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Yarbrough C, Miller M, Zulu M, Sharp D, Andom AT, Ndayizigiye M, Seung KJ, Sonenthal P. Post-tuberculosis lung disease: Addressing the policy gap. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003560. [PMID: 39236033 PMCID: PMC11376554 DOI: 10.1371/journal.pgph.0003560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
The burden of long-term functional impairment following curative treatment for tuberculosis (TB) constitutes a significant global health problem. By some estimates, chronic respiratory impairment, or post-tuberculosis lung disease (PTLD), is present in just over half of all patients who have completed TB therapy. Despite this high prevalence and substantial associated morbidity, discussion of PTLD is essentially absent from international and national TB policies and guidelines. Clear and ambitious clinical standards should be established for the diagnosis and management of PTLD, including the stipulation that all patients completing TB therapy should be screened for PTLD. Patients diagnosed with PTLD should receive linkage to chronic care, with access to inhalers and home oxygen, as indicated based on individual symptoms and pathophysiology. Leveraging their considerable influence, major funders, such as The Global Fund, could help close the gap in PTLD care by including PTLD in their strategic vision and funding streams. Immediate action is needed to address the substantial burden of disease associated with PTLD. This will require expanding the global approach to TB to include a commitment to diagnosing and treating long-term complications following initial curative therapy.
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Affiliation(s)
- Chase Yarbrough
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health-Lesotho, Maseru, Lesotho
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Michael Miller
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | | | | | | | | | - Kwonjune Justin Seung
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Partners In Health-Lesotho, Maseru, Lesotho
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Paul Sonenthal
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners In Health-Lesotho, Maseru, Lesotho
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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Prageeth NP, Wadhwa RK, Gupta NK, Popalwar H, Badhal S, Kumar BK. Study of the effectiveness of telemedicine-based pulmonary rehabilitation in recovered patients of COVID-19 pneumonitis. J Family Med Prim Care 2024; 13:2237-2241. [PMID: 39027852 PMCID: PMC11254038 DOI: 10.4103/jfmpc.jfmpc_1177_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 07/20/2024] Open
Abstract
Objective To determine the effectiveness of the telemedicine-based pulmonary rehabilitation programme in COVID-19 pneumonitis. Design Prospective intervention study. Setting Rehabilitation outpatient department, Tertiary-Care institute. Participants Consecutive sample of patients (N = 50) in recovered COVID-19 infection. Intervention Six weeks of telemedicine-based pulmonary rehabilitation in recovered patients of COVID-19 infection. Outcome Measures All patients were clinically assessed by six minutes walk test (6MWT), Modified Medical Research Council Scale (mMRC), 30s-STS and SF 36 at zero week and six weeks post-intervention. Statistical Analysis Difference in means of pre- and post-intervention was compared using paired t-test. A P value <0.05 was considered statistically significant. Results The 6MWT, mMRC Scale, 30 seconds sit-to-stand test, and WHO QoL scale-SF 36 were assessed and post-rehabilitation sessions, all the patients' showed improvement in the prescribed parameters. After six weeks of respiratory rehabilitation, the distance covered in the 6MWT was significantly longer than that of before the intervention. There was a significant difference between zero and six weeks during the PR intervention. mMRC and 30s-STS results showed a significant difference between zero and six weeks (2.36 ± 0.598, 4.54 ± 1.94. Quality of life improved significantly after six weeks of pulmonary rehabilitation in eight domains of the SF-36. Conclusion Six-week pulmonary rehabilitation programme delivered through telemedicine platform improves respiratory function, QoL and anxiety in patients with post-COVID-19 pneumonia during a recovery phase.
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Affiliation(s)
- N. P. Prageeth
- Department of PMR VMMC and Safdarjung Hospital, New Delhi, Delhi, India
| | - Ranjan K. Wadhwa
- Department of PMR VMMC and Safdarjung Hospital, New Delhi, Delhi, India
| | - Neeraj K. Gupta
- Department of Pulmonary, Medicine VMMC and Safdarjung Hospital, New Delhi, Delhi, India
| | - Harshanand Popalwar
- Department of Phyicial Medicine and Rehabilitation, AIIMS, Nagpur Maharashtra, India
| | - Suman Badhal
- Department of Physical Medicine and Rehabilitation, VMMC and Safdarjung Hospital, New Delhi, Delhi, India
| | - Banoth K. Kumar
- Department of PMR, Indira Gandhi Medical College and Research Centre, Puducherry, India
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Sun D, Zhu X, Bao Z, Lin X. Association between healthy lifestyles and post-COVID-19 syndrome among college students. Ann Thorac Med 2024; 19:139-146. [PMID: 38766372 PMCID: PMC11100468 DOI: 10.4103/atm.atm_219_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Post-COVID-19 syndrome still occurs in some populations. A healthy lifestyle is widely recognized as a first-line treatment to increase the body's antiviral resistance and tissue repair, but it is unclear whether a healthy lifestyle can promote or alleviate the symptoms of post-COVID-19 syndrome. METHODS A stratified random sampling method was used to select 498 participants from three universities in Fujian as the target of the questionnaire survey. The survey focused on students' healthy lifestyles and the symptoms of fatigue, anxiety, dyspnea, and depression that are common in post-COVID-19 syndrome. RESULTS Two months after developing COVID-19, some students continued to experience fatigue, anxiety, dyspnea, and depression, with fatigue being the most prominent symptom. The results of the study showed that there was a significant negative correlation (P < 0.01) between a healthy lifestyle and fatigue, anxiety, dyspnea, and depression among university students. Furthermore, when analyzing the different subdimensions of healthy lifestyles among university students, it was found that all dimensions showed varying degrees of negative correlation with fatigue, anxiety, dyspnea, and depression, except for health-related behaviors and interpersonal behaviors, which showed no relationship with fatigue (P < 0.01). CONCLUSIONS By improving healthy lifestyles, long-term COVID-19 symptoms can be reduced and improved and contribute positively to patient recovery, providing a viable rehabilitation option for long-term COVID-19 patients.
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Affiliation(s)
- Dezhuo Sun
- Department of Recreation Tourism and Sports Management, Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand
| | - Xiangfei Zhu
- Department of Recreation Tourism and Sports Management, Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand
| | - Zhonghan Bao
- Department of Recreation Tourism and Sports Management, Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand
| | - Xiaoping Lin
- Department of Recreation Tourism and Sports Management, Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand
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Yawn BP, Make B, Mannino D, Lopez C, Murray S, Thomashow B, Brown R, Dolor RJ, Joo M, Tapp H, Zittleman L, Meldrum C, Anderson S, Martinez FJ, Han MK. Impact of the COVID-19 Pandemic on Outcomes of CAPTURE: A Primary Care Chronic Obstructive Pulmonary Disease Screening Clinical Trial. Ann Am Thorac Soc 2024; 21:176-179. [PMID: 38099719 PMCID: PMC10867910 DOI: 10.1513/annalsats.202305-478rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Min Joo
- University of Illinois at ChicagoChicago, Illinois
| | - Hazel Tapp
- University of Illinois at ChicagoChicago, Illinois
| | - Linda Zittleman
- University of Colorado, High Plains Research NetworkAurora, Colorado
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Xiang X, Han M, Luo X, Yu Y, Lu X, Cai S, Huang L. Development of a behavior change intervention to improve physical activity in patients with COPD using the behavior change wheel: a non-randomized trial. Sci Rep 2023; 13:22929. [PMID: 38129630 PMCID: PMC10739839 DOI: 10.1038/s41598-023-50099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this study was to evaluate whether a theory-based behavior change intervention could promote changes in physical activity (PA) and sedentary behavior (SB) among patients with chronic obstructive pulmonary disease (COPD), as well as its effects on symptoms of dyspnea, lung function, exercise capacity, self-efficacy, and health-related quality of life (HRQoL). A quasi-experimental design and convenience sampling were adopted. A total of 92 patients with stable COPD were recruited from outpatient and inpatient centers of two hospitals in Zhejiang Province, China. Both the experimental and control groups received standard medical care provided in the hospital. The experimental group performed a PA program based on the behavior change wheel theory. Outcomes were measured at baseline (T0) and after 4 weeks (T1), 8 weeks (T2), and 12 weeks of the intervention (T3). The primary outcome was PA measured by the International Physical Activity Questionnaire (IPAQ). Secondary outcomes included SB measured by the IPAQ, dyspnea measured by the modified Medical Research Council (mMRC) questionnaire, exercise capacity assessed by 6-min walk distance (6MWD), self-efficacy measured by the Exercise Self-Regulatory Efficacy Scale (EX-SRES), and HRQoL measured by the COPD Assessment Test (CAT). In addition, we measured lung function using a spirometer at baseline and 12 weeks. Of the 89 patients included in this study, 64 were male (71.91%), with a mean age of 67.03 ± 6.15 years. At 12 weeks, the improvements in PA, SB, mMRC, 6MWD, EX-SRES and CAT were all statistically significant (P < 0.05) in the experimental group compared to the control group. Repeated measures analysis of variance showed that there were group effects and time effects on total PA, SB, mMRC, 6MWD, EX-SRES, and CAT in both groups (P < 0.001). However, there was no significant difference in pulmonary function between the two groups before and after intervention (P < 0.05). The PA program based on theory significantly increased PA levels, reduced sedentary time, enhanced exercise capacity and self-efficacy as well as HRQoL in patients with stable COPD. Due to the limited intervention time in this study, the pulmonary function of COPD patients may not be reversed in a short time, and the long-term effect of this program on the pulmonary function of patients needs to be further explored.Trial registration: Clinical Trials.gov (ChiCTR2200060590). Registered 05/06/2022.
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Affiliation(s)
- Xinyue Xiang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Maomao Han
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Xiaolin Luo
- Zhejiang Evaluation Center for Medical Service and Administration, Hangzhou, Zhejiang Province, China
| | - Yudi Yu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaorong Lu
- Department of Nursing, Haining People's Hospital, Haining, Zhejiang Province, China
| | - Shasha Cai
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Lihua Huang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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Cristea L, Olsson M, Sandberg J, Kochovska S, Currow D, Ekström M. Which breathlessness dimensions associate most strongly with fatigue?-The population-based VASCOL study of elderly men. PLoS One 2023; 18:e0296016. [PMID: 38117831 PMCID: PMC10732411 DOI: 10.1371/journal.pone.0296016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/04/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Breathlessness and fatigue are common symptoms in older people. We aimed to evaluate how different breathlessness dimensions (overall intensity, unpleasantness, sensory descriptors, emotional responses) were associated with fatigue in elderly men. METHODS This was a cross-sectional analysis of the population-based VAScular disease and Chronic Obstructive Lung Disease (VASCOL) study of 73-year old men. Breathlessness dimensions were assessed using the Dyspnoea-12 (D-12), Multidimensional Dyspnoea Profile (MDP), and the modified Medical Research Council (mMRC) scale. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. Clinically relevant fatigue was defined as FACIT-F≤ 30 units. Scores were compared standardized as z-scores and analysed using linear regression, adjusted for body mass index, smoking, depression, cancer, sleep apnoea, prior cardiac surgery, respiratory and cardiovascular disease. RESULTS Of 677 participants, 11.7% had clinically relevant fatigue. Higher breathlessness scores were associated with having worse fatigue; for D-12 total, -0.35 ([95% CI] -0.41 to -0.30) and for MDP A1, -0.24 (-0.30 to -0.18). Associations were similar across all the evaluated breathlessness dimensions even when adjusting for the potential confounders. CONCLUSION Breathlessness assessed using D-12 and MDP was associated with worse fatigue in elderly men, similarly across different breathlessness dimensions.
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Affiliation(s)
- Lucas Cristea
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Kallinge Health Center, Kallinge, Sweden
| | - Max Olsson
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jacob Sandberg
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Magnus Ekström
- Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Chen TT, Lee KY, Chang JH, Chung CL, Tran HM, Manullang A, Ho SC, Chen KY, Tseng CH, Wu SM, Chuang HC. Prediction value of neutrophil and eosinophil count at risk of COPD exacerbation. Ann Med 2023; 55:2285924. [PMID: 38065676 PMCID: PMC10836240 DOI: 10.1080/07853890.2023.2285924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Predicting acute exacerbations (AEs) in chronic obstructive pulmonary disease (COPD) is crucial. This study aimed to identify blood biomarkers for predicting COPD exacerbations by inflammatory phenotypes. MATERIALS AND METHODS We analyzed blood cell counts and clinical outcomes in 340 COPD patients aged 20-90 years. Patients were categorized into eosinophilic inflammation (EOCOPD) and non-eosinophilic inflammation (N-EOCOPD) groups. Blood cell counts, eosinophil-to-lymphocyte ratio (ELR), neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-eosinophil ratio (NER) were calculated. Linear and logistic regression models assessed relationships between health outcomes and blood cell counts. RESULTS EOCOPD patients had distinct characteristics compared to N-EOCOPD patients. Increased neutrophil % and decreased lymphocyte % were associated with reduced pulmonary function, worse quality of life and more exacerbations, but they did not show statistical significance after adjusting by age, sex, BMI, smoking status, FEV1% and patient's medication. Subgroup analysis revealed a 1.372-fold increase in the OR of AE for every 1 unit increase in NLR in EOCOPD patients (p < .05). In N-EOCOPD patients, every 1% increase in blood eosinophil decreased the risk of exacerbation by 59.6%. CONCLUSIONS Our study indicates that distinct white blood cell profiles in COPD patients, with or without eosinophilic inflammation, can help assess the risk of AE in clinical settings.
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Affiliation(s)
- Tzu-Tao Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang-Yun Lee
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jer-Hwa Chang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chi-Li Chung
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huan Minh Tran
- Ph.D. Program in Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Faculty of Public Health, Da Nang University of Medical Technology and Pharmacy, Da Nang, Viet Nam
| | - Amja Manullang
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yuan Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Ming Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Chi Chuang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- National Heart and Lung Institute, Imperial College London, London, UK
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El-Sobki A, Elzayat S, El-Deeb ME, Ibrahim RAE, Gehad I, Negm A, Alsobky MEI, Elgendy A. Surgical Management of Bilateral Abductor Paralysis: Diode Laser Versus Coblation; A Prospective Study. J Voice 2023:S0892-1997(23)00318-1. [PMID: 37923654 DOI: 10.1016/j.jvoice.2023.10.008] [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: 08/22/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES We aimed to compare the results of both diode laser and coblation in the treatment of bilateral vocal fold immobility (BVFI). MATERIALS AND METHODS This prospective clinical study was performed on 80 non-tracheostomised patients with bilateral vocal fold paralysis divided into two groups; Group A: diode laser, Group B: coblation. Medical Research Council "mMRC" Dyspnea scale, maximal phonatory time (MPT), Voice handicap index (VHI), and functional outcome swallowing scale (FOSS) were assessed preoperatively and postoperatively. Also, the VAS pain scale and operative time of both groups are recorded. RESULTS Within each group, there was a statistically significant decrease in the mMRC dyspnea scale and maximum phonation time and a significant increase in VHI (P < 0.001). There was a statistically significant difference between the studied groups postoperative and regarding the percent change of the MPT ( more decrease in the coblation group). Concerning the operative time and the VAS pain score, there was a statistically significant difference between the studied groups regarding operating time and the VAS pain scale (significantly lower in the coblation group) (P < 0.001). CONCLUSION Both Coblation and diode laser are effective tools in the treatment of BVFI with similar minimal voice quality affection. The maximum phonation time decreased more in the coblation group, while the voice handicap index did not significantly differ between both groups. However, Coblation may be superior to diode laser in terms of less operative pain and shorter intraoperative time. Coblation may be more favorable for patients at risk of prolonged general anesthesia duration.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine-Mansoura University, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt.
| | - Reham A E Ibrahim
- Phoniatrics Department, Faculty of Medicine, Assiut University, Egypt
| | - Ibrahim Gehad
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Ahmed Negm
- Otorhinolaryngology Department, Faculty of Medicine, Misr University for science and technology, Egypt
| | | | - Ahmed Elgendy
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt
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Khedr L, Khedr NF, Werida RH. Functional capacity and inflammatory biomarkers as predictors for right atrial volume index in COPD patients. Int J Cardiovasc Imaging 2023; 39:1493-1504. [PMID: 37217717 PMCID: PMC10427529 DOI: 10.1007/s10554-023-02871-5] [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: 10/29/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and right-heart complications. So, this study aimed to evaluate the role of right atrial volume index (RAVI), inflammatory biomarkers and functional capacity in predicting poor outcomes for patients with COPD, classified by COPD assessment test (CAT) questionnaire, as early predictors of right heart diseases. METHODS 151 patients with COPD with ejection fraction (LVEF) > 55% were enrolled and classified according to CAT questionnaire into CAT ≥ 10 (group I) and CAT < 10 (group II). RAVI was calculated using Echocardiography. Assessment of RV systolic function was done by Doppler imaging. Functional capacity parameters were assessed by modified medical research council dyspnea scale (mMRC). IL-1β, adiponectin, hs-CRP and neopterin were evaluated by ELSA kits. RESULTS Group I (CAT ≥ 10) had higher RAVI (73.92 ± 21.20 ml/m2 vs 22.73 ± 6.24 ml/m2, p < 0.001), lower S`tri (0.05 ± 0.01 vs 0.13 ± 0.03 m/s, p < 0.001), lower tricuspid annular plane systolic excursion (TAPSE) (1.20 ± 0.17 cm vs 2.17 ± 0.48 cm, p < 0.001), higher RVSP (54.88 ± 7.97 vs 26.79 ± 9.84 mmHg, p < 0.001) compared with group II (CAT < 10). RAVI was good predictor of CAT (r = 0.954, p < 0.001) and strongly correlated with tricuspid S`tri, RVSP, tricuspid E/e' and Mitral E/e' (r = -0.737, r = 0.753, r = 0.817 and r = 0.515, respectively, p < 0.001). RAVI was correlated with TAPSE (r = -0.673, p < 0.001) and with tricuspid E/A ratio & LVEF (r = 0.628, r = -0.407, respectively, p < 0.001). Hs-CRP: 2.50 ± 1.43 vs 2.03 ± 1.19, IL-1β: 37.96 ± 14.35 vs 27.57 ± 8.06, neopterin: 91.37 ± 17.30 vs 76.90 ± 16.75, p < 0.05) were significantly higher besides lower adiponectin levels (3.19 ± 1.98 vs 5.32 ± 1.33 p < 0.05) in group I as compared to group II. CONCLUSION Functional capacity might be useful predictor for right heart diseases in COPD patients. Inflammatory biomarkers, low adiponectin and high Hs-CRP, IL-1β and neopterin levels, might not only be useful to monitor treatment response but may also help to discriminate patients with a worsen prognosis.
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Affiliation(s)
- Lamiaa Khedr
- Department of Cardiology, Faculty of Medicine, Tanta University Hospital, Tanta University, Tanta, Egypt.
| | - Naglaa F Khedr
- Biochemistry Department, Faculty of Pharmacy, Tanta University, Tanta, 31527, Egypt.
| | - Rehab H Werida
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Damanhour University, Damanhour, 22514, Egypt.
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Byanova KL, Fitzpatrick J, Jan AK, McGing M, Hartman-Filson M, Farr CK, Zhang M, Gardner K, Branchini J, Kerruish R, Bhide S, Bates A, Hsieh J, Abelman R, Hunt PW, Wang RJ, Crothers KA, Huang L. Isolated abnormal diffusing capacity for carbon monoxide (iso↓DLco) is associated with increased respiratory symptom burden in people with HIV infection. PLoS One 2023; 18:e0288803. [PMID: 37463173 PMCID: PMC10353811 DOI: 10.1371/journal.pone.0288803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES An isolated reduction in the diffusing capacity for carbon monoxide (DLco; iso↓DLco) is one of the most common pulmonary function test (PFT) abnormalities in people living with HIV (PWH), but its clinical implications are incompletely understood. In this study, we explored whether iso↓DLco in PWH is associated with a greater respiratory symptom burden. STUDY DESIGN Cross-sectional analysis. METHODS We used ATS/ERS compliant PFTs from PWH with normal spirometry (post-bronchodilator FEV1/FVC ≥0.7; FEV1, FVC ≥80% predicted) from the I AM OLD cohort in San Francisco, CA and Seattle, WA, grouped by DLco categorized as normal (DLco ≥lower limit of normal, LLN), mild iso↓DLco (LLN >DLco >60% predicted), and moderate-severe iso↓DLco (DLco ≤60% predicted). We performed multivariable analyses to test for associations between DLco and validated symptom-severity and quality of life questionnaires, including the modified Medical Research Council dyspnea scale (mMRC), the COPD Assessment Test (CAT), and St. George's Respiratory Questionnaire (SGRQ), as well as between DLco and individual CAT symptoms. RESULTS Mild iso↓DLco was associated only with a significantly higher SGRQ score. Moderate-severe iso↓DLco was associated with significantly higher odds of mMRC ≥2 and significantly higher CAT and SGRQ scores. PWH with moderate-severe iso↓DLco had increased odds of breathlessness, decreased activity, lower confidence leaving home, and less energy. CONCLUSIONS Iso↓DLco is associated with worse respiratory symptom scores, and this association becomes stronger with worsening DLco, suggesting that impaired gas exchange alone has a significant negative impact on the quality of life in PWH. Additional studies are ongoing to understand the etiology of this finding and design appropriate interventions.
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Affiliation(s)
- Katerina L. Byanova
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jessica Fitzpatrick
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Amanda K. Jan
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Maggie McGing
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Marlena Hartman-Filson
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Carly K. Farr
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Michelle Zhang
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kendall Gardner
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jake Branchini
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Robert Kerruish
- School of Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, United States of America
| | - Sharvari Bhide
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Aryana Bates
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jenny Hsieh
- Department of Anesthesia and Perioperative Care, Division of Respiratory Care Services, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Rebecca Abelman
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Peter W. Hunt
- Department of Medicine, Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Richard J. Wang
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Kristina A. Crothers
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, United States of America
| | - Laurence Huang
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California San Francisco, San Francisco, California, United States of America
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11
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Candy S, Reeve J, Dobson R, Whittaker R, Garrett J, Warren J, Calder A, Tane T, Robertson T, Rashid U, Taylor D. The Impact of Patient Preference on Attendance and Completion Rates at Centre-Based and mHealth Pulmonary Rehabilitation: A Non-Inferiority Pragmatic Clinical Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1419-1429. [PMID: 37465821 PMCID: PMC10350416 DOI: 10.2147/copd.s408423] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
Purpose Pulmonary rehabilitation (PR) is vital in the management of chronic respiratory disorders (CRDs) although uptake, attendance and completion are poor. Differing models of delivering PR are emerging in an attempt to increase the uptake and completion of this intervention. This study aimed to evaluate participant rate of attendance and completion of PR when given a preference regarding model of delivery (centre-based and mPR). Secondary aims were to evaluate the factors affecting patient preference for model of delivery and determine whether mPR is non-inferior to centre-based PR in health outcomes. Methods A multi-centre non-inferiority preference based clinical trial in Auckland, New Zealand. Participants with a CRD referred for PR were offered the choice of centre-based or mHealth PR (mPR). The primary outcome was completion rate of chosen intervention. Results A total of 105 participants were recruited to the study with 67 (64%) preferring centre-based and 38 (36%) mPR. The odds of completing the PR programme were higher in the centre-based group compared to mPR (odds ratio 1.90 95% CI [0.83-4.35]). Participants opting for mPR were significantly younger (p = 0.002) and significantly more likely to be working (p = 0.0001). Results showed that mPR was not inferior to centre-based regarding changes in symptom scores (CAT) or time spent in sedentary behaviour (SBQ). When services were forced to transition to telehealth services during COVID-19 restrictions, the attendance and completion rates were higher with telephone calls and video conferencing compared to mPR - suggesting that synchronous interpersonal interactions with clinicians may facilitate the best attendance and completion rates. Conclusion When offered the choice of PR delivery method, the majority of participants preferred centre-based PR and this facilitated the best completion rates. mPR was the preferred choice for younger, working participants suggesting that mPR may offer a viable alternative to centre-based PR for some participants, especially younger, employed participants.
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Affiliation(s)
- Sarah Candy
- Te Whatu Ora Counties Manukau Health, Auckland, New Zealand
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Julie Reeve
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Waitematā, Auckland, New Zealand
| | | | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Amanda Calder
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Taria Tane
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Usman Rashid
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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12
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Beaumont M, Latiers AC, Prieur G. [The role of the physiotherapist in the assessment and management of dyspnea]. Rev Mal Respir 2023; 40:169-187. [PMID: 36682956 DOI: 10.1016/j.rmr.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/20/2022] [Indexed: 01/21/2023]
Abstract
The role of the physiotherapist in the assessment and management of dyspnea. Dyspnea is the most common symptom in cardio-respiratory diseases. Recently improved comprehension of dyspnea mechanisms have underlined the need for three-faceted assessment. The three key aspects correspond to the "breathing, thinking, functioning" clinical model, which proposes a multidimensional - respiratory, emotional and functional - approach. Before initiating treatment, it is essential for several reasons to assess each specific case, determining the type of dyspnea affecting the patient, appraising the impact of shortness of breath, and estimating the effectiveness of the treatment applied. The physiotherapist has a major role to assume in the care of dyspneic patients, not only in assessment followed by treatment but also as a major collaborator in a multidisciplinary team, especially with regard to pulmonary rehabilitation. The aim of this review is to inventory the existing assessment tools and the possible physiotherapies for dyspnea, using a holistic approach designed to facilitate the choice of techniques and to improve quality of care by fully addressing the patient's needs.
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Affiliation(s)
- M Beaumont
- Service de réadaptation respiratoire, Centre Hospitalier des Pays de Morlaix, Morlaix, France; Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France.
| | - A C Latiers
- Service ORL, Stomatologie et Soins Continus, Cliniques universitaires Saint-Luc, 1200 Brussels, Belgique
| | - G Prieur
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Groupe de Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, 1200 Brussels, Belgique; Université de Normandie, UNIROUEN, EA3830-GRHV, 76000 Rouen, France; Groupe Hospitalier du Havre, Service de pneumologie et de réadaptation respiratoire, avenue Pierre Mendes France, 76290 Montivilliers, France; Institut de Recherche et Innovation en Biomédecine (IRIB), 76000 Rouen, France
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13
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Kim T, Huh S, Chung JH, Kim YS, Yun RY, Park O, Lee SE. Clinical values of diaphragmatic movement in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2023; 23:33. [PMID: 36703157 PMCID: PMC9881315 DOI: 10.1186/s12890-022-02220-7] [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: 04/25/2022] [Accepted: 11/02/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The limitation of activity due to dyspnea in chronic obstructive pulmonary disease (COPD) patients is affected by diaphragmatic dysfunction and reduced lung function. This study aimed to analyze the association between diaphragm function variables and forced expiratory volume in the first second (FEV1) and to estimate the clinical significance of diaphragm function in the correlation between COPD severity and lung function. METHODS This prospective, single-center, cross-sectional observational study enrolled 60 COPD patients in a respiratory outpatient clinic. Data for baseline characteristics and the dyspnea scale were collected. Participants underwent a pulmonary function test (PFT), a 6-minute walk test (6MWT), and diaphragm function by ultrasonography. RESULTS The right excursion at forced breathing showed the most significant correlation with FEV1 (r = 0.370, p = 0.004). The cutoff value was 6.7 cm of the right diaphragmatic excursion at forced breathing to identify the FEV1 above 50% group. In the group with a right diaphragmatic excursion at forced breathing < 6.7 cm, modified Medical Research Council (mMRC), St. George's Respiratory Questionnaire and the total distance of 6MWT showed no difference between groups with FEV1 under and above 50% (p > 0.05). In the group with ≥ 6.7 cm, mMRC and the total distance of 6MWT showed a significant difference between FEV1 under and above 50% (p = 0.014, 456.7 ± 69.7 m vs. 513.9 ± 60.3 m, p = 0.018, respectively). CONCLUSION The right diaphragmatic forced excursion was closely related to FEV1, and analysis according to the right diaphragmatic forced excursion-based cut-off value showed a significant difference between both groups. When the diaphragm function was maintained, there was a lot of difference in the 6MWT's factors according to the FEV1 value. Our data suggest that diaphragmatic function should be performed when interpreting PFT.
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Affiliation(s)
- Taehwa Kim
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sungchul Huh
- grid.412591.a0000 0004 0442 9883Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan, Yangsan, South Korea
| | - Jae Heun Chung
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Seong Kim
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ra Yu Yun
- grid.412591.a0000 0004 0442 9883Department of Rehabilitation Medicine, Rehabilitation Hospital, Pusan National University Yangsan, Yangsan, South Korea ,grid.262229.f0000 0001 0719 8572Pusan National University School of Medicine, Yangsan, South Korea
| | - Onyu Park
- grid.412591.a0000 0004 0442 9883College of Nursing, Pusan National University, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seung Eun Lee
- grid.412591.a0000 0004 0442 9883Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital and Pusan National University School of Medicine, Geumo-ro 20, Beomeo-ri, Yangsan-si, Gyeongsangnam-do 50612 Republic of Korea ,grid.412591.a0000 0004 0442 9883BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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14
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Fekete M, Horvath A, Santa B, Tomisa G, Szollosi G, Ungvari Z, Fazekas-Pongor V, Major D, Tarantini S, Varga JT. COVID-19 vaccination coverage in patients with chronic obstructive pulmonary disease - A cross-sectional study in Hungary. Vaccine 2023; 41:193-200. [PMID: 36424256 PMCID: PMC9671791 DOI: 10.1016/j.vaccine.2022.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/02/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Coronavirus infection is a particular risk for patients with chronic obstructive pulmonary disease (COPD), because they are much more likely to become severely ill due to oxygen supply problems. Primary prevention, including COVID-19 vaccination is of paramount importance in this disease group. The aim of our study was to assess COVID-19 vaccination coverage in COPD patients during the first vaccination campaign of the COVID-19 pandemic. METHODS A cross-sectional observational study (CHANCE) has been conducted in COPD patients in the eastern, western and central regions of Hungary from 15th November 2021. The anthropometric, respiratory function test results and vaccination status of 1,511 randomly selected patients were recorded who were aged 35 years and older. RESULTS The median age was 67 (61-72) years, for men: 67 (62-73) and for women: 66 (60-72) years, with 47.98 % men and 52.02 % women in our sample. The prevalence of vaccination coverage for the first COVID-19 vaccine dose was 88.62 %, whereas 86.57 % of the patients received the second vaccine dose. When unvaccinated (n = 172) and double vaccinated (n = 1308) patients were compared, the difference was significant both in quality of life (CAT: 17 (12-23) vs 14 (10-19); p < 0.001) and severity of dyspnea (mMRC: 2 (2-2) vs 2 (1-2); p = 0.048). The COVID-19 infection rate between double vaccinated and unvaccinated patients was 1.61 % vs 22.67 %; p < 0.001 six months after vaccination. The difference between unvaccinated and vaccinated patients was significant (8.14 % vs 0.08 %; p < 0.001) among those with acute COVID-19 infection hospitalized. In terms of post-COVID symptoms, single or double vaccinated patients had significantly fewer outpatient hospital admissions than unvaccinated patients (7.56 vs 0 %; p < 0.001). CONCLUSION The COVID-19 vaccination coverage was satisfactory in our sample. The uptake of COVID-19 vaccines by patients with COPD is of utmost importance because they are much more likely to develop severe complications.
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Affiliation(s)
- Monika Fekete
- Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Alpar Horvath
- Chiesi Hungary Ltd., Budapest, Hungary,Department of Pulmonology, Semmelweis University, Budapest, Hungary,Department of Pulmonology, Szent Borbála County Hospital, Tatabánya, Hungary
| | - Balazs Santa
- Chiesi Hungary Ltd., Budapest, Hungary,Department of Pulmonology, Szent Borbála County Hospital, Tatabánya, Hungary
| | - Gabor Tomisa
- Chiesi Hungary Ltd., Budapest, Hungary,Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gergo Szollosi
- University of Debrecen, Faculty of Health Sciences, Debrecen, Hungary
| | - Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - David Major
- Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Stefano Tarantini
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA,International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Janos Tamas Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary,Corresponding author
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15
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Mitra P, Chakraborty D, Nayek S, Kundu S, Mishra D, Dan U, Mondal NK. Biomass using tribal women exhibited respiratory symptoms, hypertensive risks and abnormal pulmonary function. CHEMOSPHERE 2023; 311:136995. [PMID: 36330973 DOI: 10.1016/j.chemosphere.2022.136995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
In rural areas of developing countries, solid fuels are still widely used for cooking, heating, and lighting purposes. This study investigates the effects of household air pollutants (HAPs) exposure on the occurrence of respiratory symptoms, blood pressure, and lung function. In this study, we randomly selected 123 (83 biomass and 40 clean fuel user) subjects to assess the impact of smoke generated from solid biomass fuel by assessing their health status along with the ventilation pattern of the kitchens and living rooms. HAPs (PM10, PM2.5, and CO) and different health parameters were measured along with monitoring of self-reported health symptoms for a consecutive period of eight months. Results revealed that the concentration of CO, PM2.5, and PM10 were found highest in biomass using households. Higher odds of the upper respiratory symptoms, runny nose (OR: 4.08, 95% CI: 1.22-22.14, p < 0.03), nasal congestion (OR: 9.07, 95% CI: 1.39-97.89, p < 0.01) and the odds of the lower respiratory symptoms like wheezing (OR: 1.62, 95% CI: 1.23-10.94, p < 0.01), breathlessness (OR: 4.44, 95% CI: 1.3-14.75, p < 0.01), chest tightness (OR: 4.89, 95% CI: 1.23-22.14, p < 0.03) and dry cough (OR: 3.661, 95% CI: 1.05-12.25, p < 0.04) were significantly higher in biomass fuel user. Similarly higher systolic (+11.41 mmHg), higher diastolic pressure (+3.3 mmHg), higher pulse pressure (+8.11 mmHg), and a 6 mmHg higher mean arterial pressure among biomass fuel using tribal women. The risk of hypertension was significantly (p < 0.03) higher (OR: 3.04; 95% CI: 1.18-7.89) among solid biomass fuel users. The lung abnormality was recorded 28.91% (OR: 5.02, 95% CI: 1.50 to 16.56, p < 0.01) among biomass fuel user. Finally, it is suggested that the use of efficient cookstoves, increase in cross ventilation, and cleaner fuel are urgently needed to curb the pollution load.
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Affiliation(s)
- Pradip Mitra
- Environmental Chemistry Laboratory, Department of Environmental Science, The University of Burdwan, West, Bengal, India
| | - Deep Chakraborty
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamilnadu, 600116, India
| | - Sukanta Nayek
- Environmental Chemistry Laboratory, Department of Environmental Science, The University of Burdwan, West, Bengal, India
| | - Soumya Kundu
- Environmental Chemistry Laboratory, Department of Environmental Science, The University of Burdwan, West, Bengal, India
| | - Debojyoti Mishra
- Environmental Chemistry Laboratory, Department of Environmental Science, The University of Burdwan, West, Bengal, India
| | - Utpal Dan
- Principal, Diamond Harbour Government Medical College and Hospital, South 24, Pargans, West Bengal, India
| | - Naba Kumar Mondal
- Environmental Chemistry Laboratory, Department of Environmental Science, The University of Burdwan, West, Bengal, India.
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16
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Giray E, Turan Z, Öke D, Topalo M, Baygul A, Curci C, de Sire A, Taskiran OO. Validity, inter-rater reliability, and feasibility of the Chelsea Physical Assessment Tool for assessing physical function in post-acute COVID-19 patients: A cross-sectional study. J Back Musculoskelet Rehabil 2022; 36:527-539. [PMID: 36617777 DOI: 10.3233/bmr-220191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics. OBJECTIVE This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU. METHODS Demographic and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-stand test. CPAx and the other functional assessment tools were administered to 16 patients within 48 hours following ICU discharge. For inter-rater reliability, another physiatrist independently re-assessed the patients. MRC sum score, Barthel and Katz indexes were used to assess construct validity of CPAx. The discriminative validity of CPAx was determined by its ability to differentiate between patients with and without ICU acquired muscle weakness based on MRC sum score. The intra-class correlation coefficients (ICC) were calculated to determine inter-rater reliability for total scores of the functional assessment tools. Cohen's Kappa (κ) coefficient and weighed Kappa (κw) were calculated to determine inter-rater reliability of individual CPAx items. Ceiling and flooring effects were calculated by percentage frequency of lowest or highest possible score achieved. The number and percentages of the patients who were able to complete each tool were calculated to assess feasibility. RESULTS The CPAx score was strongly correlated with MRC sum score (rho: 0.83), Barthel Index (rho: 0.87) and Katz Index (rho: 0.89) (p< 0.001) showing construct validity. Area under the ROC curve demonstrated that cut off score for CPAx was ⩽ 12 to discriminate patients with MRC sum score < 48, with a sensitivity and a specificity of 100% and 63%, respectively (AUC = 0.859, p< 0.001). ICC was high for CPAx, MRC sum score, Barthel and Katz indexes, Glasgow Coma Scale, and hand grip strength measurement, with the highest value observed for CPAx (ICC, 0.96; 95% confidence interval (CI), 0.71-0.98). κ and κw analysis showed good to excellent inter-rater reliability for individual CPAx items. No floor or ceiling effect was observed at CPAx while floor effect was observed at Barthel Index scores (25%) and Katz Index scores (37.5%). All patients could be evaluated using CPAx while less were physically able to complete the 5 time sit-to-stand, 30 seconds sit-to-stand tests (n= 4) and MRC sum score (n= 14). CONCLUSION CPAx is a valid, reliable, and feasible tool to assess the physical functional state in COVID-19 patients following discharge from the ICU.
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Affiliation(s)
- Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Turan
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
| | - Deniz Öke
- Department of Physical Medicine and Rehabilitation, Gaziosmanpaşa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mahir Topalo
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
| | - Arzu Baygul
- Statistics Unit, Koç University School of Medicine, Istanbul, Turkey
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, Mantova, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Ozden Ozyemisci Taskiran
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
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17
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Yang Y, Chen Z, Li W, Zeng N, Guo Y, Wang S, Duan W, Liu Y, Chen H, Li X, Chen R, Kang Y. Multi-modal data combination strategy based on chest HRCT images and PFT parameters for intelligent dyspnea identification in COPD. Front Med (Lausanne) 2022; 9:980950. [PMID: 36619622 PMCID: PMC9811121 DOI: 10.3389/fmed.2022.980950] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Because of persistent airflow limitation in chronic obstructive pulmonary disease (COPD), patients with COPD often have complications of dyspnea. However, as a leading symptom of COPD, dyspnea in COPD deserves special consideration regarding treatment in this fragile population for pre-clinical health management in COPD. Methods: Based on the above, this paper proposes a multi-modal data combination strategy by combining the local and global features for dyspnea identification in COPD based on the multi-layer perceptron (MLP) classifier. Methods First, lung region images are automatically segmented from chest HRCT images for extracting the original 1,316 lung radiomics (OLR, 1,316) and 13,824 3D CNN features (O3C, 13,824). Second, the local features, including five selected pulmonary function test (PFT) parameters (SLF, 5), 28 selected lung radiomics (SLR, 28), and 22 selected 3D CNN features (S3C, 22), are respectively selected from the original 11 PFT parameters (OLF, 11), 1,316 OLR, and 13,824 O3C by the least absolute shrinkage and selection operator (Lasso) algorithm. Meantime, the global features, including two fused PFT parameters (FLF, 2), six fused lung radiomics (FLR, 6), and 34 fused 3D CNN features (F3C, 34), are respectively fused by 11 OLF, 1,316 OLR, and 13,824 O3C using the principal component analysis (PCA) algorithm. Finally, we combine all the local and global features (SLF + FLF + SLR + FLR + S3C + F3C, 5+ 2 + 28 + 6 + 22 + 34) for dyspnea identification in COPD based on the MLP classifier. Results Our proposed method comprehensively improves classification performance. The MLP classifier with all the local and global features achieves the best classification performance at 87.7% of accuracy, 87.7% of precision, 87.7% of recall, 87.7% of F1-scorel, and 89.3% of AUC, respectively. Discussion Compared with single-modal data, the proposed strategy effectively improves the classification performance for dyspnea identification in COPD, providing an objective and effective tool for COPD management.
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Affiliation(s)
- Yingjian Yang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China,College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Ziran Chen
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Wei Li
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Nanrong Zeng
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China,School of Applied Technology, Shenzhen University, Shenzhen, China
| | - Yingwei Guo
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China,College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China
| | - Shicong Wang
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China,School of Applied Technology, Shenzhen University, Shenzhen, China
| | - Wenxin Duan
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China,School of Applied Technology, Shenzhen University, Shenzhen, China
| | - Yang Liu
- College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China,School of Applied Technology, Shenzhen University, Shenzhen, China
| | - Huai Chen
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xian Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, Shenzhen, China,The Second Clinical Medical College, Jinan University, Guangzhou, China,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China,Rongchang Chen ✉
| | - Yan Kang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China,College of Health Science and Environmental Engineering, Shenzhen Technology University, Shenzhen, China,School of Applied Technology, Shenzhen University, Shenzhen, China,Engineering Research Centre of Medical Imaging and Intelligent Analysis, Ministry of Education, Shenyang, China,*Correspondence: Yan Kang ✉
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18
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Scaramuzzo G, Ronzoni L, Campo G, Priani P, Arena C, La Rosa R, Turrini C, Volta CA, Papi A, Spadaro S, Contoli M. Long-term dyspnea, regional ventilation distribution and peripheral lung function in COVID-19 survivors: a 1 year follow up study. BMC Pulm Med 2022; 22:408. [PMCID: PMC9643983 DOI: 10.1186/s12890-022-02214-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Dyspnea is common after COVID-19 pneumonia and can be characterized by a defective CO2 diffusion (DLCO) despite normal pulmonary function tests (PFT). Nevertheless, DLCO impairment tends to normalize at 1 year, with no dyspnea regression. The altered regional distribution of ventilation and a dysfunction of the peripheral lung may characterize dyspnea at 1 year after COVID-19 pneumonia. We aimed at assessing the pattern of airway resistance and inflammation and the regional ventilation inhomogeneity in COVID-19 pneumonia survivors at 12-months after hospital discharge.
Methods
We followed up at 1-year patients previously admitted to the respiratory units (intensive care or sub-intensive care unit) for COVID-19 acute respiratory failure at 1-year after hospital discharge. PFT (spirometry, DLCO), impulse oscillometry (IOS), measurements of the exhaled nitric oxide (FENO) and Electrical Impedance Tomography (EIT) were used to evaluate lung volumes, CO2 diffusion capacity, peripheral lung inflammation/resistances and the regional inhomogeneity of ventilation distribution. A full medical examination was conducted, and symptoms of new onset (not present before COVID-19) were recorded. Patients were therefore divided into two groups based on the presence/absence of dyspnea (defined as mMRC ≥1) compared to evaluate differences in the respiratory function derived parameters.
Results
Sixty-seven patients were admitted between October and December 2020. Of them, 42/67 (63%) patients were discharged alive and 33 were evaluated during the follow up. Their mean age was 64 ± 11 years and 24/33 (73%) were males. Their maximum respiratory support was in 7/33 (21%) oxygen, in 4/33 (12%) HFNC, in 14/33 (42%) NIV/CPAP and in 8/33 (24%) invasive mechanical ventilation. During the clinical examination, 15/33 (45%) reported dyspnea. When comparing the two groups, no significant differences were found in PFT, in the peripheral airway inflammation (FENO) or mechanical properties (IOS). However, EIT showed a significantly higher regional inhomogeneity in patients with dyspnea both during resting breathing (0.98[0.96–1] vs 1.1[1–1.1], p = 0.012) and during forced expiration (0.96[0.94–1] vs 1 [0.98–1.1], p = 0.045).
Conclusions
New onset dyspnea characterizes 45% of patients 1 year after COVID-19 pneumonia. In these patients, despite pulmonary function test may be normal, EIT shows a higher regional inhomogeneity both during quiet and forced breathing which may contribute to dyspnea.
Clinical trial registration
Clinicaltrials.gov NCT04343053, registration date 13/04/2020.
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19
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Csizmadia Z, Ács P, Szőllősi GJ, Tóth B, Kerti M, Kovács A, Varga JT. Freedive Training Gives Additional Physiological Effect Compared to Pulmonary Rehabilitation in COPD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11549. [PMID: 36141823 PMCID: PMC9517084 DOI: 10.3390/ijerph191811549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is beneficial for lung mechanics, chest kinematics, metabolism, and inspiratory and peripheral muscle function. Freediving training (FD) can be effective in sportsmen and can improve breath-holding time. AIMS We sought to determine the effectiveness of freediving training in the pulmonary rehabilitation of COPD patients. PATIENTS AND METHODS Twenty-three COPD patients (15 men and 8 women; median age 63 years; FEV1: 41% pred; BMI: 28 kg/m2) participated in the FD + PR group (3 weeks PR and 3 weeks FD + PR) and 46 patients with COPD (25 men and 21 women; median age 66 years; FEV1: 43% pred; BMI: 27 kg/m2) participated in an inpatient PR program (6 weeks). Patients performed comfort zone breath holding for 30 min/day. Patients increased their breath-holding time within their comfort zone for 30 min. We detected lung function, chest expansion (CWE), inspiratory muscle pressure (MIP), peripheral muscle function (GS), and exercise capacity (6MWD), and we included breath-holding time (BHT), quality of life score (COPD Assessment Test (CAT)), modified Medical Research Dyspnea Scale (mMRC) score, and the severity of the disease assessed by the BODE index (FEV1, BMI, 6MWD, and mMRC) and an alternative scale (FEV1, BMI, 6MWD, and CAT). RESULT There were significant differences in the characteristics of the two groups. Significant improvement was detected in all functional and quality of life parameters except lung function in both groups. Significantly higher improvement was detected in CWE, GS, 6MWD, BHT, CAT, mMRC, alternative scale, and MIP. The improvement in forced vital capacity (FVC) was not significant. There were no side effects of FD training. CONCLUSION The FD method can potentiate the effect of PR, improving not only BHT but also other parameters. TRIAL REGISTRATION ISRCTN ISRCTN13019180. Registered 19 December 2017.
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Affiliation(s)
- Zoltán Csizmadia
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Pongrác Ács
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | | | - Blanka Tóth
- Department of Pulmonary Rehabilitation, National Koranyi Institute of Pulmonology, 1122 Budapest, Hungary
| | - Mária Kerti
- Department of Pulmonary Rehabilitation, National Koranyi Institute of Pulmonology, 1122 Budapest, Hungary
| | - Antal Kovács
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - János Tamás Varga
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary
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20
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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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21
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El-Sobki A, El-Deeb ME, El-Kholy NA, Habaza FR, Shawky MA, Alsobky MEI. Surgical management of laryngeal bilateral abductor palsy: comparative study between carbon dioxide and diode lasers. Lasers Med Sci 2022; 37:3169-3175. [PMID: 35699806 DOI: 10.1007/s10103-022-03589-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
This study aims to compare the results of both CO2 laser and diode laser combined arytenoidectomy with posterior cordectomy in managing patients with bilateral vocal fold paralysis. A prospective study involved 80 bilateral vocal cord immobility patients in adduction. They are divided into two groups according to the laser used, whether CO2 (with a wavelength of 10.6 µm) or diode (with a wavelength of 980 nm). We used mMRC (Modified Medical Research Council) dyspnea scale to assess dyspnea in our patients, while the voice was evaluated by both maximum phonation time and the voice handicap index. Quantitative variables were described using means and standard deviations, while categorical variables were described using frequencies and were compared using the chi-square test, Fisher exact test, and Monte Carlo test. There was a statistically non-significant difference between the studied groups regarding mMRC dyspnea scale and Voice Handicap Index preoperatively and postoperatively. There is a statistically significant difference between the two groups regarding maximum phonation time postoperatively (significantly higher in the CO2 laser group) (p < 0.001). The CO2 laser and diode laser could be used safely for the management of bilateral vocal cord paralysis. The CO2 laser maintains better voice parameters and less postoperative pain, while the diode laser gives less operative time, lower cost, and simplicity of use.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, 33155, Egypt.
| | - Noha Ahmed El-Kholy
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Fedaey R Habaza
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Ahmed Shawky
- Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
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22
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Umemura A, Sasaki A, Nikai H, Yanari S, Ishioka H, Takahashi N, Katagiri H, Kanno S, Takeda D, Morishita T, Eizuka M, Oizumi T, Nitta H. Improvements of lung volumes and respiratory symptoms after weight loss through laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2022; 407:2747-2754. [PMID: 35588327 DOI: 10.1007/s00423-022-02549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the improvement of respiratory function and airway volumes using spirometry and computed tomography (CT) in severely obese Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also evaluated the quality of life (QOL) of enrolled patients using questionnaires. METHODS A total of 71 patients who underwent LSG at Iwate Medical University Hospital between October 2013 and September 2020 were enrolled. The changes and relationships between respiratory parameters including CT volumetry and weight-loss effects were evaluated. Improvements to QOL and bronchial asthma (BA) were also assessed before LSG and 1 year after LSG. RESULTS The mean excess weight loss percentage (%EWL) and total weight loss percentage (%TWL) were measured at 55.1% and 26.1%, respectively. The attack frequency of BA significantly decreased (6.1/month vs. 1.5/month; P < 0.001), and the disease severity decreased according to severity classification (P = 0.032). Almost spirometric parameters, lung volume (LV) (4905.0 mL vs. 5490.3 mL; P < 0.001), and airway volume (AV) (108.6 mL vs. 119.3 mL; P = 0.022) significantly improved. The change of functional residual capacity (FRC) was correlated with both %EWL (ρ = 0.69, P < 0.001) and %TWL (ρ = 0.62, P < 0.001). The increase of LV (ρ = 0.79, P < 0.001) and AV (ρ = 0.69, P < 0.001) were correlated with the increase of FRC. Scores of QOL questionnaires dramatically became better owing to improvements in dyspnea. CONCLUSION Weight loss effects and the reduction of body fat mass correlated significantly with increase in LV and AV. Improvements of respiratory functions after LSG contributes to QOL and BA symptoms.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Shingo Yanari
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hideki Ishioka
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Naoto Takahashi
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Daiki Takeda
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Toshifumi Morishita
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Tomofumi Oizumi
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
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23
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De Lorenzo R, Palmisano A, Esposito A, Gnasso C, Nicoletti V, Leone R, Vignale D, Falbo E, Ferrante M, Cilla M, Magnaghi C, Martinenghi S, Vitali G, Molfino A, Rovere-Querini P, Muscaritoli M, Conte C. Myosteatosis Significantly Predicts Persistent Dyspnea and Mobility Problems in COVID-19 Survivors. Front Nutr 2022; 9:846901. [PMID: 35464004 PMCID: PMC9024358 DOI: 10.3389/fnut.2022.846901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Persistent symptoms including dyspnea and functional impairment are common in COVID-19 survivors. Poor muscle quality (myosteatosis) associates with poor short-term outcomes in COVID-19 patients. The aim of this observational study was to assess the relationship between myosteatosis diagnosed during acute COVID-19 and patient-reported outcomes at 6 months after discharge. Methods Myosteatosis was diagnosed based on CT-derived skeletal muscle radiation attenuation (SM-RA) measured during hospitalization in 97 COVID-19 survivors who had available anthropometric and clinical data upon admission and at the 6-month follow-up after discharge. Dyspnea in daily activities was assessed using the modified Medical Research Council (mMRC) scale for dyspnea. Health-related quality of life was measured using the European quality of life questionnaire three-level version (EQ-5D-3L). Results Characteristics of patients with (lowest sex- and age-specific tertile of SM-RA) or without myosteatosis during acute COVID-19 were similar. At 6 months, patients with myosteatosis had greater rates of obesity (48.4 vs. 27.7%, p = 0.046), abdominal obesity (80.0 vs. 47.6%, p = 0.003), dyspnea (32.3 vs. 12.5%, p = 0.021) and mobility problems (32.3 vs. 12.5%, p = 0.004). Myosteatosis diagnosed during acute COVID-19 was the only significant predictor of persistent dyspnea (OR 3.19 [95% C.I. 1.04; 9.87], p = 0.043) and mobility problems (OR 3.70 [95% C.I. 1.25; 10.95], p = 0.018) at 6 months at logistic regression adjusted for sex, age, and BMI. Conclusion Myosteatosis diagnosed during acute COVID-19 significantly predicts persistent dyspnea and mobility problems at 6 months after hospital discharge independent of age, sex, and body mass. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [NCT04318366].
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Affiliation(s)
- Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Palmisano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Esposito
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Gnasso
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Nicoletti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Leone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Vignale
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Falbo
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marica Ferrante
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marta Cilla
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristiano Magnaghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabina Martinenghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giordano Vitali
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Patrizia Rovere-Querini
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
- *Correspondence: Caterina Conte,
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Fei F, Koffman J, Zhang X, Gao W. Synergistic Impact of the Symptom Cluster on Health-Related Quality of Life in Patients With Chronic Obstructive Pulmonary Disease: A Secondary Data Analysis. Clin Nurs Res 2022; 31:991-999. [PMID: 35362332 PMCID: PMC9266057 DOI: 10.1177/10547738221085765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to quantify the synergistic impact of symptom clusters on health-related quality of life (HRQoL) among patients with chronic obstructive pulmonary disease (COPD). We conducted a secondary analysis of a cross-sectional data collected via convenience sampling from patients with COPD. Multiple linear regressions were used to quantify the relationships between symptom clusters and HRQoL. The sample included 106 COPD patients from whom three symptom clusters were identified comprising of dyspnea depression, anxiety-sleep, and depression-anxiety. Depression-anxiety (psychological symptom cluster) was significantly associated with poorer HRQoL (β = 13.88, 95% CI [7.94, 19.82]), while no significant associations were detected with HRQoL for either depression or anxiety alone (β = 6.66, 95% CI [-2.99, 16.31]; β = 7.29, 95% CI [-0.78, 15.35]). Assessment and early intervention led by nurses targeting the psychological symptom cluster may represent an initial approach to improve HRQoL. Understanding the phenomenon of symptom clusters that are present in patients with COPD provides a breakthrough insight to devise strategies for their management.
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Affiliation(s)
- Fei Fei
- King's College London, UK.,Jiangsu College of Nursing, Huai'an, P.R. China
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25
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Hagenburg J, Bertin E, Salmon JH, Thierry A, Perotin JM, Dormoy V, Dury S, Gaubil I, Bolko L, Lebargy F, Deslee G, Launois C. Association between obesity-related dyspnea in daily living, lung function and body composition analyzed by DXA: a prospective study of 130 patients. BMC Pulm Med 2022; 22:103. [PMID: 35337302 PMCID: PMC8957162 DOI: 10.1186/s12890-022-01884-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background Obesity is a risk factor for dyspnea. However, investigations of daily living obesity-related dyspnea are limited and its mechanisms remain unclear. We conducted a cross-sectional study to analyze the relationships between dyspnea in daily living, lung function, and body composition in patients with obesity. Methods One-hundred and thirty patients (103 women/27 men), candidate for bariatric surgery, with a mean ± SD Body Mass Index (BMI) of 44.8 ± 6.8 kg/m2 were included. Dyspnea was assessed by the modified Medical Research Council (mMRC) scale. Comorbidities, laboratory parameters, pulmonary function tests, arterial blood gases, six-minute walk test (6MWT), handgrip strength, and DXA body composition were analyzed. Results Thirty-one percent of patients exhibited disabling dyspnea in daily living (mMRC ≥ 2). Compared with patients without disabling dyspnea (mMRC < 2), significant dyspnea (mMRC ≥ 2) was associated with a lower 6MWT distance (395 ± 103 m vs 457 ± 73 m, p < 0.001), lower lung volumes including Expiratory Reserve Volume (42 ± 28% vs 54 ± 27%, p = 0.024), Vital Capacity (95 ± 14 vs 106 ± 15%, p < 0.001) and Forced expiratory volume in one second (95 ± 13 vs 105 ± 15%, p = 0.002), a higher BMI (48.2 ± 7.7 vs 43.2 ± 5.7 kg/m2, p = 0.001) and a higher percentage of fat mass in the trunk (46 ± 5 vs 44 ± 5 p = 0.012) and android region (52 ± 4 vs 51 ± 4%, p = 0.024). There was no difference regarding comorbidities (except hypertension), laboratory parameters, and sarcopenia markers between patients with (mMRC ≥ 2) and without (mMRC < 2) disabling dyspnea. Conclusion Dyspnea in patients with obesity is associated with a reduction in lung volumes and a higher percentage of fat mass in central body regions. How dyspnea and body composition may change with interventions like physical activity or bariatric surgery remains to be investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01884-5.
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Affiliation(s)
- Jean Hagenburg
- Service Des Maladies Respiratoires, CHU Reims, Reims, France
| | - Eric Bertin
- Service d'Endocrinologie Diabète Nutrition, Centre Spécialisé Obésité, CHU Reims, Reims, France
| | | | | | - Jeanne-Marie Perotin
- Service Des Maladies Respiratoires, CHU Reims, Reims, France.,INSERM UMR-S 1250 "Pathologies Pulmonaires Et Plasticité Cellulaire", Reims, France
| | - Valérian Dormoy
- INSERM UMR-S 1250 "Pathologies Pulmonaires Et Plasticité Cellulaire", Reims, France
| | - Sandra Dury
- Service Des Maladies Respiratoires, CHU Reims, Reims, France
| | - Isabelle Gaubil
- Service d'Endocrinologie Diabète Nutrition, Centre Spécialisé Obésité, CHU Reims, Reims, France
| | - Lois Bolko
- Service de Rhumatologie, CHU Reims, Reims, France
| | | | - Gaëtan Deslee
- Service Des Maladies Respiratoires, CHU Reims, Reims, France.,INSERM UMR-S 1250 "Pathologies Pulmonaires Et Plasticité Cellulaire", Reims, France
| | - Claire Launois
- Service Des Maladies Respiratoires, CHU Reims, Reims, France.
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Eid W, El Shinnawy O, Metwally M, Abdel Aleem N. Assessment of noninvasive ventilation in patients with acute severe asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2022. [DOI: 10.4103/ejcdt.ejcdt_64_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Szucs B, Petrekanits M, Fekete M, Varga JT. The use of near-infrared spectroscopy for the evaluation of a 4-week rehabilitation program in patients with COPD. Physiol Int 2021; 108:427-439. [PMID: 34662293 DOI: 10.1556/2060.2021.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) technology can evaluate muscle metabolism and oxygenation. NIRS-based oximeters can measure skeletal muscle oxygen delivery and utilization during static and dynamic work non-invasively. Our goal was to assess the value and usability of NIRS technology in chronic obstructive pulmonary disease (COPD) rehabilitation program. METHODS Forty patients with COPD participated in a 4-week inpatient rehabilitation program that included breathing exercises and personalized cycle/treadmill training adjusted to the functional capacity, physical activity and comorbidities of the patients. A NIRS muscle oxygen monitor was used to measure tissue oxygenation and hemoglobin levels. Total hemoglobin index, average muscle oxygenation, minimal and maximal muscle oxygenation were recorded before and after the rehabilitation program. RESULTS Rehabilitation resulted improvement in 6 min walking distance (6MWD:335.3 ± 110. vs. 398.3 ± 126.2 m; P < 0.01), maximal inspiratory pressure (MIP: 57.7 ± 22.7 vs. 63.6 ± 18.0 cmH2O; P < 0.01), chest wall expansion (CWE: 2.84 ± 1.26 vs, 4.00 ± 1.76 cm; P < 0.01), breath hold time (BHT: 25.8 ± 10.6 vs. 29.2 ± 11.6 s; P < 0.01) and grip strength (GS: 24.9 ± 11.9 vs. 27.0 ± 11.4 kg; P < 0.01). Quality of life improvement was monitored by COPD Assessment Test (CAT: 17.00 ± 8.49 vs. 11.89 ± 7.3, P < 0.05). Total hemoglobin index (tHb: 12.8 ± 1.3% vs. 12.8 ± 1.4), average muscle oxygenation (SmO2: 67.5 ± 14.4% vs. 65.2 ± 20.4%) showed a tendency for improvement. Maximal muscle oxygenation decreased (SmO2 max: 98.0 ± 20.5% vs. 90.1 ± 14.3%; P < 0.01). Minimal muscle oxygenation increased (SmO2 min: 42.6 ± 12.6% vs. 54.8 ± 14.3%; P < 0.01). CONCLUSIONS NIRS results showed that muscle oxygenation and microcirculation can be described as a high-risk factor in COPD patients. The 4-week rehabilitation improves functional parameters, quality of life and tissue oxygenation levels in COPD patients.
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Affiliation(s)
- Botond Szucs
- 1 PharmaFlight Research and Training Center, Debrecen, Hungary
| | - Mate Petrekanits
- 2 Institute of Exercise Physiology and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Monika Fekete
- 3 Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Janos T Varga
- 4 Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Abnormal pulmonary function and imaging studies in critical COVID-19 survivors at 100 days after the onset of symptoms. Respir Investig 2021; 59:614-621. [PMID: 34148855 PMCID: PMC8185183 DOI: 10.1016/j.resinv.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
Background The long-term repercussions of critical COVID-19 on pulmonary function and imaging studies remains unexplored. In this study, we investigated the pulmonary function and computed tomography (CT) findings of critical COVID-19 patients approximately 100 days after symptom onset. Methods We retrospectively extracted data on critical COVID-19 patients who received invasive mechanical ventilation during hospitalization from April to December 2020 and evaluated their pulmonary function, residual respiratory symptoms and radiographic abnormalities on CT. Results We extracted 17 patients whose median age was 63 (interquartile range [IQR], 59–67) years. The median lengths of hospitalization and mechanical ventilation were 23 (IQR, 18–38) and 9 (IQR, 6–13) days, respectively. At 100 days after symptom onset, the following pulmonary function abnormalities were noted in 8 (47%) patients: a diffusion capacity of the lung for carbon monoxide (%DLCO) of <80% for 6 patients (35%); a percent vital capacity (%VC) of <80% for 4 patients (24%); and a forced expiratory volume in one second/forced vital capacity (FEV1%) of <70% for 1 patient (6%) who also presented with %DLCO and %VC abnormalities. Twelve (71%) patients reported residual respiratory symptoms and 16 (94%) showed abnormalities on CT. Conclusions Over 90% of the critical COVID-19 patients who underwent invasive mechanical ventilation continued presenting with abnormal imaging studies and 47% of the patients presented with abnormal pulmonary function 100 days after symptom onset. The extent of the residual CT findings might be associated with the degree of abnormal pulmonary function in critical COVID-19 survivors.
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Nugmanova D, Feshchenko Y, Iashyna L, Polianska M, Malynovska K, Stafeyeva I, Makarova J, Vasylyev A. Association between body mass index and patient-reported-outcome questionnaire scores (CAT™, ACT™, mMRC dyspnoea scale, IPAQ) in Ukraine, Kazakhstan and Azerbaijan: results of the CORE study. BMC Pulm Med 2021; 21:192. [PMID: 34098922 PMCID: PMC8182935 DOI: 10.1186/s12890-021-01542-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/13/2021] [Indexed: 01/01/2023] Open
Abstract
Background The overweight/obese population (evaluated by a body mass index, BMI) represents a global health problem and contributes to the development of various chronic diseases. In this epidemiological study we evaluated this relationship by analyzing patient-reported questionnaires related to respiratory function, physical activity and BMI. Methods In 2013–2015, adult residents of selected cities were enrolled to this study in: Ukraine (M/F: 403/561), Kazakhstan (M/F = 348/597) and Azerbaijan (M/F: 389/544). Height was measured using a vertical measuring board, and body weight was measured by using portable digital scales. All participants were interviewed using CAT™, mMRC scale and IPAQ; respondents who also reported wheezing or whistling chest sounds during the previous 12 months additionally ACT™. Results 45.4% of respondents in Ukraine, 47.6% in Kazakhstan and 54.9% of respondents in Azerbaijan were found to be overweight/obese (BMI ≥ 25 kg/m2). The mean CAT™ total score among this population versus those respondents with a normal weight was 5.2 versus 3.6 (Ukraine, p < 0.001), 4.2 versus 2.9 (Kazakhstan, p < 0.001) and 5.9 versus 4.3 (Azerbaijan, p < 0.001). The number of respondents without airflow limitations (mMRC score 0) among overweight/obese respondents versus normal weight respondents was 298 (68.2%) versus 456 (86.7%) in Ukraine, 261 (58.1%) versus 387 (78.2%) in Kazakhstan and 343 (67.1%) versus 345 (82.3%) in Azerbaijan. The ACT™ total score between overweight/obese respondents and normal weight respondents was not statistically different. IPAQ showed a tendency towards a higher proportion of “low activity” results (compared to “moderate” and “high”) in the overweight/obese subgroup (24.7% vs. 23.8% in Kazakhstan, 18.5% vs. 14.6% in Azerbaijan), and in Ukraine this difference was significant (12.4% vs. 5.2%, p < 0.001). Conclusion CAT™ and mMRC are widely used tools for respiratory function assessment. Despite CAT™ scores being close to a normal value (< 5), the relationship of both CAT™ and mMRC scores with being overweight/obese was demonstrated in the general adult population of three CIS countries. IPAQ may also be a useful instrument for measuring activity level however, more objective studies are required to evaluate the relationship between BMI and physical activity. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01542-2.
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Affiliation(s)
- D Nugmanova
- Semey State Medical University, Almaty, Kazakhstan
| | - Y Feshchenko
- National Institute of Phtysiology and Pulmonology Named After F.G. Yanovskiy NA, Kyiv, Ukraine
| | - L Iashyna
- National Institute of Phtysiology and Pulmonology Named After F.G. Yanovskiy NA, Kyiv, Ukraine
| | - M Polianska
- National Institute of Phtysiology and Pulmonology Named After F.G. Yanovskiy NA, Kyiv, Ukraine
| | | | - I Stafeyeva
- Semey State Medical University, Almaty, Kazakhstan
| | - J Makarova
- GlaxoSmithKline, Moscow, 125167, Russia.
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Yawn BP, Han M, Make BM, Mannino D, Brown RW, Meldrum C, Murray S, Spino C, Bronicki JS, Leidy N, Tapp H, Dolor RJ, Joo M, Knox L, Zittleman L, Thomashow BM, Martinez FJ. Protocol Summary of the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) Validation in Primary Care Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2021; 8. [PMID: 33156981 DOI: 10.15326/jcopdf.2020.0155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) often remains undiagnosed and untreated. To date, COPD screening/case finding has not been designed to identify clinically significant COPD, disease ready for therapies beyond smoking cessation. Herein, we describe the ongoing prospective, pragmatic cluster-randomized controlled trial to assess specificity and sensitivity of the COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool consisting of 5 questions and peak expiratory flow. The tool is designed to identify clinically significant COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity [FVC] ratio <.70 plus FEV1% predicted <60% or increased risk for exacerbation) and the trial will explore the impact of CAPTURE-based screening on COPD diagnosis and treatment rates in primary care patients. Of a total planned enrollment of 5000 English- or Spanish-speaking patients 45 to 80 years of age without a prior COPD diagnosis from 100 primary care practices, a total of 68 practices and 3064 patients have been enrolled in the study. Practices are centrally randomized to either usual care or clinician receipt of patient-level CAPTURE results. All clinicians receive basic COPD education with those in intervention practices also receiving CAPTURE interpretation education. In a single visit, patient participants complete a CAPTURE screening, pre- and post-bronchodilator spirometry and baseline demographic and health questionnaires to validate CAPTURE sensitivity, specificity, and predictive value of identifying undiagnosed, clinically significant COPD. One-year follow-up chart reviews and participant surveys assess the impact of sharing versus not sharing CAPTURE results with clinicians on clinical outcomes including level of respiratory symptoms and events and clinicians' initiation of recommendation-concordant COPD care. This is one of the first U.S. studies to validate and assess impact of a simple COPD screening tool in primary care.
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Affiliation(s)
- Barbara P Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minnesota, United States.,COPD Foundation, Miami, Florida, United States
| | - Meilan Han
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Barry M Make
- Pulmonary Sciences and Critical Care Medicine, National Jewish Health, Denver, Colorado, United States
| | - David Mannino
- College of Public Health, Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, Kentucky, United States
| | - Randall W Brown
- School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | - Catherine Meldrum
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States
| | - Susan Murray
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | - Cathie Spino
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | - Jacqueline S Bronicki
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, North Carolina, United States
| | - Rowena J Dolor
- Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina, United States
| | - Min Joo
- Medicine and Pulmonary and Critical Care, University of Illinois, Chicago, Illinois, United States
| | - Lyndee Knox
- L.A. Net Community Health Center, Los Angeles, California, United States
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado, High Plains Research Network, Aurora, Colorado, United States
| | - Byron M Thomashow
- Division of Pulmonary and Critical Care Medicine, Columbia University, New York, New York
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, United States
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Andersén H, Ilmarinen P, Honkamäki J, Tuomisto LE, Piirilä P, Hisinger-Mölkänen H, Sovijärvi A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Kankaanranta H. Dyspnea has an association with lifestyle: differences between Swedish and Finnish speaking persons in Western Finland. Eur Clin Respir J 2020; 8:1855702. [PMID: 33343838 PMCID: PMC7733976 DOI: 10.1080/20018525.2020.1855702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Difference in dyspnea mMRC ≥2 between Finnish speaking and Swedish-speaking populations in Finland has not been previously studied. Methods In February 2016, a respiratory questionnaire was sent to 8000 randomly selected subjects aged 20–69 years in western Finland with a response rate of 52.3%. The registered native language of each subject determined whether questionnaire in Finnish or Swedish was applied. Multiple logistic regression was performed to calculate Odds Ratios (OR) with 95% CI for the simultaneous effects of independent variables on dyspnea mMRC ≥2. Results Of all participants, 2780 (71.9%) were Finnish speakers and 1084 (28.1%) were Swedish speakers. Finnish speakers had a higher prevalence of dyspnea mMRC ≥2 (11.1% vs 6.5% p < 0.001) when compared to Swedish speakers. Finnish speakers smoked more often, had higher BMI, spent less time moving during the day, had more often occupational exposure to vapours, gases, dusts or fumes (VGDF), and had lower socioeconomic status based on occupation. Significant risk factors for dyspnea mMRC ≥2 were COPD (OR = 10.94), BMI >35 (OR = 9.74), asthma (OR = 4.78), female gender (OR = 2.38), older age (OR = 2.20), current smoking (OR = 1.59), and occupational exposure to VGDF (OR = 1.47). Conclusions Swedish speakers had less dyspnea mMRC ≥2 which is explained by a healthier lifestyle. Smoking, obesity, and occupational exposures should be in focus to improve respiratory health.
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Affiliation(s)
- Heidi Andersén
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Respiratory Medicine, Vaasa Central Hospital, Vaasa, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Anssi Sovijärvi
- Unit of Clinical Physiology, Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Department of Internal Medicine, Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Management of bilateral abductor paralysis: posterior cordectomy with partial arytenoidectomy using diode laser. Eur Arch Otorhinolaryngol 2020; 278:1145-1151. [PMID: 33245452 DOI: 10.1007/s00405-020-06492-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to assess the role of diode laser-assisted posterior cordectomy with partial arytenoidectomy in the management of bilateral vocal fold paralysis patients. METHODS Posterior cordectomy with partial arytenoidectomy using diode laser was performed to thirty-nine patients with bilateral vocal fold paralysis. Voice was evaluated by maximal phonation time and Arabic version of the voice handicap index, while breathing difficulty was assessed by mMRC (Modified Medical Research Council) dyspnea scale. RESULTS There is a statistically significant decrease in mMRC from 2.8 ± 0.645 preoperatively to 0.84 ± 0.554 postoperatively (p < 0.001). However, maximum phonation time is significantly decreased from 8.04 ± 0.978 preoperatively to 6.92 ± 0.997 postoperatively (p < 0.001); there is a statistically non-significant increase in vocal handicap index from 37.12 ± 6.26 preoperatively to 37.24 ± 6.22) postoperatively (p > 0.05). CONCLUSIONS The diode laser is a viable method that should be considered for the management of bilateral vocal cord paralysis. It seems to be a very promising laser device, so we expect that new diode laser wavelengths (980 nm) will continue to emerge, making it a good alternative to the CO2 laser, but with lower cost, accurate manipulation, portability, shorter duration, and simplicity of use. LEVEL OF EVIDENCE 4.
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Rong B, Fu T, Rong C, Liu W, Li K, Liu H. Association between serum CCL-18 and IL-23 concentrations and disease progression of chronic obstructive pulmonary disease. Sci Rep 2020; 10:17756. [PMID: 33082377 PMCID: PMC7576212 DOI: 10.1038/s41598-020-73903-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
This study aimed to investigate the association between serum concentrations of chemokine (C-C Motif) ligand 18 (CCL-18) and interleukin 23 (IL-23) and clinical parameters of chronic obstructive pulmonary disease (COPD). The serum concentrations of CCL-18 and IL-23 were tested by enzyme linked immunosorbent assay (ELISA). The association between their concentrations and clinical parameters of COPD patients were analyzed by linear regression, logistic regression and ROC curve. The results showed that the serum concentrations of CCL-18 and IL-23 in COPD patients were increased compared with healthy people (P < 0.001) and that patients with acute exacerbation of COPD (AECOPD) had higher serum CCL-18 and IL-23 concentrations than stable patients (P < 0.001). Synergistic increase of CCL-18 and IL-23 in COPD patients was positively correlated with COPD patients' higher GOLD grade (P < 0.001), higher mMRC score (P < 0.001) and longer medical history (P < 0.001), but negatively correlated with the forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) (P < 0.001) and FEV1% predicted (P < 0.001). The serum concentrations of CCL-18 and IL-23 were most related to the GOLD grade (OR = 2.764 for CCL-18 and OR = 4.215 for IL-23) and detection of both showed considerable sensitivity (72.57% for CCL-18 and 76.92% for IL-23) and specificity (92.50% for CCL-18 and 77.5% for IL-23) in identifying COPD. Increased serum concentrations of CCL-18 and IL-23 correlated with the disease progression of COPD and they could be used as biomarkers for disease evaluation of COPD.
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Affiliation(s)
- Biaoxue Rong
- Department of Gerontology, The First Affiliated Hospital, Xi'an Medical University, 48 Fenghao West Road, Xi'an, 710077, China. .,School of Clinical Medicine, Xi'an Medical University, Xi'an, China.
| | - Tian Fu
- Department of Respiratory Medicine, Jining No. 1 People's Hospital, Jining, China
| | - Congxue Rong
- Comprehensive Medical Department, Zhangye Second People Hospital, Zhangye, China
| | - Wen Liu
- Department of Respiratory Medicine, Minqin County People's Hospital, Minqin, China
| | - Kai Li
- School of Clinical Medicine, Xi'an Medical University, Xi'an, China
| | - Hua Liu
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, China
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de Paula WD, Rodrigues MP, Ferreira NMC, Passini VV, Melo-Silva CA. Lung MRI to predict response or lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 match/mismatch. Expert Rev Respir Med 2020; 15:285-292. [PMID: 32993387 DOI: 10.1080/17476348.2020.1828070] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ground-glass opacities (GGO) are frequently found in interstitial lung diseases (ILD) and may represent either active inflammation or subresolution interstitial fibrosis. We sought to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO. Methods: prospective cohort, 15 participants presenting with ILD manifested as predominant GGO and referred for a new treatment regimen with a systemic glucocorticoid and/or an immunosuppressive agent, underwent 1.5 T lung MRI. SSFSE/PROPELLER T2 mismatch sign, relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response, defined as a greater than 10% increase in forced vital capacity in 10 weeks (primary endpoint). RESULTS SSFSE/PROPELLER T2 match/mismatch was able to discriminate responders from nonresponders for the primary endpoint in 12 of 15 participants (80% accuracy, p = 0.026) for readers 1 and 2, and in 13 of 15 participants (87% accuracy, p = 0.011) for reader 3, with interrater agreement of 87% between readers 1 and 2 (Cohen's kappa coefficient of 0.732) and 93% between readers 1/2 and 3 (Cohen's kappa coefficient of 0.865). CONCLUSIONS SSFSE-PROPELLER T2 match/mismatch was predictive of treatment response status in this group of ILD patients. Abbreviations FVC: forced vital capacityGGO; ground-glass opacities; HRCT: High-Resolution Computed Tomography; ILD: interstitial lung disease; LAVA: Liver Acquisition with Volume Acceleration; mMRC: modified Medical Research Council dyspnea score; MRI: Magnetic Resonance Image; PROPELLER: Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction; SI: signal intensity; SSFSE: Single-Shot Fast Spin Echo.
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Affiliation(s)
- Wagner Diniz de Paula
- Department of Radiology, University Hospital of the University of Brasilia School of Medicine , Brasília, Brazil
| | - Marcelo Palmeira Rodrigues
- Department of Pulmonology, University Hospital of the University of Brasilia School of Medicine , Brasília, Brazil
| | | | - Viviane Vieira Passini
- Department of Pulmonology, University Hospital of the University of Brasilia School of Medicine , Brasília, Brazil
| | - César Augusto Melo-Silva
- Department of Pulmonology, University Hospital of the University of Brasilia School of Medicine , Brasília, Brazil
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Strand M, Austin E, Moll M, Pratte KA, Regan EA, Hayden LP, Bhatt SP, Boriek AM, Casaburi R, Silverman EK, Fortis S, Ruczinski I, Koegler H, Rossiter HB, Occhipinti M, Hanania NA, Gebrekristos HT, Lynch DA, Kunisaki KM, Young KA, Sieren JC, Ragland M, Hokanson JE, Lutz SM, Make BJ, Kinney GL, Cho MH, Pistolesi M, DeMeo DL, Sciurba FC, Comellas AP, Diaz AA, Barjaktarevic I, Bowler RP, Kanner RE, Peters SP, Ortega VE, Dransfield MT, Crapo JD. A Risk Prediction Model for Mortality Among Smokers in the COPDGene® Study. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2020; 7:346-361. [PMID: 32877963 PMCID: PMC7883903 DOI: 10.15326/jcopdf.7.4.2020.0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Risk factor identification is a proven strategy in advancing treatments and preventive therapy for many chronic conditions. Quantifying the impact of those risk factors on health outcomes can consolidate and focus efforts on individuals with specific high-risk profiles. Using multiple risk factors and longitudinal outcomes in 2 independent cohorts, we developed and validated a risk score model to predict mortality in current and former cigarette smokers. METHODS We obtained extensive data on current and former smokers from the COPD Genetic Epidemiology (COPDGene®) study at enrollment. Based on physician input and model goodness-of-fit measures, a subset of variables was selected to fit final Weibull survival models separately for men and women. Coefficients and predictors were translated into a point system, allowing for easy computation of mortality risk scores and probabilities. We then used the SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) cohort for external validation of our model. RESULTS Of 9867 COPDGene participants with standard baseline data, 17.6% died over 10 years of follow-up, and 9074 of these participants had the full set of baseline predictors (standard plus 6-minute walk distance and computed tomography variables) available for full model fits. The average age of participants in the cohort was 60 for both men and women, and the average predicted 10-year mortality risk was 18% for women and 25% for men. Model time-integrated area under the receiver operating characteristic curve statistics demonstrated good predictive model accuracy (0.797 average), validated in the external cohort (0.756 average). Risk of mortality was impacted most by 6-minute walk distance, forced expiratory volume in 1 second and age, for both men and women. CONCLUSIONS Current and former smokers exhibited a wide range of mortality risk over a 10- year period. Our models can identify higher risk individuals who can be targeted for interventions to reduce risk of mortality, for participants with or without chronic obstructive pulmonary disease (COPD) using current Global initiative for obstructive Lung Disease (GOLD) criteria.
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Affiliation(s)
| | | | - Matthew Moll
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | | | | | | | - Richard Casaburi
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Ingo Ruczinski
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Harry B. Rossiter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
- University of Leeds, Leeds, United Kingdom
| | - Mariaelena Occhipinti
- University of Florence, Florence, Italy
- *Dr. Occhipinti is now at the Imaging Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | | | | | - Ken M. Kunisaki
- Minneapolis Veterans Administration Health Care System, Minnesota
| | | | | | | | | | - Sharon M. Lutz
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | | | - Dawn L. DeMeo
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | | | - Igor Barjaktarevic
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles
| | | | | | - Stephen P. Peters
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Victor E. Ortega
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Mansour W, El-Shabrawy M, Khalil WA, Eldamanhory AS, Embarak S. Arterial stiffness can occur early in mild-to-moderate chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a well-known respiratory system disorder impacting patient’s morbidity and mortality. Many COPD patients die from cardiovascular diseases. Criteria of arterial stiffness might be the early clue for cardiovascular affection in COPD patients. This study aimed to evaluate the occurrence of arterial stiffness as an early subclinical change in stable mild to moderate COPD patients.
Results
This cross-sectional study included 80 mild-to-moderate COPD patients and another 80 healthy controls. The carotid-femoral pulse wave velocity (cf-PWV) and the heart rate adjusted augmentation index (AIx75) were statistically significantly higher (13.8 ± 2.6 and 23.9 ± 10.8, respectively) among studied mild-to-moderate COPD patients when compared to healthy controls (10.7 ± 1.1 and 18.1 ± 8.9, respectively) (p < 0.001). FEV1 (forced expiratory volume in 1 s) % of predicted correlated negatively with both AIx75 (r = − 0.84, p < 0.001) and cf-PWV (r = − 0.85, p < 0.001), while BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index correlated positively with both AIx75 (r = 0.58, p < 0.001) and cf-PWV (r = 0.52, p < 0.001) in patients with mild-to-moderate COPD.
Conclusions
Pulse wave velocity and augmentation index correlated with FEV1% of predicted and BODE index in patients with mild-to-moderate COPD.
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Correlation between serum IL-32 concentration and clinical parameters of stable COPD: a retrospective clinical analysis. Sci Rep 2020; 10:12092. [PMID: 32694699 PMCID: PMC7374623 DOI: 10.1038/s41598-020-69000-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/06/2020] [Indexed: 01/24/2023] Open
Abstract
This study was to investigate the association between serum interleukin 32 (IL-32) concentration and clinical parameters in patients with stable chronic obstructive pulmonary disease (COPD). One hundred and sixteen patients with stable COPD and 70 healthy subjects were included in the study. The serum concentration of IL-32 was detected by enzyme-linked immunosorbent assay. The correlation between serum IL-32 and clinical parameters of patients with COPD was analyzed by T-test, one-way analysis of variance, multiple linear regression and receiver operating characteristic curve. The serum concentration of IL-32 in patients with stable COPD was higher than that in healthy control group (p < 0.001) and increased serum IL-32 was positively correlated with GOLD grading (p = 0.026), mMRC score (p = 0.004) and clinical medical history (p = 0.005), but negatively related to FEV1/FVC (p = 0.001) and FEV1% predicted (p = 0.001). Patient's COPD grading (p = 0.001), clinical medical history (p < 0.001) and FEV1/FVC (p = 0.001) exerted a significant impact on serum IL-32. The sensitivity and specificity of serum IL-32 for discerning COPD patients from healthy individuals were 85.34% and 64.29%, and the area under the curve was 0.808 (p < 0.001). Increased IL-32 is involved in the chronic disease progression of COPD, suggesting that IL-32 may be a molecular biomarker that reflects the severity of COPD and contributes to the disease diagnosis.
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Dyspnea perception during the inspiratory resistive loads test in obese subjects waiting bariatric surgery. Sci Rep 2020; 10:8023. [PMID: 32415112 PMCID: PMC7228946 DOI: 10.1038/s41598-020-64677-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/15/2020] [Indexed: 12/05/2022] Open
Abstract
Identification of low dyspnea perception is relevant, since this condition is significantly associated with worse outcomes. We investigated dyspnea perception during the inspiratory resistive loads test on obese subjects waiting bariatric surgery in comparison with normal subjects. Secondarily, we analysed the proportion of obese subjects with low, moderate and high dyspnea perception. This observational study included subjects with body mass index (BMI) ≥ 35 kg/m2, compared to healthy subjects with BMI ≥ 18 and <25 kg/m2. Subject underwent clinical evaluation, inspiratory test with progressive resistive loads and spirometry. We studied 23 obese subjects (mean BMI = 51.9 ± 9.3 kg/m2) and 25 normal subjects (mean BMI = 24.3 ± 2.3 kg/m2). With the increase magnitude of resistive loads there was a significant increase in dyspnea score (p < 0.001) and progressive increase of the generated inspiratory pressure (p < 0.001), but there was no difference between the groups in terms of dyspnea score (p = 0.191) and no interaction effect (p = 0.372). Among the obese subjects, 4 individuals were classified as low perception, 11 as moderate and 8 as high. In conclusion, the degree of dyspnea perception during the inspiratory progressive resistive loads test did not differ between obese and normal subjects. Among obese subjects, only 17% were classified as low dyspnea perception.
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Rong B, Fu T, Gao W, Li M, Rong C, Liu W, Liu H. Reduced Serum Concentration of CC16 Is Associated with Severity of Chronic Obstructive Pulmonary Disease and Contributes to the Diagnosis and Assessment of the Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:461-470. [PMID: 32184583 PMCID: PMC7060081 DOI: 10.2147/copd.s230323] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to reveal the correlations between serum concentration of Clara cell secretory protein (CC16) and clinical parameters of stable chronic obstructive pulmonary disease (COPD). Patients and Methods Serum concentration of CC16 was determined by enzyme-linked immunosorbent assay (ELISA). The correlations between serum concentration of CC16 and clinical parameters was performed by linear correlation analysis and multiple linear regression analysis. The sensitivity and specificity of serum CC16 for differential diagnosis of COPD were determined by receiver operator characteristic curve (ROC). Results The serum concentration of CC16 was down-regulated in stable COPD patients compared with healthy control group (p < 0.05). The decreased serum CC16 was negatively related to smoking (p < 0.05), GOLD grading (p < 0.005), mMRC score (p < 0.05) and medical history (p < 0.05) of patients, but positively correlated with pulmonary function (p < 0.05). The smoking, FEV1/FVC values, COPD grading and mMRC scores all affected the concentration of CC16 (p < 0.05). The decreased CC16 was an independent risk factor in the process of deterioration of lung function. The sensitivity and specificity of serum CC16 for identifying COPD reached to 65.3% and 75%. Conclusion Decreased serum concentration of CC16 correlated with the disease progression of COPD, suggesting that it can be used as an indicator contributing to the diagnosis and assessment of COPD.
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Affiliation(s)
- Biaoxue Rong
- Department of Oncology and Gerontology, First Affiliated Hospital, Xi'an Medical University, Xi'an, People's Republic of China
| | - Tian Fu
- Department of Respiratory Medicine, Jining No.1 People's Hospital, Jining, People's Republic of China
| | - Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, People's Republic of China
| | - Min Li
- Nursing Department, Binhe New District Branch, Shenmu Hospital, Yulin City, Shaanxi, People's Republic of China
| | - Congxue Rong
- Comprehensive Medical Department, Zhangye Second People Hospital, Zhangye, People's Republic of China
| | - Wen Liu
- Department of Respiratory Medicine, Minqin County People's Hospital, Minqin, People's Republic of China
| | - Hua Liu
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, People's Republic of China
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Copley SJ, Jones LC, Soneji ND, Cousins J, Edey A, Ahmed AR, Wells AU. Lung Parenchymal and Tracheal CT Morphology: Evaluation before and after Bariatric Surgery. Radiology 2020; 294:669-675. [DOI: 10.1148/radiol.2020191060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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de Paula WD, Rodrigues MP, Ferreira NMC, Passini VV, Melo-Silva CA. Noninvasive assessment of peripheral skeletal muscle weakness in idiopathic pulmonary fibrosis: a pilot study with multiparametric MRI of the rectus femoris muscle. Multidiscip Respir Med 2020; 15:707. [PMID: 33282283 PMCID: PMC7686790 DOI: 10.4081/mrm.2020.707] [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: 08/03/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background To investigate differences in magnetic resonance imaging (MRI) features of rectus femoris muscle between idiopathic pulmonary fibrosis (IPF) patients and healthy volunteers. Methods Thirteen IPF patients with GAP Index stage II disease were subjected to pulmonary function tests, 6-minute walk test (6MWT), quadriceps femoris muscle strength measurement and MRI of the thigh at rest. At MRI, muscle cross-sectional areas, T2 and T2* relaxometry, and 3-point Dixon fat fraction were measured. The results were compared to those of eight healthy sedentary volunteers. Results IPF patients had significantly lower %predicted FVC, FEV1 and DLCO (p<0.001 for the three variables) and walked significantly less in the 6MWT (p=0.008). Mean quadriceps femoris muscle strength also was significantly lower in IPF patients (p=0.041). Rectus femoris muscle T2* measurements were significantly shorter in IPF patients (p=0.027). No significant intergroup difference was found regarding average muscle cross-sectional areas (p=0.790 for quadriceps and p=0.816 for rectus femoris) or rectus femoris fat fraction (p=0.901). Rectus femoris T2 values showed a non-significant trend to be shorter in IPF patients (p=0.055). Conclusions Our preliminary findings suggest that, besides disuse atrophy, other factors such as hypoxia (but not inflammation) may play a role in the peripheral skeletal muscle dysfunction observed in IPF patients. This might impact the rehabilitation strategies for IPF patients and warrants further investigation.
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Affiliation(s)
| | - Marcelo Palmeira Rodrigues
- Department of Pulmonology, Brasilia University Hospital, University of Brasilia, Brazil Institution where the work was done: Hospital Universitário de Brasília / Universidade de Brasília, Brazil
| | - Nathali Mireise Costa Ferreira
- Department of Pulmonology, Brasilia University Hospital, University of Brasilia, Brazil Institution where the work was done: Hospital Universitário de Brasília / Universidade de Brasília, Brazil
| | - Viviane Vieira Passini
- Department of Pulmonology, Brasilia University Hospital, University of Brasilia, Brazil Institution where the work was done: Hospital Universitário de Brasília / Universidade de Brasília, Brazil
| | - César Augusto Melo-Silva
- Department of Pulmonology, Brasilia University Hospital, University of Brasilia, Brazil Institution where the work was done: Hospital Universitário de Brasília / Universidade de Brasília, Brazil
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Guguen C, Launois C, Dormoy V, Dewolf M, Dumazet A, Dury S, Lebargy F, Deslee G, Perotin JM. [Obesity and asthma: Mechanisms and therapeutic options]. Rev Mal Respir 2019; 37:134-143. [PMID: 31864881 DOI: 10.1016/j.rmr.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Abstract
Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.
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Affiliation(s)
- C Guguen
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - C Launois
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - V Dormoy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Dewolf
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - A Dumazet
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - G Deslee
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
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Bokov P, Delclaux C. [The impact of obesity on respiratory function]. Rev Mal Respir 2019; 36:1057-1063. [PMID: 31522948 DOI: 10.1016/j.rmr.2019.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/06/2019] [Indexed: 01/28/2023]
Abstract
The respiratory impact of obesity can be both symptomatic (resting and exertional breathlessness) and functional (pulmonary function at rest and on exercise). The prevalence of breathlessness is increased in adult obese individuals, ∼50% at rest and ∼75% on exertion (mMRC score>0). Pulmonary function abnormalities in obese adults include reduced functional residual capacity (FRC) and expiratory residual volume (ERV), and less frequently reduced total lung capacity (a restrictive defect, with TLC below the 5th percentile of predicted is present in around 15% in severe obese adults), with normal residual volume (RV). Airflows are barely affected by obesity, but bronchial hyperresponsiveness (BHR) is very prevalent, which may be due to the loss of bronchoprotective effect of deep inspiration in obesity (mechanical pathophysiology of BHR). In children, the modifications of lung volumes seen are quite different: TLC is normal while FRC and RV are reduced, explaining the increase in FVC. FEV1/FVC is therefore reduced by obesity, without true airflow obstruction (dysanaptic growth). Resting oxygen consumption (V'O2) is increased due to obesity and normally increases with exercise. Maximum V'O2 is normal or weakly reduced in obese patients; on the other hand, the increase in respiratory load increases the oxygen cost of ventilation, which tends to be rapid, both at rest and during exertion. Finally, it should be noted that there is only limited statistical correlation between exercise dyspnoea and respiratory function abnormalities in obesity.
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Affiliation(s)
- P Bokov
- Service de physiologie pédiatrique, centre pédiatrique des pathologies du sommeil, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, faculté de médecine, 75018 Paris, France; Inserm, UMR1141, 75019 Paris, France
| | - C Delclaux
- Service de physiologie pédiatrique, centre pédiatrique des pathologies du sommeil, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, faculté de médecine, 75018 Paris, France; Inserm, UMR1141, 75019 Paris, France.
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Ekström MP, Blomberg A, Bergström G, Brandberg J, Caidahl K, Engström G, Engvall J, Eriksson M, Gränsbo K, Hansen T, Jernberg T, Nilsson L, Nilsson U, Olin AC, Persson L, Rosengren A, Sandelin M, Sköld M, Sundström J, Swahn E, Söderberg S, Tanash HA, Torén K, Östgren CJ, Lindberg E. The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study. Thorax 2019; 74:958-964. [DOI: 10.1136/thoraxjnl-2019-213349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/03/2022]
Abstract
IntroductionBreathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.MethodsThis population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.ResultsWe included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness.ConclusionBreathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.
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Matsui Y, Yoshida S, Iwata T, Tanaka K, Yamamoto T, Nishii K, Iizasa T. A strategy for pulmonary resection after contralateral diaphragm plication: a surgical case report. Surg Case Rep 2019; 5:88. [PMID: 31147850 PMCID: PMC6542892 DOI: 10.1186/s40792-019-0648-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022] Open
Abstract
Abstract Background Pulmonary carcinoma patients with low pulmonary function cannot be treated surgically because of the high risk of complications. Diaphragmatic eventration is a disease characterized by diaphragmatic paralysis and dyspnea. Here, we report a surgical case of multiple pulmonary carcinomas with contralateral diaphragmatic eventration. Case presentation The patient was a 75-year-old woman with multiple metachronous right lung carcinomas complicated by left diaphragmatic eventration. When she was 70 years old, a right upper lobectomy and right S6b wedge resection were performed for double lung carcinomas. Five years later, two new lung tumors in her right lower lobe and left diaphragmatic eventration were identified, but resection was thought to be impossible because of her low pulmonary function. We performed video-assisted thoracoscopic surgery (VATS) plication with carbon dioxide (CO2) insufflation for the left diaphragmatic eventration, and her pulmonary function improved. Subsequently, we performed a right S6 wedge resection and right S9 segmentectomy for the double lung tumors with no complications. The tumors were diagnosed as double primary carcinomas. Conclusions Our case presented with low pulmonary function and right multiple lung carcinomas with left diaphragmatic eventration. VATS plication for the left diaphragmatic eventration achieved improvement in her pulmonary function, and right pulmonary resection for the lung carcinomas was performed. VATS plication can expand the choice of treatments in such cases.
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Affiliation(s)
- Yukiko Matsui
- Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.
| | - Shigetoshi Yoshida
- Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan.,Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Takekazu Iwata
- Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Kazuhisa Tanaka
- Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Takayoshi Yamamoto
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kai Nishii
- Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
| | - Toshihiko Iizasa
- Department of Thoracic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan
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Abstract
The severity of the clinical condition and co-morbidities of the patients for esophagectomy require a complex assessment and risk stratification before the operation, and most of the cases need complex management. We did a literature search and considered the data on risk stratification and complex management of patients who undergo thoracic surgery. Smoking cessation programs can protect against complications, which is related to the respiratory system, the heart and the convalescence of the wounds in postoperative condition, but the timing is critical due to the operation. A complex team of physicians and healthcare professionals, as well as respiratory prehabilitation, can help to improve the clinical condition, chest kinematics, lung mechanics, peripheral and respiratory muscle function, metabolism and quality of life of this type of patients. We need to consider a complex risk stratification before esophagectomy and require complex management for these patients, including smoking cessation and respiratory prehabilitation, to improve the post-operative complications.
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Affiliation(s)
- Janos T Varga
- Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary
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Schunk M, Schulze F, Bausewein C. What Constitutes Good Health Care for Patients with Breathlessness? Perspectives of Patients, Caregivers, and Health Care Professionals. J Palliat Med 2018; 22:656-662. [PMID: 30589622 DOI: 10.1089/jpm.2018.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background/Objective: Breathlessness is a highly prevalent and distressing symptom in patients with cancer and advanced chronic diseases. Symptom management is often overlooked. We explored the experiences of patients, caregivers, and health care providers (HCPs) and their expectations for future service developments. Design: This is a multiperspective qualitative study drawing on semistructured interviews. Setting/Subjects: Participants were recruited from palliative, respiratory, and cardiology departments of the Munich University Hospital and from a chronic obstructive pulmonary disease (COPD) patient group. Measurements: Interviews were analyzed using qualitative content analysis. Subcategories used the directional views of participants (positive, negative, and indifferent). The coding tree identified three categories: (1) attributes of symptom management, (2) practice pattern gaps, and (3) components of good practice. Results: Ten patients (5 female, 65.2 median age; COPD n = 3, cancer n = 3, chronic heart failure n = 2, and lung fibrosis n = 2), 3 caregivers (2 female, 53.6 median age), and 10 HCPs were interviewed. Patients and caregivers felt stressed and frustrated due to a lack of awareness regarding the symptom burden and little support from HCPs. HCPs pointed to a lack of therapeutic concepts and unclear assumptions of responsibilities. Specialist breathlessness services are perceived as addressing important gaps in professional practice from the viewpoint of all stakeholders. Accessibility and collaboration with other local health care services are important features of such specialist services. Conclusions: Chronic refractory breathlessness in advanced disease is managed insufficiently for most patients, caregivers, and HCPs. Increased knowledge about effective interventions and availability of skills-based training for patients, caregivers, and HCPs would help in breathlessness management.
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Affiliation(s)
- Michaela Schunk
- 1 Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Friederike Schulze
- 1 Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany.,2 Center for Internal Medicine, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, Germany
| | - Claudia Bausewein
- 1 Department of Palliative Medicine, Munich University Hospital, Ludwig-Maximilians-University, Munich, Germany
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Szucs B, Petrekanits M, Varga J. Effectiveness of a 4-week rehabilitation program on endothelial function, blood vessel elasticity in patients with chronic obstructive pulmonary disease. J Thorac Dis 2018; 10:6482-6490. [PMID: 30746192 DOI: 10.21037/jtd.2018.10.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Chronic obstructive pulmonary disease (COPD) may have considerable cardiovascular risk. Physical activity has a paramount role in COPD treatment. Our aim was to evaluate the applicability of arteriograph in COPD and measure the effectiveness of pulmonary rehabilitation on endothelial function. Methods A total of 40 patients with COPD (FEV1: 45.43±20.20%pred, BMI: 27.99±6.98 kg/m2, male: female was 21:19, age: 65.47±7.39 years) participated in a 4-week rehabilitation program. We used a patented, invasively validated Arteriograph. Blood pressure, pulse, augmentation index (AIX), pulse wave velocity (PWV), diastolic area index (DAI) were registered with functional measurements in pulmonary rehabilitation. Results Pulmonary rehabilitation was effective in 6 minutes walking distance (6MWD: 335.32±110.43 vs. 398.32±126.21 m), maximal inspiratory pressure (MIP: 57.72±22.69 vs. 63.63±18.01 cmH2O), chest wall expansion (CWE: 2.84±1.26 vs. 4.00±1.76 cm), breath holding time (BHT: 25.77±10.63 to 29.21±11.60 sec) and grip strength (GS: 24.87±11.88 vs. 27.03±11.43 kg) (P<0.05). Improvement in quality of life was monitored by COPD assessment test marker (CAT: 17.00±8.49 vs. 11.89±7.31, P<0.05). Systolic (133.38±22.15 vs. 126.48±20.22 mmHg) and diastolic blood pressure (76.95±14.37 vs. 75.4±12.7 mmHg) showed a reduction tendency. Pulse also decreased (76.95±14.37 vs. 72.53±13.65 bpm). AIX levels showed slight improvement (3.54±35.59% vs. 2.93±30.79%); 23 patients peripheral circulation progressed. The PWV data showed abnormal elasticity with minimal change (11.74±2.13 vs. 11.4±2.73 m/s); although 20 patients showed improvement. DAI detected slightly diminished coronary circulation with moderate improvement (43.32±6.81 vs. 47.1±7.01 m/s). Conclusions Elevated arterial stiffness, high PWV turned the COPD patients to the high/very high-risk cluster. Rehabilitation resulted significant improvement in MIP, CWE, BHT, 6MWD, CAT with mild, but favorable changes in blood pressure, pulse, AIX, PWV. As a consequence of the four weeks rehabilitation period overall quality of life improved and cardiovascular risk showed a reduction tendency in COPD.
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Affiliation(s)
- Botond Szucs
- PharmaFlight Research and Training Center, Debrecen, Hungary.,Institute of Exercise Physiology and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Mate Petrekanits
- PharmaFlight Research and Training Center, Debrecen, Hungary.,Institute of Exercise Physiology and Sport Medicine, University of Physical Education, Budapest, Hungary
| | - Janos Varga
- Department of Pulmonary Rehabilitation, National Koranyi Institute for Pulmonology, Budapest, Hungary
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Lanza FC, Castro RAS, de Camargo AA, Zanatta DJM, Rached S, Athanazio R, Cukier A, Stelmach R, Dal Corso S. COPD Assessment Test (CAT) is a Valid and Simple Tool to Measure the Impact of Bronchiectasis on Affected Patients. COPD 2018; 15:512-519. [PMID: 30468091 DOI: 10.1080/15412555.2018.1540034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The COPD assessment test (CAT) is a short questionnaire developed to help patients and clinicians to assess the impact of symptoms in routine clinical practice. We aimed to validate and to test the reproducibility of CAT in patients with bronchiectasis and correlate with the severity of dyspnea, aerobic and functional capacity, and physical activity in daily life. This is a cross-sectional study, patients with bronchiectasis underwent spirometry, cardiopulmonary exercise test (CPET), incremental shuttle walk test (ISWT), Saint George`s Respiratory Questionnaire (SGRQ), and received pedometer. CAT was applied twice (CAT-1 and CAT-2, 7 to 10 days apart). The severity of bronchiectasis was assessed by E-FACED and bronchiectasis severity index (BSI). A total of 100 patients were evaluated (48 ± 14 years, 59 women, FVC: 67 ± 22% pred, FEV1: 52 ± 25% pred). According to CAT, 14% patients presented low, 40% medium, 32% high, and 14% very high impact. The higher the CAT, the worse the severity of bronchiectasis, dyspnea, quality of life, performance on the CPET, and smaller the distance walked (DW) on the ISWT and number of steps (NS) per day. There was significant correlation between CAT and SGRQ, E-FACED, BSI, NS, ISWT, oxygen uptake, and workload at CPET. CAT-1 and CAT-2 presented similar values: 21 (13-26) and 19 (13-26), respectively. The CAT is a valid and reproducible instrument in patients with bronchiectasis presenting good correlation with clinical, functional, and quality of life measurements. This easy-to-use, easy-to-understand, quick, and useful tool may play an important role to assess the impact of bronchiectasis on both daily medical practice and clinical trial settings.
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Affiliation(s)
- Fernanda C Lanza
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Rejane A S Castro
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Anderson A de Camargo
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Drielly J M Zanatta
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
| | - Samia Rached
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Rodrigo Athanazio
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Alberto Cukier
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Rafael Stelmach
- b Pulmonary Division, Heart Institute (InCor) , Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | - Simone Dal Corso
- a Postgraduate Program in Rehabilitation Sciences , Universidade Nove de Julho - UNINOVE , São Paulo , Brazil
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Rong B, Liu Y, Li M, Fu T, Gao W, Liu H. Correlation of serum levels of HIF-1α and IL-19 with the disease progression of COPD: a retrospective study. Int J Chron Obstruct Pulmon Dis 2018; 13:3791-3803. [PMID: 30538441 PMCID: PMC6254505 DOI: 10.2147/copd.s177034] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to disclose the correlation between the serum levels of hypoxia-inducible factor 1 alpha (HIF-1α) and IL-19 and stable COPD. Methods The serum levels of HIF-1α and IL-19 were tested by ELISA. The relationships between their levels and clinical parameters of stable COPD patients were analyzed by linear regression methods. Results Patients with stable COPD showed higher serum levels of HIF-1α and IL-19 compared with healthy control group (P<0.001), and serum levels of HIF-1α and IL-19 had a positive linear correlation (P<0.05). In stable COPD patients, increased serum levels of HIF-1α and IL-19 were positively correlated with the GOLD grading (P<0.005), modified British Medical Research Council (mMRC) score (P<0.05), and medical history (P<0.05) but negatively related to the pulmonary function (P<0.05). The serum level of HIF-1α (P<0.05) was affected by the patient’s FEV1/FVC value and COPD grading, and the serum level of IL-19 was associated with the mMRC scores and the serum level of HIF-1α (P<0.05). Conclusion Increased serum levels of HIF-1α and IL-19 correlated with the disease progression of COPD, suggesting that they can be used as indicators to help us understand the COPD.
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Affiliation(s)
- Biaoxue Rong
- Department of Respiratory Medicine, First Affiliated Hospital, Xi'an Medical University, Xi'an, China,
| | - Yufang Liu
- Comprehensive Medicine Department, Shenmu Hospital, Shenmu, China
| | - Min Li
- Department of Respiratory Medicine, Shenmu Hospital, Shenmu, China
| | - Tian Fu
- Department of Respiratory Medicine, Jining No 1 People's Hospital, Jining, China
| | - Wenlong Gao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Hua Liu
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, China
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