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Klimczak MK, Krzepkowski HA, Piotrowski WJ, Białas AJ. The Short-Term Efficacy of a Three-Week Pulmonary Rehabilitation Program among Patients with Obstructive Lung Diseases. J Clin Med 2024; 13:2576. [PMID: 38731105 PMCID: PMC11084422 DOI: 10.3390/jcm13092576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Introduction: The recommended duration for pulmonary rehabilitation stands at a minimum of six weeks; however, this stipulation may pose constraints in various countries due to financial limitations imposed by insurance companies and/or national health funds, as is the case in Poland. Consequently, our study endeavors to analyze the short-term outcomes stemming from a condensed three-week PR regimen administered to patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, and the concomitance of these conditions (COPD-A)-this is an approach that is standard in the rehabilitation protocols endorsed by our national health fund. Methods: Patients diagnosed with COPD, asthma, and COPD-A, referred to the PR program, underwent retrospective analysis to evaluate the short-term efficacy of a three-week PR program. Patients underwent comprehensive assessment by respiratory physicians and rehabilitation consultants, leading to individualized PR programs. Clinical evaluations occurred at program onset and completion. Results: 125 patients participated: 37 COPD, 61 asthma, and 27 COPD-A. Significant improvements were observed in the COPD Assessment Test (CAT), the consensus-based GINA symptom control tool (GINA-SCT), the Modified Medical Research Council (mMRC) scale, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the 6-min walk test (6 MWT) distance, as well as in the St. George's Respiratory Questionnaire (SGRQ) scores. All groups experienced reduced dyspnea severity and improved exercise tolerance. FEV1 and FVC improved in asthma and COPD-A, but not significantly in COPD. Multivariable logistic regression identified predictive factors for PR response. Conclusions: The study supports the short-term efficacy of the three-week PR program in improving clinical outcomes, exercise tolerance, and quality of life in COPD and asthma patients. Tailoring interventions based on predictors of PR response can optimize outcomes. Further research, particularly of the COPD-A group, is needed for individualized approaches. Larger sample sizes are necessary to confirm our findings.
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Affiliation(s)
- Magdalena K. Klimczak
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland; (M.K.K.); (H.A.K.); (W.J.P.)
- Department of Pulmonary Rehabilitation, Regional Medical Center for Lung Diseases and Rehabilitation, Blessed Rafal Chylinski Memorial Hospital for Lung Diseases, 91-520 Lodz, Poland
| | - Hubert A. Krzepkowski
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland; (M.K.K.); (H.A.K.); (W.J.P.)
| | - Wojciech J. Piotrowski
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland; (M.K.K.); (H.A.K.); (W.J.P.)
| | - Adam J. Białas
- Department of Pneumology, Medical University of Lodz, 90-419 Lodz, Poland; (M.K.K.); (H.A.K.); (W.J.P.)
- Department of Pulmonary Rehabilitation, Regional Medical Center for Lung Diseases and Rehabilitation, Blessed Rafal Chylinski Memorial Hospital for Lung Diseases, 91-520 Lodz, Poland
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Li D, Abhadiomhen SE, Zhou D, Shen XJ, Shi L, Cui Y. Asthma prediction via affinity graph enhanced classifier: a machine learning approach based on routine blood biomarkers. J Transl Med 2024; 22:100. [PMID: 38268004 PMCID: PMC10809685 DOI: 10.1186/s12967-024-04866-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Asthma is a chronic respiratory disease affecting millions of people worldwide, but early detection can be challenging due to the time-consuming nature of the traditional technique. Machine learning has shown great potential in the prompt prediction of asthma. However, because of the inherent complexity of asthma-related patterns, current models often fail to capture the correlation between data samples, limiting their accuracy. Our objective was to use our novel model to address the above problem via an Affinity Graph Enhanced Classifier (AGEC) to improve predictive accuracy. METHODS The clinical dataset used in this study consisted of 152 samples, where 24 routine blood markers were extracted as features to participate in the classification due to their ease of sourcing and relevance to asthma. Specifically, our model begins by constructing a projection matrix to reduce the dimensionality of the feature space while preserving the most discriminative features. Simultaneously, an affinity graph is learned through the resulting subspace to capture the internal relationship between samples better. Leveraging domain knowledge from the affinity graph, a new classifier (AGEC) is introduced for asthma prediction. AGEC's performance was compared with five state-of-the-art predictive models. RESULTS Experimental findings reveal the superior predictive capabilities of AGEC in asthma prediction. AGEC achieved an accuracy of 72.50%, surpassing FWAdaBoost (61.02%), MLFE (60.98%), SVR (64.01%), SVM (69.80%) and ERM (68.40%). These results provide evidence that capturing the correlation between samples can enhance the accuracy of asthma prediction. Moreover, the obtained [Formula: see text] values also suggest that the differences between our model and other models are statistically significant, and the effect of our model does not exist by chance. CONCLUSION As observed from the experimental results, advanced statistical machine learning approaches such as AGEC can enable accurate diagnosis of asthma. This finding holds promising implications for improving asthma management.
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Affiliation(s)
- Dejing Li
- Department of Respiratory, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Stanley Ebhohimhen Abhadiomhen
- School of Computer Science and Communication Engineering, JiangSu University, Zhenjiang, JiangSu, 212013, China
- Department of Computer Science, University of Nigeria, Nsukka, Nigeria
| | - Dongmei Zhou
- Clinical Research Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Xiang-Jun Shen
- School of Computer Science and Communication Engineering, JiangSu University, Zhenjiang, JiangSu, 212013, China
| | - Lei Shi
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Chinese Traditional Medicine, Shanghai, 201203, China.
| | - Yubao Cui
- Clinical Research Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China.
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Khan J, Moran B, McCarthy C, Butler MW, Franciosi AN. Management of comorbidities in difficult and severe asthma. Breathe (Sheff) 2023; 19:230133. [PMID: 38020342 PMCID: PMC10644109 DOI: 10.1183/20734735.0133-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians' assessment of asthma treatment efficacy.
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Affiliation(s)
- Jehangir Khan
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Barry Moran
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Cormac McCarthy
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Marcus W. Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
| | - Alessandro N. Franciosi
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
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Duignan N, Ridge P, Leonard S, McDonnell M, Cusack R, Harrison M, Rutherford R, O'Malley N, Dolan C. Expanded central role of the respiratory physiotherapists in the community setting. Ir J Med Sci 2023; 192:1581-1588. [PMID: 36380190 PMCID: PMC9666941 DOI: 10.1007/s11845-022-03213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022]
Abstract
The development of community hubs through the Slaintecare initiative will rely on respiratory physiotherapists and clinical nurse specialists for the management of chronic respiratory diseases. The role of the respiratory physiotherapist has evolved dramatically over the last decade. We review the increasing scope of practice of the physiotherapist and the evidence base for same. We pay particular attention to the role of the physiotherapist in areas such as pulmonary rehabilitation, sputum clearance, neuromuscular disease, chronic respiratory failure, ambulatory oxygen assessments and dysfunctional breathing. We give an in depth review of sputum clearance techniques. We also address areas of potential future expansion for the role of the physiotherapist such as prescription and initiation of non-invasive ventilation.
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Affiliation(s)
- Niamh Duignan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Padraic Ridge
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland.
| | - Sinead Leonard
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Melissa McDonnell
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ruth Cusack
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Michael Harrison
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Robert Rutherford
- Department of Respiratory Medicine, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Niamh O'Malley
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
| | - Ciara Dolan
- Department of Respiratory Physiotherapists, Galway University Hospitals, Newcastle Road, Galway, Ireland
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Alwadeai KS, Alhammad SA. Asthma and its relationship with anthropometric markers among adults. PLoS One 2023; 18:e0281923. [PMID: 36800359 PMCID: PMC9937501 DOI: 10.1371/journal.pone.0281923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/05/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Many studies have examined the association between anthropometric indicators and the likelihood of developing asthma. However, no study has yet examined the link between asthma and anthropometric markers of risk. This study addresses this gap in the literature by evaluating the relationship between asthma, smoking, and anthropometric measurements such as body mass index (BMI), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) among individuals residing in the United States. METHODS This cross-sectional study conducted a secondary analysis of the 2011-2014 National Survey of Midlife Development in the United States, using data from 2,257 participants aged 25-74. We classified the participants into four groups based on self-reported smoking and asthma status: nonsmokers with no asthma, asthma alone, smokers only, and smokers with asthma. The outcomes of interest were BMI, WC, HC, and WHR scores in the latter three groups compared to the nonsmokers with no asthma group. RESULTS Linear regression analysis showed that those with asthma alone and smokers with asthma were significantly more likely to have a BMI, WC, or HC score of 1 or higher than people without asthma and smokers only. CONCLUSION A higher score on the anthropometric parameters was substantially related to participants who had only asthma and those who had both asthma and smoking.
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Affiliation(s)
- Khalid S. Alwadeai
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- * E-mail:
| | - Saad A. Alhammad
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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D'Amato M, Ambrosino P, Simioli F, Adamo S, Stanziola AA, D'Addio G, Molino A, Maniscalco M. A machine learning approach to characterize patients with asthma exacerbation attending an acute care setting. Eur J Intern Med 2022; 104:66-72. [PMID: 35922367 DOI: 10.1016/j.ejim.2022.07.019] [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: 05/24/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND One of the main problems in poorly controlled asthma is the access to the Emergency Department (ED). Using a machine learning (ML) approach, the aim of our study was to identify the main predictors of severe asthma exacerbations requiring hospital admission. METHODS Consecutive patients with asthma exacerbation were screened for inclusion within 48 hours of ED discharge. A k-means clustering algorithm was implemented to evaluate a potential distinction of different phenotypes. K-Nearest Neighbor (KNN) as instance-based algorithm and Random Forest (RF) as tree-based algorithm were implemented in order to classify patients, based on the presence of at least one additional access to the ED in the previous 12 months. RESULTS To train our model, we included 260 patients (31.5% males, mean age 47.6 years). Unsupervised ML identified two groups, based on eosinophil count. A total of 86 patients with eosinophiles ≥370 cells/µL were significantly older, had a longer disease duration, more restrictions to daily activities, and lower rate of treatment compared to 174 patients with eosinophiles <370 cells/μL. In addition, they reported lower values of predicted FEV1 (64.8±12.3% vs. 83.9±17.3%) and FEV1/FVC (71.3±9.3 vs. 78.5±6.8), with a higher amount of exacerbations/year. In supervised ML, KNN achieved the best performance in identifying frequent exacerbators (AUROC: 96.7%), confirming the importance of spirometry parameters and eosinophil count, along with the number of prior exacerbations and other clinical and demographic variables. CONCLUSIONS This study confirms the key prognostic value of eosinophiles in asthma, suggesting the usefulness of ML in defining biological pathways that can help plan personalized pharmacological and rehabilitation strategies.
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Affiliation(s)
- Maria D'Amato
- Department of Respiratory Medicine, Federico II University, Naples, Italy.
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy
| | - Francesca Simioli
- Department of Respiratory Medicine, Federico II University, Naples, Italy
| | - Sarah Adamo
- Department of Information Technology and Electrical Engineering, University of Naples "Federico II", Napoli, Italy
| | | | - Giovanni D'Addio
- Istituti Clinici Scientifici Maugeri IRCCS, Bioengineering Unit of Telese Terme Institute, Telese Terme, Italy
| | - Antonio Molino
- Department of Respiratory Medicine, Federico II University, Naples, Italy
| | - Mauro Maniscalco
- Department of Respiratory Medicine, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Telese Terme, Italy.
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Hasina SN, Livana PH, Ainiyah N, Firdaus F, Wardani EM, Putri RA, Umamah F. Exposure to Cigarette Smoke and Daily Physical Activity Associated with Asthma. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Asthmatic sufferers complain of sudden relapse when performing daily activities. exposure to cigarette smoke makes asthmatics where the longer the exposure is experienced by the patient, the more frequent asthma exacerbations are experienced. For people with asthma, avoiding excessive physical activity and exposure to cigarette smoke is very necessary to prevent recurrence of symptoms. So it is necessary to control the level of asthma, which is influenced by factors that trigger asthma recurrence.
Aim: The purpose of the study was to determine the relationship between daily physical activity and exposure to cigarette smoke on asthma recurrence in asthmatic patients
Methods: This type of research uses observational analytic using a cross sectional approach. Sampling in this study using purposive sampling obtained the number of respondents 358 with a vulnerable age of 18-45 years. This research was conducted for 6 months. The measuring instrument for exposure to cigarette smoke uses a questionnaire containing the categories of exposure to cigarette smoke less than 1 hour, exposure to cigarette smoke 1-4 hours and exposure to cigarette smoke more than 4 hours. Physical activity measurement tool using the International Physical Activity Questionnaire (IPAQ). Asthma recurrence was measured by using a questionnaire that refers to the Asthma Control Test (ACT). The research procedure was carried out by researchers by ensuring that respondents were in good health and signed the informed consent provided. Data analysis using Chi-Square test.
Result: The results of the Chi Square test with a significance value of = 0.05, p value = 0.000, which means p < then there is a relationship between daily physical activity and exposure to cigarette smoke on asthma recurrence in asthmatic patients.
Conclusions: There is a relationship between exposure to cigarette smoke and daily physical activity on asthma relapse in asthmatic patients. It is expected that asthmatics should avoid triggering factors for asthma relapse to achieve controlled asthma levels.
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8
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Alhammad SA, Alwadeai KS. All Types Obesity and Physical Inactivity Associated with the Risk of Activity of Daily Living Limitations Among People with Asthma. J Multidiscip Healthc 2022; 15:1573-1583. [PMID: 35909421 PMCID: PMC9326037 DOI: 10.2147/jmdh.s368660] [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: 05/10/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the association between all types of obesity, physical inactivity, and the risk of activity of daily living limitations in people with asthma. Patients and Methods In this cross-sectional study, data from 2555 people aged between 25 and 74 years were acquired from the National Survey of Midlife Development in the United States Refresher conducted between 2011 and 2014. Self-reported questions were used to specify the presence or absence of asthma and physical inactivity. All participants were categorized as having no asthma or asthma. Obesity was defined based on three distinctive indicators: body mass index, waist circumference, and waist-to-hip ratio. Results Logistic regression analysis showed that people with asthma who had all types of obesity alone or both all types of obesity and physical inactivity were significantly (P <0.0001) almost more than three times more likely to have limitations in the activity of daily living than those without this condition, even after adjusting for all covariates. Moreover, the odds of activity of daily living limitations were 1.69 times increased in asthma patients with physical inactivity alone, but this increase in risk was not significant (P =0.465). In addition, the odds of activity of daily living limitations were significantly (P <0.0001) more than twice independently in people with asthma aged between 60 and 74 years, female, undergraduate level of education, smoking, and having joint/bone underlying diseases. Conclusion The results demonstrated that the presence of all types of obesity is related to a higher risk of activity of daily living limitations in people with asthma than in those without asthma. Having both all types of obesity and physical inactivity are also linked to a greater risk of activity of daily living limitations in these patients.
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Affiliation(s)
- Saad A Alhammad
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid S Alwadeai
- Department of Rehabilitation Science, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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9
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Elnaggar RK, Osailan AM, Elbanna MF. The rationale of applying inspiratory/expiratory muscle training within the same respiratory cycle in children with bronchial asthma: A placebo-controlled randomized clinical investigation. J Asthma 2022; 60:900-911. [PMID: 35849445 DOI: 10.1080/02770903.2022.2103708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Even though positive implications of inspiratory muscle training (In-MT) have been established in children and adolescents with bronchial asthma (C/AwBA), the role of combined inspiratory and expiratory muscle training (Ex-MT) within the same respiratory cycle (In/Ex-SC) is still unknown. This study was, therefore, set out to explore the effect of In/Ex-SC on respiratory muscle strength, pulmonary functions, and control of asthma symptoms in C/AwBA.Methods: This was a placebo-controlled randomized clinical investigation that included 51 C/AwBA (12-18 years). Participants were assigned randomly into three groups: Placebo, In-MT only, or combined In/Ex-SC training (n = 17, each group). The training was conducted for ∼35 min, thrice/week over 12 weeks. The maximal inspiratory (IPmax) and expiratory (EPmax) pressure (indicating the strength of the inspiratory and expiratory muscles, respectively), pulmonary functions [forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC index], and asthma control test (ACT) were assessed before and after the intervention.Results: The In/Ex-SC yielded larger increases in IPmax and EPmax than either the Placebo training (P=.031 and P=.009 respectively) or the In-MT (P=.029 and P=.032 respectively). Further, In/Ex-SC produced favorable improvement in FEV1, FVC, and FEV1/FVC compared to the Placebo training (P=.001, P=.004, and P=.0005 respectively) or In-MT (P=.038, P=.037, and P=.025 respectively) training. Furthermore, In/Ex-SC led to better control of asthma symptoms than the Placebo (P<.001) or In-MT (P=.002) training.Conclusion: This study provides evidence that combined In/Ex-SC can considerably improve respiratory muscle strength, enhance pulmonary function, and promote control over asthma symptoms in C/AwBA.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ahmad M Osailan
- Department of Physical Therapy and Health Rehabilitation, Collage of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammed F Elbanna
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Zampogna E, Ambrosino N, Oliva FM, Sotgiu G, Saderi L, Cremonese G, Bellelli G, Spanevello A, Angeli F, Visca D. Heart rate recovery in adult individuals with asthma. Monaldi Arch Chest Dis 2022; 93. [PMID: 35546720 DOI: 10.4081/monaldi.2022.2265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/10/2022] [Indexed: 01/21/2023] Open
Abstract
Slow heart rate recovery (HRR) after exercise is a predictor of overall mortality in individuals with and without cardiovascular or respiratory disorders. No data on adults with asthma are available. The purpose of the study is to evaluate the prevalence of slow HRR in these individuals as compared with those with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of baseline characteristics and physiological response to the six-minute walking distance test of stable individuals with asthma or COPD. Slow HRR was defined as HRpeak - HR at 1 minute after end exercise <12 bpm. Individuals with asthma walked significantly longer (median (IQR): 455 (385-512) vs 427 (345-485) meters; p=0.005) with a lower prevalence of slow HRR (30.3% vs 49.0%, respectively: p<0.001) than those with COPD. Individuals with asthma and slow HRR were older and walked less than those with normal HRR, without any difference in airway obstruction or in disease severity. Multivariate analysis showed that only the difference HRpeak - baseline HR (∆HR), was a predictor of slow HRR in both groups. More than 30% of adult individuals with asthma may show slow HRR. Only exercise ∆HR but no baseline characteristic seems to predict the occurrence of slow HRR.
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Affiliation(s)
- Elisabetta Zampogna
- Division of Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate.
| | - Nicolino Ambrosino
- Division of Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Montescano.
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Medicine, University of Sassari.
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Medicine, University of Sassari.
| | - Gioele Cremonese
- Division of Cardiac Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate.
| | - Giorgio Bellelli
- Division of Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate.
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate; Department of Medicine and Surgery, University of Insubria, Varese.
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese; Division of Cardiac Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate; Department of Medicine and Surgery, University of Insubria, Varese.
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Zou H, Qin Y, Gong F, Liu J, Zhang J, Zhang L. ABCDEF pulmonary rehabilitation program can improve the mid-term lung function of lung cancer patients after thoracoscopic surgery: A randomized controlled study. Geriatr Nurs 2022; 44:76-83. [DOI: 10.1016/j.gerinurse.2021.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
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12
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Fieten KB, Drijver‐Messelink MT, Cogo A, Charpin D, Sokolowska M, Agache I, Taborda‐Barata LM, Eguiluz‐Gracia I, Braunstahl GJ, Seys SF, den Berge M, Bloch KE, Ulrich S, Cardoso‐Vigueros C, Kappen JH, Brinke AT, Koch M, Traidl‐Hoffmann C, da Mata P, Prins DJ, Pasmans SGMA, Bendien S, Rukhadze M, Shamji MH, Couto M, Oude Elberink H, Peroni DG, Piacentini G, Weersink EJM, Bonini M, Rijssenbeek‐Nouwens LHM, Akdis CA. Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper. Allergy 2022; 77:1991-2024. [PMID: 35113452 PMCID: PMC9305916 DOI: 10.1111/all.15242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/14/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022]
Abstract
Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro‐immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.
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Sanchez-Ramirez DC. Impact of Pulmonary Rehabilitation Services in Patients with Different Lung Diseases. J Clin Med 2022; 11:407. [PMID: 35054101 PMCID: PMC8780231 DOI: 10.3390/jcm11020407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND the effect of pulmonary rehabilitation (PR) services, beyond research contexts, on patients with lung diseases other than COPD requires further study. OBJECTIVES to (i) assess the impact of a publicly funded PR on patients' exercise capacity, self-efficacy, and health-related quality of life (HRQoL), and (ii) explore whether the effects vary across lung diseases. METHODS this retrospective pre-post study analyzed data from the Winnipeg Regional Health Authority PR program between 2016 and 2019. RESULTS 682 patients completed the full PR program. Pooled analyses found significant improvements in the patients' exercise capacity (six-minute walk test (6MWT) (13.6%), fatigue (10.3%), and dyspnea (6.4%)), Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD6) (11.6%), and HRQoL (Clinical COPD Questionnaire (CCQ) (18.5%) and St George's Respiratory Questionnaire (SGRQ) (10.9%)). The analyses conducted on sub-groups of patients with chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, interstitial lung diseases (ILDs), other restrictive lung diseases (e.g., obesity, pleural effusion, etc.), lung cancer, and pulmonary hypertension (PH) indicated that, except for patients with PH, all the patients improved in the 6MWT. Fatigue decreased in patients with COPD, ILDs, and other restrictive lung diseases. Dyspnea decreased in patients with COPD, asthma, and lung cancer. SEMCD6 scores increased in COPD, ILDs and PH patients. CCQ scores decreased in all lung diseases, except lung cancer and PH. SGRQ scores only decreased in patients with COPD. CONCLUSION PR services had a significant impact on patients with different lung diseases. Therefore, publicly funded PR should be available as a critical component in the management of patients with these diseases.
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Affiliation(s)
- Diana C Sanchez-Ramirez
- Department of Respiratory Therapy, College of Rehabilitation Sciences, University of Manitoba, Room 334-771 McDermot Ave, Winnipeg, MB R3E 0T6, Canada
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Yu A, Ding W, Lin W, Cai J, Huang W. Application of pulmonary rehabilitation in patients with pulmonary embolism (Review). Exp Ther Med 2022; 23:96. [PMID: 34976138 DOI: 10.3892/etm.2021.11019] [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: 08/03/2021] [Accepted: 11/09/2021] [Indexed: 11/06/2022] Open
Abstract
As a common clinical emergency, pulmonary embolism (PE) is the third most fatal cardiovascular disease worldwide. Although current sophisticated medical technology has considerably improved the prognosis of patients with PE, they remain at risk of developing long-term complications such as post-PE syndrome. Pulmonary rehabilitation is of great value for patients with chronic lung diseases since it can improve their quality of life while also relieving clinical symptoms. Rehabilitation therapy has been demonstrated to improve recovery and prognosis of patients with PE. Due to short implementation time and the small number of studies, its effectiveness and safety in PE warrant further investigation. The present review focused on elucidating PE pathogenesis, post-PE syndrome and the clinical application of pulmonary rehabilitation in patients with PE.
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Affiliation(s)
- Aiping Yu
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Weiping Ding
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Wanmi Lin
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Juan Cai
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Weina Huang
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
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Press VG, Lugogo N. Utilizing Culturally Tailored Approaches and Participant Feedback to Successfully Implement an Exercise Intervention in Black Women with Asthma: Are There Lessons That Can Be Applied to Address Disparities in Asthma Outcomes? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:4322-4323. [PMID: 34893192 DOI: 10.1016/j.jaip.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Valerie G Press
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Ill.
| | - Njira Lugogo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Mich
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Streibelt M, Zollmann P. [Work Participation after Multimodal Rehabilitation due to Respiratory Diseases - Representative Analyses using Routine Data of the German Pension Insurance]. REHABILITATION 2021; 60:330-338. [PMID: 34187079 DOI: 10.1055/a-1478-9823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE For the German rehabilitation system there are only few representative findings on occupational reintegration after medical rehabilitation. For persons who have undergone rehabilitation on behalf of the German Pension Insurance (GPI) due to a respiratory disease, it is therefore needed to determine (a) what socio-medical risks exist prior to rehabilitation, (b) how well persons were able to participate in working life after rehabilitation, and (c) what conditions determine the work participation. METHODS The study is conducted on the basis of the GPI's database of rehabilitation statistics. Included were all persons, who completed medical rehabilitation in 2016 with a main discharged diagnosis from chapter J of the ICD-10. The analyses were carried out for the entire group and also in a differentiated manner for the the 2 main diseases bronchial asthma and COPD. Work participation was operationalized both via a monthly status variable until 24 months after rehabilitation and as a rate of all persons who were employed at the 12 and 24 months follow up and in the 3 months before, respectively. To analyze the factors influencing stable work participation, multiple logistic regression models with stepwise inclusion were calculated separately for the rates after 12 and 24 months. RESULTS A total of 19,287 data sets were included in the analysis (bronchial asthma: n=9,108, 47%; COPD: n=6,215, 32%). Patients with respiratory diseases were 53 years old on average, both genders were equally distributed. 14% had no absenteeism, 11 % stated an absence leave 6 months or more in the year prior to rehabilitation. Mental and cardiovascular comorbidity was documented in 39 and 38% of the cases, respectively. Overall, patients with COPD had higher socio-medical risks before rehabilitation than asthma patients. Accordingly, only about half of the COPD patients remained in active employment, while about 80% of the asthma patients succeeded in this. The strongest influencing factors on stable work participation were the time of sick leave as well as income prior to rehabilitation. CONCLUSION About two thirds of all persons with respiratory diseases are in stable employment after medical rehabilitation in Germany, with large differences between asthma bronchiale and COPD. In particular, the absenteeism as well as the wage before rehabilitation determine this. The analysis provides representative data on occupational reintegration after medical rehabilitation due to a respiratory disease for the first time.
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Affiliation(s)
- Marco Streibelt
- Deutsche Rentenversicherung Bund, Geschäftsbereich Sozialmedizin und Rehabilitation, Berlin
| | - Pia Zollmann
- Deutsche Rentenversicherung Bund, Geschäftsbereich Sozialmedizin und Rehabilitation, Berlin
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Zampogna E, Pignatti P, Ambrosino N, Cherubino F, Maria Fadda A, Zappa M, Spanevello A, Visca D. The 5-Repetition Sit-to-Stand Test as an Outcome Measure for Pulmonary Rehabilitation in Subjects With Asthma. Respir Care 2021; 66:769-776. [PMID: 33593936 PMCID: PMC9994123 DOI: 10.4187/respcare.08452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The 5-repetition sit-to-stand test (5STS) is valid and responsive in subjects with COPD, but there is a lack of information in subjects with asthma. We aimed to evaluate the usefulness of the 5STS as an outcome measure of pulmonary rehabilitation in subjects with asthma as compared to subjects with COPD. METHODS We conducted a retrospective evaluation of subjects with asthma or COPD who underwent pulmonary rehabilitation. Both before and after in-patient pulmonary rehabilitation, subjects underwent the 5STS and the 6-min walk test; dyspnea was assessed with the Medical Research Council scale and the Barthel Index for dyspnea, and the burden of symptoms was assessed with the COPD Assessment Test. RESULTS Of 475 patients admitted during the study period, 103 subjects with asthma and 108 with COPD were included. After pulmonary rehabilitation, the 5STS improved significantly in both populations (by a median value of -1.7 s [interquartile range -4.2 to -0.5] and -1.1 s [interquartile range -3.4 to 0.0] in subjects with asthma and COPD, respectively; P < .001 for both, P = .17 between groups) independent of body mass index, as did other outcome measures. The baseline 5STS correlated slightly but significantly with age, the 6-min walk test, and the Barthel Index for dyspnea in both populations, whereas it correlated significantly with the Medical Research Council scale only in subjects with asthma and correlated with COPD Assessment Test only in subjects with COPD. No significant correlations between changes in the 5STS and in other assessed outcome measures before and after pulmonary rehabilitation were observed in subjects with asthma, whereas changes in the 5STS correlated slightly but significantly only with changes in 6-min walk test in subjects with COPD. CONCLUSIONS The 5STS was a reliable outcome measure of pulmonary rehabilitation in subjects with asthma. It must be specifically assessed and may be included in the tools for assessment of effects of pulmonary rehabilitation also in these patients.
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Affiliation(s)
- Elisabetta Zampogna
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy.
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Nicolino Ambrosino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Montescano, Italy
| | - Francesca Cherubino
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Anna Maria Fadda
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
| | - Martina Zappa
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese. Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese. Italy
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy
- Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese. Italy
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Grosbois JM, Fry S, Tercé G, Wallaert B, Chenivesse C. [Physical activity and pulmonary rehabilitation in adults with asthma]. Rev Mal Respir 2021; 38:382-394. [PMID: 33744072 DOI: 10.1016/j.rmr.2021.02.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
Physical activity is reduced in people with asthma compared to the general population, especially in situations where patients have uncontrolled asthma symptoms, persistent airflow obstruction and other long-term medical problems, in particular obesity and anxiety. Exertional dyspnea, which is of multifactorial origin, is the main cause of reduced physical activity reduction and draws patients into a vicious circle further impairing quality of life and asthma control. Both the resumption of a regular physical activity, integrated into daily life, adapted to patients' needs and wishes as well as physical and environmental possibilities for mild to moderate asthmatics, and pulmonary rehabilitation (PR) for severe and/or uncontrolled asthmatics, improve control of asthma, dyspnea, exercise tolerance, quality of life, anxiety, depression and reduce exacerbations. A motivational interview to promote a regular programme of physical activity in mild to moderate asthma (steps 1 to 3) should be offered by all health professionals in the patient care pathway, within the more general framework of therapeutic education. The medical prescription of physical activities, listed in the Public Health Code for patients with long-term diseases, and pulmonary rehabilitation should be performed more often by specialists or the attending physician. Pulmonary rehabilitation addresses the needs of severe asthma patients (steps 4 and 5), and of any asthmatic patient with poorly controlled disease and/or requiring hospitalized for acute exacerbations, regardless of the level of airflow obstruction, and/or with associated comorbidities, and before prescribing biological therapies.
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Affiliation(s)
- J-M Grosbois
- FormAction Santé, zone d'activité du bois, rue de Pietralunga, 59840 Pérenchies, France; CH Béthune, service de réadaptation respiratoire et de pneumologie, 62400 Béthune, France; Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France.
| | - S Fry
- CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France; CRISALIS, F-CRIN INSERM network, Lille, France
| | - G Tercé
- CH Béthune, service de réadaptation respiratoire et de pneumologie, 62400 Béthune, France
| | - B Wallaert
- Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France; CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France
| | - C Chenivesse
- CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France; CRISALIS, F-CRIN INSERM network, Lille, France
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- Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France
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