IQR -64.3--12.7 mL·year-1; FVC -20.0 mL·year-1, IQR -55.4-18.8 mL·year-1). Of 5459 subjects with informed consent for follow-up, 692 (12.7%) died during 9.3 years (maximum) follow-up: 10.3% of controls, 18.7% of PRISm subjects and 20.8% of COPD subjects. Relative to controls, subjects with PRISm and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2-4 had increased all-cause mortality (PRISm: HR 1.6, 95% CI 1.2-2.0; COPD GOLD 2-4: HR 1.7, 95% CI 1.4-2.1) and cardiovascular mortality (PRISm: HR 2.8, 95% CI 1.5-5.1; COPD 2-4: HR 2.1, 95% CI 1.2-3.6). Mortality within <1 year was highest in PRISm, with patients often having cardiovascular comorbidities (heart failure or coronary heart disease; 70.0%).PRISm is associated with increased mortality and this population encompasses at least three distinct subsets: one that develops COPD during follow-up, a second with high cardiovascular burden and early mortality, and a third with persistent PRISm and normal age-related lung function decline.
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Affiliation(s)
- Sara Renata Alex Wijnant
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Emmely De Roos
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno Hugo Stricker
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Natalie Terzikhan
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Both authors contributed equally
| | - Guy G Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium .,Dept of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Dept of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,Both authors contributed equally
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26
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Brick T, Hose A, Wawretzka K, von Mutius E, Roduit C, Lauener R, Riedler J, Karvonen AM, Pekkanen J, Divaret-Chauveau A, Dalphin JC, Ege MJ. Parents know it best: Prediction of asthma and lung function by parental perception of early wheezing episodes. Pediatr Allergy Immunol 2019; 30:795-802. [PMID: 31441979 DOI: 10.1111/pai.13118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/29/2019] [Accepted: 08/14/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood asthma is often preceded by early wheeze. Usually, wheezing episodes are recorded retrospectively, which may induce recall bias. AIMS AND OBJECTIVES The aim of this study was to investigate true-positive recall of parent-reported wheeze at 1 year of age, its determinants, and its implications for asthma and lung function at 6 years of age. METHODS The PASTURE (Protection Against Allergy-Study in Rural Environments) study followed 880 children from rural areas in 5 European countries from birth to age 6 years. Wheeze symptoms in the first year were asked weekly. At age 6, parent-reported asthma diagnosis was ascertained and lung function measurements were conducted. Correct parental recall of wheeze episodes at the end of the first year was assessed for associations with lung function, asthma, and the asthma risk locus on chromosome 17q21. RESULTS Parents correctly recalled wheeze after the first year in 54% of wheezers. This true-positive recall was determined by number of episodes, timing of the last wheeze episode, and parental asthma. Independently from these determinants, true-positive recall predicted asthma at age 6 years (odds ratio 4.54, 95% confidence interval (CI) [1.75-14.16]) and impaired lung function (β = -0.62, 95% CI [-1.12; -0.13], P-value = .02). Associations were stronger in children with asthma risk SNPs on chromosome 17q21. CONCLUSION Correct parental recall of wheezing episodes may reflect clinical relevance of early wheeze and its impact on subsequent asthma and lung function impairment. Questions tailored to parental perception of wheezing episodes may further enhance asthma prediction.
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Affiliation(s)
- Tabea Brick
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Alexander Hose
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Wawretzka
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Institute for Asthma and Allergy Prevention, Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Munich, Germany.,Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | | | - Anne M Karvonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Juha Pekkanen
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Amandine Divaret-Chauveau
- UMR/CNRS 6249 Chrono-Environment, University of Bourgogne Franche Comté, Besanҫon, France.,Pediatric Allergy Department, University Hospital of Nancy, Nancy, France.,EA3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jean-Charles Dalphin
- UMR/CNRS 6249 Chrono-Environment, University of Bourgogne Franche Comté, Besanҫon, France.,Department of Respiratory Disease, University Hospital of Besanҫon, Besanҫon, France
| | - Markus J Ege
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
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Abstract
INTRODUCTION Adolescent idiopathic Scoliosis (AIS) affects 2% to 3% of the population of which only 0.3% to 0.5% of affected patients will have a curvature of >20 degrees, the curve magnitude at which treatment is generally recommended. For AIS the current natural history data is limited and most of the information comes from a small body of literature from the University of Iowa. METHODS The Iowa natural history studies began as retrospective reviews but beginning in 1976, the cohort was followed prospectively. Outcomes assessed in this group of patients included; mortality, pulmonary function, pregnancy-(effect of pregnancy on scoliosis and the effect of scoliosis on pregnancy), radiographic, curve progression, and osteoarthritis. In addition, validated questionnaires were used to evaluate back pain, pulmonary symptoms, general function, depression, and body image. RESULTS Patients with untreated AIS can function well as adults, become employed, get married, have children, and grow to become active older adults. Unfortunately, untreated scoliosis may lead to increased back pain and pulmonary symptoms for patients with large thoracic curves. Patients with untreated AIS can also develop substantial deformity, and the cosmetic aspect of this condition cannot be disregarded. CONCLUSIONS The summary findings of this unique lifetime natural history of AIS patients provides patients and parents a solid evidence base upon which to make informed decisions.
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A Comparison of Global Lung Initiative 2012 with Third National Health and Nutrition Examination Survey Spirometry Reference Values. Implications in Defining Obstruction. Ann Am Thorac Soc 2019; 16:225-230. [DOI: 10.1513/annalsats.201805-317oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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29
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Hall GL, Stanojevic S. The Global Lung Function Initiative (GLI) Network ERS Clinical Research Collaboration: how international collaboration can shape clinical practice. Eur Respir J 2019; 53:53/2/1802277. [DOI: 10.1183/13993003.02277-2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 11/05/2022]
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Jacinto T, Amaral R, Malinovschi A, Janson C, Fonseca J, Alving K. Exhaled NO reference limits in a large population-based sample using the Lambda-Mu-Sigma method. J Appl Physiol (1985) 2018; 125:1620-1626. [PMID: 30161011 DOI: 10.1152/japplphysiol.00093.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Absolute values are used in the interpretation of the fraction of exhaled nitric oxide (FeNO), but it has been suggested that equations to calculate reference values may be a practical and clinically useful approach. We hypothesize that the application of the Lambda-Mu-Sigma (LMS) method may improve FeNO reference equations and their interpretation. Our aims were to develop FeNO reference equations with the LMS method and to describe the difference between this method and the absolute fixed cut-offs of the current recommendations. We utilized the United States National Health and Nutrition Examination Surveys 2007-2012 and included healthy individuals with no respiratory diseases and blood eosinophils <300/mm3 ( n = 8,340). Natural log-transformed FeNO was modeled using the LMS method, imbedded in the generalized additive models for location, scale, and shape models. A set of FeNO reference equations was developed. The explanatory variables were sex, age, height, smoking habits, and race/ethnicity. A significant proportion of individuals with normal FeNO given by the equations were classified as having intermediate levels by the current recommendations. Further lower predicted FeNO compared with previous linear models was seen. In conclusion, we suggest a novel model for the prediction of reference FeNO values that can contribute to the interpretation of FeNO in clinical practice. This approach should be further validated in large samples with an objective measurement of atopy and a medical diagnosis of asthma and rhinitis. NEW & NOTEWORTHY Novel reference equations and fraction of exhaled nitric oxide (FeNO)-predicted values to improve interpretation of FeNO in clinical practice are presented. These may increase the accuracy of ruling out airway inflammation in patients with asthma or suspected asthma.
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Affiliation(s)
- Tiago Jacinto
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto , Porto , Portugal.,Department of Cardiovascular and Respiratory Sciences, Porto Health School , Porto , Portugal
| | - Rita Amaral
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto , Porto , Portugal
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University , Uppsala , Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy, and Sleep Research, Uppsala University , Uppsala , Sweden
| | - João Fonseca
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto , Porto , Portugal.,Department of Community Medicine, Information, and Health Sciences: Faculty of Medicine, University of Porto , Porto , Portugal
| | - Kjell Alving
- Department of Women's and Children's Health, Paediatric Research, Uppsala University , Uppsala , Sweden
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31
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COL6A and LAMA2 Mutation Congenital Muscular Dystrophy: A Clinical and Electrophysiological Study. J Clin Neuromuscul Dis 2018; 19:108-116. [PMID: 29465610 DOI: 10.1097/cnd.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES COL6A and LAMA2 are subtypes of congenital muscular dystrophy. METHODS Retrospective chart review of clinical findings, spirometry, muscle histology, muscle ultrasound, neuroimaging, and Electromyography (EMG)/Nerve Conduction Study data in genetically confirmed COL6A and LAMA2 subjects. RESULTS We identified 8 COL6A and 6 LAMA2 subjects: the female-to-male ratio was 1.3:1 and the mean age was 11.9 ± 3.6 years. Gross motor delays since birth, proximal muscle weakness, and contractures were noted in both groups. Joint hyperlaxity and skin changes (follicular hyperkeratosis and muscle biopsy scar thinning) were unique to COL6A. Severe scoliosis, macrocephaly, and nonambulatory status were common in LAMA2. Increasing age was associated with poor respiratory function in COL6A. There was central "cloud appearance" on rectus femoris muscle ultrasound in COL6A and white matter T2 hyperintensity on brain magnetic resonance imaging in LAMA2. LAMA2 also showed demyelinating polyneuropathy. Neurogenic changes on EMG and muscle histology were noted in 37% and 33% of COL6A cases, respectively. CONCLUSIONS COL6A has unique skin changes, central cloud appearance on muscle ultrasound. LAMA2 has demyelinating polyneuropathy and white matter changes on brain imaging. The presence of neurogenic changes on EMG and muscle histology in COL6A suggests motor axonal neuropathy. Genetic testing remains the gold standard in confirming COL6A congenital muscular dystrophy.
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Derom E, Liistro G, Oostveen E, Marchand E, Bedert L, Peché R, Janssens W. Launching Global Lung Function Initiative reference values in Belgium: tips and tricks. Eur Respir J 2018; 52:52/2/1800922. [DOI: 10.1183/13993003.00922-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/10/2018] [Indexed: 11/05/2022]
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Zhang J, Hu X, Tian X, Xu KF. Global lung function initiative 2012 reference values for spirometry in Asian Americans. BMC Pulm Med 2018; 18:95. [PMID: 29855299 PMCID: PMC5984415 DOI: 10.1186/s12890-018-0658-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background Spirometry reference values specifically designed for Asian Americans are currently unavailable. The performance of Global Lung Function Initiative 2012 (GLI-2012) equations on assessing spirometry in Asian Americans has not been evaluated. This study aimed to assess the fitness of relevant GLI-2012 equations for spirometry in Asian Americans. Methods Asian subjects who never smoked and had qualified spirometry data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Z-scores of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were separately constructed with GLI-2012 equations for North East (NE) Asians, South East (SE) Asians, and individuals of mixed ethnic origin (Mixed). In addition, Proportions of subjects with observed spirometry data below the lower limit of normal (LLN) were also evaluated on each GLI-2012 equation of interest. Results This study included 567 subjects (250 men and 317 women) aged 6–79 years. Spirometry z-scores (z-FEV1, z-FVC, and z-FEV1/FVC) based on GLI-2012 Mixed equations had mean values close to zero (− 0.278 to − 0.057) and standard deviations close to one (1.001 to 1.128); additionally, 6.0% (95% confidence interval (CI) 3.1–8.9%) and 6.4% (95% CI 3.7–9.1%) of subjects were with observed data below LLN for FEV1/FVC in men and women, respectively. In contrast, for NE Asian equations, all mean values of z-FEV1 and z-FVC were smaller than − 0.5; for SE Asian equations, mean values of z-FEV1/FVC were significantly smaller than zero in men (− 0.333) and women (− 0.440). Conclusions GLI-2012 equations for individuals of mixed ethnic origin adequately fitted spirometry data in this sample of Asian Americans. Future studies with larger sample sizes are needed to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s12890-018-0658-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jingzhou Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Xiao Hu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.,Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Xinlun Tian
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Kai-Feng Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Vukoja M, Bokan A, Vujasinovic G, Kopitovic I. The Differences in Spirometry Predictive Equations in Classifying Presence and Degree of Lung Function Impairment: Which Suit Fits the Best? Lung 2017; 196:87-92. [PMID: 29043487 DOI: 10.1007/s00408-017-0065-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/06/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the differences between three most commonly used predictive equations (PE): ECCS (European Community of Coal and Steel), the third National Health and Nutrition Examination Survey (NHANES III), and GLI (Global Lung Initiative) in healthy individuals and when grading severity of lung function impairment in patients with obstructive lung diseases. METHODS The study included 200 healthy volunteers and 200 patients with obstructive lung diseases at the Institute for Pulmonary Diseases of Vojvodina. In all subjects, we calculated the absolute and relative (percent) predicted values using ECCS, NHANES III, and GLI reference equations. RESULTS The mean differences between ECCS and NHANES III predicted values were 5.63% (95% CI 5.29-5.98%, p < 0.001) for FEV1 and 10% (95% CI 9.52-10.79%, p < 0.001) for FVC. Similar differences were observed between ECCS and GLI predicted values. There were minimal differences between NHANES III and GLI predictive values. In healthy subjects, the mean absolute difference between measured FEV1 and FEV1 ECCS predicted was 0.36l (95% CI 0.32l, 0.40l, p < 0.001), FEV1 NHANES predicted was 0.30 l (95% CI 0.27-0.35l, p < 0.001), and FEV1 GLI predicted was 0.31l (95% CI 0.27- 0.35l, p < 0.001). The use of three different PE leads to significant differences in classification of obstruction severity in both asthma and COPD patients. CONCLUSIONS There were significant differences between FEV1 and FVC predicted when using different PE. The absolute difference between actual and predicted FEV1 in healthy individuals was highest when using ECCS. The use of different PE may change the interpretation of severity of airway obstruction.
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Affiliation(s)
- Marija Vukoja
- Centre for Pathophysiology of Breathing and Sleep Medicine, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4 St, 21204, Sremska Kamenica, Serbia.
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3 St, 21000, Novi Sad, Serbia.
| | - Aleksandar Bokan
- Centre for Pathophysiology of Breathing and Sleep Medicine, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4 St, 21204, Sremska Kamenica, Serbia
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3 St, 21000, Novi Sad, Serbia
| | - Gordana Vujasinovic
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3 St, 21000, Novi Sad, Serbia
- Centre for Radiology, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4 St, 21204, Sremska Kamenica, Serbia
| | - Ivan Kopitovic
- Centre for Pathophysiology of Breathing and Sleep Medicine, The Institute for Pulmonary Diseases of Vojvodina, Put dr Goldmana 4 St, 21204, Sremska Kamenica, Serbia
- Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3 St, 21000, Novi Sad, Serbia
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35
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Cooper BG, Stocks J, Hall GL, Culver B, Steenbruggen I, Carter KW, Thompson BR, Graham BL, Miller MR, Ruppel G, Henderson J, Vaz Fragoso CA, Stanojevic S. The Global Lung Function Initiative (GLI) Network: bringing the world's respiratory reference values together. Breathe (Sheff) 2017; 13:e56-e64. [PMID: 28955406 PMCID: PMC5607614 DOI: 10.1183/20734735.012717] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Global Lung Function Initiative (GLI) Network has become the largest resource for reference values for routine lung function testing ever assembled. This article addresses how the GLI Network came about, why it is important, and its current challenges and future directions. It is an extension of an article published in Breathe in 2013 [1], and summarises recent developments and the future of the GLI Network. Learn about the GLI Network, the largest resource reference for routine lung function testinghttp://ow.ly/ZZor30epWgi
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Affiliation(s)
- Brendan G Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Bruce Culver
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Bruce Robert Thompson
- Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Brian L Graham
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Martin R Miller
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Gregg Ruppel
- Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - John Henderson
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Carlos A Vaz Fragoso
- Dept of Internal Medicine, Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT, USA
| | - Sanja Stanojevic
- Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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Asthma diagnosis in children: more evidence needed. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:83-85. [PMID: 30169208 DOI: 10.1016/s2352-4642(17)30019-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/23/2022]
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37
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Spirometry reference equations for Indian children: Create local or go global? Indian Pediatr 2016; 53:779-780. [DOI: 10.1007/s13312-016-0929-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Labor M, Vrbica Ž, Gudelj I, Labor S, Plavec D. Diagnostic accuracy of a pocket screening spirometer in diagnosing chronic obstructive pulmonary disease in general practice: a cross sectional validation study using tertiary care as a reference. BMC FAMILY PRACTICE 2016; 17:112. [PMID: 27542843 PMCID: PMC4992327 DOI: 10.1186/s12875-016-0518-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND COPD-6™ is a lung function testing device for a rapid pre-spirometry testing to screen-out at-risk individuals not having COPD and indicating those at risk. The aim of this study was to validate COPD-6™ lung function testing (index test) in general practice in discriminating patients with COPD out of the population at risk - smokers/ex-smokers with no previous diagnosis of COPD, using measurements at tertiary care as reference standard. METHODS Consecutive 227 subjects (115 women, 185 smokers/42 ex-smokers, ≥20 pack-years) with no previous diagnosis of COPD, aged 52.5 (SD 6.8) years from 26 general practitioners (GPs) were recruited, lung function tested with COPD-6™, referred to the tertiary institution for repeated COPD-6™ testing followed by spirometry with a bronchodilator (salbutamol), examination, and pulmonologist consultation for the diagnosis and severity of COPD. RESULTS COPD was diagnosed in 43 subjects (18.9 %), with an AUC of 0.827 (95 % CI 0.769-0.875, P < 0.001) for the diagnosis of COPD when lung function was measured using COPD-6™ in GP's office with a specificity of 100 % (95 % CI, 97.95-100 %) but a very low sensitivity of 32.56 % (95 % CI, 20.49-47.48 %). Significant agreement for forced expiratory volume in 1 s measured at GP's office and at lung function lab was found (mean difference 0.01 L, p = 0.667) but not for other measured parameters (p < 0.001 for all). CONCLUSIONS Our study results point out that active case finding in a population at risk for COPD should be instituted (almost 20 % of undiagnosed COPD). Based on our results lung function testing with COPD-6™ can substitute spirometry testing in cases where it is not readily available to the patient/physician taken into account that the traditional FEV1/FEV6 cutoff value of <0.7 is not the only criterion for diagnosis and/or further referral. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01550679 Registered 28 September 2014, retrospectively registered.
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Affiliation(s)
- Marina Labor
- Department of Pulmonology, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
| | - Žarko Vrbica
- Department of Pulmonology an Immunology, General Hospital Dubrovnik, Dr. Roka Mišetića 2, Dubrovnik, Croatia
- University of Dubrovnik, Branitelja Dubrovnika 29, Dubrovnik, Croatia
| | - Ivan Gudelj
- Department of Pulmonology, University Hospital Center Split, Spinčićeva 1, Split, Croatia
| | - Slavica Labor
- Department of Pulmonology, University Hospital Center Osijek, Josipa Huttlera 4, Osijek, Croatia
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
| | - Davor Plavec
- Faculty of Medicine, J.J. Strossmayer University of Osijek, Ulica cara Hadrijana 10E, Osijek, Croatia
- Research Department, Children’s Hospital Srebrnjak, Srebrnjak 100, Zagreb, Croatia
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Brazzale D, Hall G, Swanney MP. Reference values for spirometry and their use in test interpretation: A Position Statement from the Australian and New Zealand Society of Respiratory Science. Respirology 2016; 21:1201-9. [DOI: 10.1111/resp.12855] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Danny Brazzale
- Respiratory Laboratory and Institute for Breathing and Sleep Austin Hospital Melbourne Victoria Australia
| | - Graham Hall
- Paediatric Respiratory Physiology Telethon Kids Institute Perth Western Australia Australia
- School of Physiotherapy and Exercise Science Curtin University Perth Western Australia Australia
- Centre for Child Health Research University of Western Australia Perth Western Australia Australia
| | - Maureen P. Swanney
- Respiratory Physiology Laboratory Christchurch Hospital Christchurch New Zealand
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Burkhardt R, Pankow W. The diagnosis of chronic obstructive pulmonary disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:834-45, quiz 846. [PMID: 25556602 PMCID: PMC4284520 DOI: 10.3238/arztebl.2014.0834] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Estimates of the prevalence of chronic obstructive pulmonary disease (COPD) in Germany range from 1.9% to 13.2%, depending on the population studied and the investigative methods used. About 30% of all patients already have severe airway obstruction by the time the condition is diagnosed. METHODS Review of pertinent literature retrieved by a selective search, including current guidelines and textbooks. RESULTS Smoking is the main risk factor for COPD. The diagnosis is based on characteristic symptoms that patients at risk should be actively asked about-cough, dyspnea, diminished physical reserve, and frequent airway infections-together with abnormal pulmonary function tests. Spirometry usually suffices to document impaired air flow. The clinical evaluation and the treatment strategy are based on the severity of airway obstruction and dyspnea, and the frequency of exacerbations. According to a European study, dyspnea is present in 73% of persons with severe COPD, expectoration in 64%, cough in 59%, and wheezing in 42%. Asthma, congestive heart failure, and interstitial lung disease are the main differential diagnoses. CONCLUSION COPD may begin with symptoms that are only mild at first even in a longstanding smoker. The available diagnostic techniques need better prospective validation with respect to relevant endpoints, including mortality, symptom progression, quality of life, and frequency of exacerbations.
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Affiliation(s)
- Rainer Burkhardt
- Lower Saxony State Association of Statutory Health Insurance Physicians, Office Oldenburg
| | - Wulf Pankow
- Vivantes Klinikum Berlin-Neukölln, Department of Internal Medicine, Pneumology, and Infectious Diseases
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41
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Early Onset Scoliosis: A Pulmonary Perspective. Spine Deform 2014; 2:425-429. [PMID: 27927400 DOI: 10.1016/j.jspd.2014.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/10/2014] [Accepted: 04/18/2014] [Indexed: 11/22/2022]
Abstract
Early-onset scoliosis impairs lung function, often severely as it progresses. This review depicts current understanding of the changes in respiratory function resulting from early-onset scoliosis and how pulmonologists and their assessment tools affect clinical treatment decisions by spine surgeons.
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Stocks J, Sonnappa S, Lum S. Lung function testing in children: importance of race and ethnic-specific reference equations. Expert Rev Respir Med 2014; 8:527-31. [PMID: 24968697 DOI: 10.1586/17476348.2014.927317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Marked differences in lung function occur between children of different racial and ethnic backgrounds even when all known confounders including socioeconomic circumstances have been taken into account. Use of ethnic-specific equations, such as those recently published by the Global Lung Function Initiative, help to minimize such differences, thereby improving the accuracy with which lung disease can be identified and treated during childhood, as well as enabling the true impact of adverse environmental or socioeconomic exposures to be assessed, irrespective of ethnic background. In future, incorporation of ancestry and, within emerging nations undergoing secular changes in anthropometry, sitting height, into normative equations may further improve the accuracy of predicting lung function and hence assessment of disease severity within any given individual.
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Affiliation(s)
- Janet Stocks
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Abstract
Assessments of pulmonary function play an integral part in the clinical management of school age children as well as providing objective outcome measures in clinical and epidemiological research studies. Pulmonary function tests (PFTs) can also be undertaken in sleeping infants and in awake young children from 3 years of age. However, the clinical utility of such assessments, which are generally confined to specialist centres, has yet to be established. Whether requesting or undertaking paediatric PFTs, or simply reading about how these tests have been applied in research studies, it is essential to question whether results have been interpreted in a meaningful way. This review summarises some of the issues that need to be considered, including: why the tests are being performed; which tests are most likely to detect the suspected pathophysiology; how often such tests should be repeated; whether results are likely to be reliable (in terms of data quality, repeatability and the availability of suitable reference equations with which to distinguish the effects of disease from those of growth and development), and whether the selected tests are likely to be feasible in the individual child or study group under investigation.
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