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Hessels LM, Speksnijder E, Paternotte N, van Huisstede A, Thijs W, Scheer M, van der Steen-Dieperink M, Knarren L, van Den Bergh JP, Winckers K, Henry R, Simsek S, Boersma WG. Procalcitonin-Guided Antibiotic Prescription in Patients With COVID-19: A Multicenter Observational Cohort Study. Chest 2023; 164:596-605. [PMID: 37116748 PMCID: PMC10132833 DOI: 10.1016/j.chest.2023.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Despite the low rate of bacterial coinfection, antibiotics are very commonly prescribed in hospitalized patients with COVID-19. RESEARCH QUESTION Does the use of a procalcitonin (PCT)-guided antibiotic protocol safely reduce the use of antibiotics in patients with a COVID-19 infection? STUDY DESIGN AND METHODS In this multicenter cohort, three groups of patients with COVID-19 were compared in terms of antibiotic consumption, namely one group treated based on a PCT-algorithm in one hospital (n = 216) and two control groups, consisting of patients from the same hospital (n = 57) and of patients from three similar hospitals (n = 486) without PCT measurements during the same period. The primary end point was antibiotic prescription in the first week of admission. RESULTS Antibiotic prescription during the first 7 days was 26.8% in the PCT group, 43.9% in the non-PCT group in the same hospital, and 44.7% in the non-PCT group in other hospitals. Patients in the PCT group had lower odds of receiving antibiotics in the first 7 days of admission (OR, 0.33; 95% CI, 0.16-0.66 compared with the same hospital; OR, 0.42; 95% CI, 0.28-0.62 compared with the other hospitals). The proportion of patients receiving antibiotic prescription during the total admission was 35.2%, 43.9%, and 54.5%, respectively. The PCT group had lower odds of receiving antibiotics during the total admission only when compared with the other hospitals (OR, 0.23; 95% CI, 0.08-0.63). There were no significant differences in other secondary end points, except for readmission in the PCT group vs the other hospitals group. INTERPRETATION PCT-guided antibiotic prescription reduces antibiotic prescription rates in hospitalized patients with COVID-19, without major safety concerns.
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Affiliation(s)
- Lisa M Hessels
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands.
| | - Esther Speksnijder
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Nienke Paternotte
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Willemien Thijs
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Margot Scheer
- Department of Intensive Care Medicine, Martini Hospital, Groningen, The Netherlands
| | | | - Lieve Knarren
- Department of Internal Medicine, Viecuri Medical Centre, Venlo, The Netherlands
| | | | - Kristien Winckers
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald Henry
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Wim G Boersma
- Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands
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2
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Bendien SA, Kroes JA, van Hal LHG, Braunstahl GJ, Broeders MEAC, Oud KTM, Patberg KW, Smeenk FWJM, van Veen IHPAA, Weersink EJM, Fieten KB, Hashimoto S, van Veen A, Sont JK, van Huisstede A, van de Ven MJT, Langeveld B, Maitland-van der Zee AH, Ten Brinke A. Real-World Effectiveness of IL-5/5Ra Targeted Biologics in Severe Eosinophilic Asthma With Comorbid Bronchiectasis. J Allergy Clin Immunol Pract 2023; 11:2724-2731.e2. [PMID: 37295671 DOI: 10.1016/j.jaip.2023.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Bronchiectasis is a common comorbidity in patients with asthma and is associated with increased disease severity. In patients with severe eosinophilic asthma, biologics targeting IL-5/5Ra have beneficial effects on oral corticosteroid (OCS) use and exacerbation frequency. However, how coexisting bronchiectasis affects the response to such treatments is unknown. OBJECTIVE To evaluate the real-world effectiveness of anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma and comorbid bronchiectasis on exacerbation frequency and daily maintenance and cumulative OCS dose. METHODS This real-world study evaluated data from 97 adults with severe eosinophilic asthma and computed tomography-confirmed bronchiectasis from the Dutch Severe Asthma Registry, who initiated anti-IL5/5Ra biologics (mepolizumab, reslizumab, and benralizumab) and had follow-up data for 12 months or greater. The analysis was performed for the total population and subgroups with or without maintenance OCS use. RESULTS Anti-IL-5/5Ra therapy significantly reduced exacerbation frequency in patients with maintenance OCS use as well as in those without it. In the year before biologic initiation, 74.5% of all patients had two or more exacerbations, which decreased to 22.1% in the follow-up year (P < .001). The proportion of patients on maintenance OCS decreased from 47% to 30% (P < .001), and in the OCS-dependent patients (n = 45) maintenance OCS dose decreased from median (interquartile range) of 10.0 mg/d (5-15 mg/d) to 2.5 mg/d (0-5 mg/d) after 1 year (P < .001). CONCLUSIONS This real-world study shows that anti-IL-5/5Ra therapy reduces exacerbation frequency and daily maintenance as well as the cumulative OCS dose in patients with severe eosinophilic asthma and comorbid bronchiectasis. Although it is an exclusion criterion in phase 3 trials, comorbid bronchiectasis should not preclude anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma.
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Affiliation(s)
- Sarah A Bendien
- Department of Pulmonology, Haga Teaching Hospital, The Hague, the Netherlands.
| | - Johannes A Kroes
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Lotte H G van Hal
- Department of Clinical Pharmacy and Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Respiratory Medicine, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Marielle E A C Broeders
- Department of Respiratory Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - Karen T M Oud
- Department of Respiratory Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands
| | | | - Frank W J M Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Els J M Weersink
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Karin B Fieten
- Dutch Asthma Center Davos (NAD), Davos, Switzerland, Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos Wolfgang, Switzerland
| | - Simone Hashimoto
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Anneke van Veen
- Department of Respiratory Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Jaap K Sont
- Department of Biomedical Data Sciences, Medical Decision Making Section, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Bas Langeveld
- Department of Pulmonology, Deventer Ziekenhuis, Deventer, the Netherlands
| | | | - Anneke Ten Brinke
- Department of Pulmonology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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3
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Ten Have L, Visser E, Meulmeester FL, Bendien SA, Braunstahl GJ, Broeders MEAC, Fieten KB, Hashimoto S, van Huisstede A, Langeveld B, Oud KTM, Patberg KW, Smeenk FWJM, van Veen A, van Veen IH, van de Ven MJT, Weersink EJM, de Jong K, Sont JK, Kroes JA, Ten Brinke A. Long-Term Weight Changes After Starting Anti-IL-5/5Ra Biologics in Severe Asthma: The Role of Oral Corticosteroids. J Allergy Clin Immunol Pract 2023; 11:2748-2756.e3. [PMID: 37399945 DOI: 10.1016/j.jaip.2023.06.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Many patients with severe asthma are overweight or obese, often attributed to unintentional weight gain as a side effect of oral corticosteroids (OCSs). Anti-IL-5/5Ra biologics significantly reduce OCS use, but their long-term effects on weight are unknown. OBJECTIVES To examine (1) weight change up to 2 years after anti-IL-5/5Ra initiation in subgroups on the basis of maintenance OCS use at start of treatment and (2) whether cumulative OCS exposure before or changes in OCS exposure during treatment are related to weight change. METHODS Real-world data on weight and cumulative OCS dose from adults included in the Dutch Registry of Adult Patients with Severe asthma for Optimal DIsease management before and at least 2 years after starting anti-IL-5/5Ra were analyzed using linear mixed models and linear regression analyses. RESULTS For the included 389 patients (55% female; mean body mass index, 28 ± 5 kg/m2; 58% maintenance OCS), mean weight decreased -0.27 kg/y (95% CI, -0.51 to -0.03; P = .03), with more weight loss in patients with maintenance OCS use than in those without maintenance OCS use (-0.87 kg/y [95% CI, -1.21 to -0.52; P < .001] vs +0.54 kg/y [0.26 to 0.82; P < .001]). Greater weight loss at 2 years was associated with higher cumulative OCS dose in the 2 years before anti-IL-5/5Ra initiation (β = -0.24 kg/g; 95% CI, -0.38 to -0.10; P < .001) and, independently, greater reduction in cumulative OCS dose during follow-up (β = 0.27 kg/g; 95% CI, 0.11 to 0.43; P < .001). CONCLUSIONS Anti-IL-5/5Ra therapy is associated with long-term weight reduction, especially in patients with higher OCS exposure before treatment and those able to reduce OCS use during treatment. However, the effect is small and does not apply to all patients, and so additional interventions seem necessary if weight change is desired.
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Affiliation(s)
- Lianne Ten Have
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Biomedical Data Science, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
| | - Edith Visser
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Fleur L Meulmeester
- Department of Biomedical Data Science, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarah A Bendien
- Department of Respiratory Medicine, HAGA Teaching Hospital, Den Haag, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Respiratory Medicine, St Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Marielle E A C Broeders
- Department of Respiratory Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Karin B Fieten
- Nederlands Astmacentrum Davos, Davos, Switzerland; Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
| | - Simone Hashimoto
- Department of Pulmonary Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bas Langeveld
- Department of Respiratory Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
| | - Karen T M Oud
- Department of Respiratory Medicine, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - Kornelis W Patberg
- Department of Respiratory Medicine, ISALA Clinics, Zwolle, The Netherlands
| | - Frank W J M Smeenk
- Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Anneke van Veen
- Department of Respiratory Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Ilonka H van Veen
- Department of Respiratory Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Els J M Weersink
- Department of Pulmonary Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kim de Jong
- Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Science, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes A Kroes
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Anneke Ten Brinke
- Department of Pulmonary Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Witte J, Singh H, Turk Y, van Huisstede A, Birnie E, Hiemstra P, Kappen J, Braunstahl GJ. Effect of bariatric surgery on lung function and asthma control after 8 years of follow-up. Allergy Asthma Proc 2023; 44:165-170. [PMID: 37160751 DOI: 10.2500/aap.2023.44.230009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background: Bariatric surgery has a proven beneficial effect on asthma symptoms and lung function in patients with class III obesity and asthma. The effects of bariatric surgery on asthma control and small airway function persist for at least 12 months after bariatric surgery. However, long-term follow-up data are lacking. Objectives: To evaluate the very-long term effects of bariatric surgery on asthma symptoms and lung function. Methods: In a prospective, longitudinal follow-up study, we planned an 8-year follow-up visit for patients previously included in the OBAS 1.0 trial, which evaluated the effects of bariatric surgery on asthma control and lung function in patients with asthma and class III obesity in The Netherlands. Results: Fifteen of 78 patients from the OBAS trial completed the 8-year follow-up visit. Nine patients underwent bariatric surgery, and six patients did not. After 8 years of follow-up, asthma control (Asthma Control Questionnaire [ACQ] score at 12 months of 0,4 versus an ACQ score of 0.7 at 8 years of follow-up; p = 0.075) and small airway function (R5-R20 (frequency-dependent resistance at 5Hz-20Hz); score at 12 months of 0,25 versus an ACQ score of 0.07 at 8 years of follow-up; p = 0.345) remained clinically stable compared with 12 months of follow-up. Patients who underwent bariatric surgery had a statistically significant weight regain between 12 months of follow-up and 8 years of follow-up (median [interquartile range] body mass index 30.2 kg/m² [23.9-43.4 kg/m²] versus 32.3 kg/m² [24.0-36.4 kg/m²]; p = 0.025). However, the impact of weight regain on asthma control, and asthma quality of life was clinically insignificant (ACQ, β (regression coefficient) = 0.04; 95% Confidence Interval [0.02; 0.06]; p < 0.001; and AQLQ; β = -0.04 CI [-0.07; -0.009]; p = 0.013). Conclusion: These results emphasize the importance of bariatric surgery in treating obesity-related asthma.
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Affiliation(s)
- Jan Witte
- From the Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Harman Singh
- From the Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Yasemin Turk
- From the Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Astrid van Huisstede
- From the Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Academy, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Pieter Hiemstra
- Department of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jasper Kappen
- From the Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Gert-Jan Braunstahl
- From the Department of Pulmonology, Franciscus Gasthuis, Rotterdam, The Netherlands
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5
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van Zelst CM, de Boer GM, Türk Y, van Huisstede A, In't Veen JCCM, Birnie E, Boxma- de Klerk BM, Tramper- Stranders GA, Braunstahl GJ. Association between elevated serum triglycerides and asthma in patients with obesity: An explorative study. Allergy Asthma Proc 2021; 42:e71-e76. [PMID: 33980342 DOI: 10.2500/aap.2021.42.210020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Adults with a high body mass index (BMI) have an increased risk of developing asthma. To explore the impact of increased lipids on the presence of asthma, this study investigated the relationship between lipid levels and inflammatory markers in patients with asthma and controls with obesity. Objective: We hypothesized that higher lipid levels are more prevalent in patients with obesity and asthma. Methods: In this explorative cohort study, 96 patients with asthma and 45 controls were included. All the patients participated in one of three asthma studies; two of these studies included only patients with obesity. An asthma diagnosis was defined by the presence of typical clinical symptoms, reversible airway obstruction (+12% improvement in forced expiratory volume in the first second of expiration after bronchodilator), or bronchial hyperreactivity (Histamine PC20 < 8 mg/mL), or a fractional exhaled nitric oxide of > 50 ppb. We compared lipid levels and neutrophils and eosinophils in patients with asthma and the controls with a wide BMI range (17.8-63.8 kg/m²). Multivariable logistic regression was used to analyze the data. Results: Serum triglycerides were statistically significantly higher in patients with obesity and asthma adjusted for BMI, blood eosinophils, and statin use (odds ratio [OR] 2.56 [95% confidence interval, 1.34-4.88]; p = 0.004). Inclusion or exclusion of those who used long-acting β2-agonists and inhaled corticosteroids led to comparable adjusted ORs for blood triglyceride and blood eosinophils levels. Conclusion: Elevated serum triglycerides were associated with the presence of asthma in patients with obesity. This indicated that elevated triglycerides might be a yet unrecognized trait that contributed to the development of asthma. The precise cause and effect of these high triglyceride levels in the patients with asthma and with obesity were not determined in this study.Clinical trial Trial registration NCT03278561, <ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">www.clinicaltrials.gov</ext-link>; NL4262, NL3056, trialregister.nl.
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Affiliation(s)
- Cathelijne M. van Zelst
- From the Department of Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Geertje M. de Boer
- From the Department of Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Yasemin Türk
- From the Department of Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | | | | | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - Bianca M. Boxma- de Klerk
- Department of Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | | | - Gert-Jan Braunstahl
- From the Department of Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
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6
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Türk Y, Theel W, van Huisstede A, van de Geijn GJM, Birnie E, Hiemstra PS, Sont JK, Taube C, Braunstahl GJ. Short-term and long-term effect of a high-intensity pulmonary rehabilitation programme in obese patients with asthma: a randomised controlled trial. Eur Respir J 2020; 56:13993003.01820-2019. [PMID: 32299852 DOI: 10.1183/13993003.01820-2019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/16/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the short-term and long-term effects of a high intensity pulmonary rehabilitation programme on asthma control, body composition, lung function and exercise capacity in obese asthma patients. METHODS Patients with obesity (body mass index (BMI)≥30 kg·m-2) and suboptimal controlled asthma (Asthma Control Questionnaire (ACQ)≥0.75) were randomly assigned to a 3-month pulmonary rehabilitation programme (PR only), pulmonary rehabilitation programme with the use of an internet based self-management support programme (PR+SMS) or usual care. The pulmonary rehabilitation programme included high-intensity interval training, nutritional intervention and psychological group sessions. Patients in the usual care group were advised to lose weight and to exercise. The primary outcome was the difference of change of ACQ between PR only and PR+SMS after 3 months. Total follow-up was 12 months. RESULTS 34 patients were included in the study (14 PR only, nine PR+SMS, 11 control). Compared with patients in usual care, patients in the PR only group had a significant reduction in BMI and significant improvements in asthma control, exercise capacity and aerobic capacity after 3 months. These improvements persisted during 12 months of follow-up. No difference in ACQ between PR+SMS and PR only groups was observed. However, users of the SMS programme had a significantly lower BMI after 12 months compared with subjects in the PR only group. CONCLUSION A high-intensity pulmonary rehabilitation programme provides sustained improvements in asthma control, body composition and exercise capacity in obese asthmatics that are not optimally controlled and, therefore, should be considered in the treatment of these patients.
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Affiliation(s)
- Yasemin Türk
- Dept of Pulmonology Franciscus Gasthuis & Vlietland Rotterdam The Netherlands
| | - Willy Theel
- Dept of Physiotherapy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Astrid van Huisstede
- Dept of Pulmonology Franciscus Gasthuis & Vlietland Rotterdam The Netherlands.,Dept of Pulmonology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gert-Jan M van de Geijn
- Dept of Clinical Chemistry, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Dept of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Dept of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Dept of Statistics and Education, Francis Academy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Pieter S Hiemstra
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob K Sont
- Dept of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Christian Taube
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.,Dept of Pulmonary Medicine, University Hospital Essen - Ruhrlandklinik, Essen, Germany
| | - Gert-Jan Braunstahl
- Dept of Pulmonology Franciscus Gasthuis & Vlietland Rotterdam The Netherlands.,Dept of Pulmonology, Erasmus Medical Center, Rotterdam, The Netherlands
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7
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van Mil SR, Vijgen GHEJ, van Huisstede A, Klop B, van de Geijn GJM, Birnie E, Braunstahl GJ, Mannaerts GHH, Biter LU, Castro Cabezas M. Discrepancies Between BMI and Classic Cardiovascular Risk Factors. Obes Surg 2019; 28:3484-3491. [PMID: 29931482 DOI: 10.1007/s11695-018-3359-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Obesity is related to increased cardiovascular risk. It is unknown whether increasing levels of obesity also increase levels of cardiovascular risk factors and systemic inflammation. This study describes the relationship between classic cardiovascular risk factors and inflammatory markers with BMI in a group of obese and non-obese subjects. MATERIALS AND METHODS Obese subjects (BMI ≥ 30 kg/m2; n = 576; mean ± SD BMI 43.8 ± 7.58 kg/m2) scheduled for bariatric surgery were included. The reference population consisted of non-obese volunteers (BMI < 30 kg/m2; n = 377, BMI 25.0 ± 2.81 kg/m2). The relationship between BMI quintiles and the levels of cardiovascular risk factors was analyzed. Adipose tissue volumetry was performed in 42 obese subjects using abdominal CT scans. RESULTS The obese group included more women and subjects with type 2 diabetes mellitus, hypertension, and current smoking behavior. In obese subjects, HDL-C and triglycerides decreased with increasing BMI. Systolic and diastolic blood pressure, total cholesterol, LDL-C, and apoB were not related to BMI in the obese group, in contrast to the non-obese group. Inflammatory markers CRP, leukocyte count, and serum complement C3 increased with increasing BMI in the obese group, while these relations were less clear in the non-obese group. The subcutaneous adipose tissue surface was positively correlated to BMI, while no correlation was observed between BMI and visceral adipose tissue. CONCLUSIONS Markers of inflammation are strongest related to BMI in obese subjects, most likely due to increased adipose tissue mass, while cardiovascular risk factors do not seem to deteriorate above a certain BMI level. Limited expansion capacity of visceral adipose tissue may explain these findings.
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Affiliation(s)
- Stefanie R van Mil
- Department of Surgery, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands.
| | - Guy H E J Vijgen
- Department of Surgery, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - Astrid van Huisstede
- Department of Pulmonology, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - Boudewijn Klop
- Department of Internal Medicine, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - Gert-Jan M van de Geijn
- Department of Clinical Chemistry, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands.,Division Women and Baby, Department of Obstetrics and Gynecology, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - Guido H H Mannaerts
- Department of Surgery, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis, PO Box 10900, 3004 BA, Rotterdam, The Netherlands
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8
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Abstract
This pilot study was performed to investigate the feasibility of pre-surgical pulmonary rehabilitation (PR) in morbidly obese patients with uncontrolled asthma, undergoing bariatric surgery. Four morbidly obese female patients with asthma participated in a 12-week PR program (exercise, diet, and psychological intervention) before undergoing bariatric surgery, and the outcomes were compared to a matched group of seven female controls (bariatric surgery only). In patients who participated in PR, asthma control and asthma quality of life improved dramatically after 3 months of PR. Besides, asthma control was better at the moment of surgery. The results of this pilot study show that PR is feasible in morbidly obese asthmatics and should be considered for a selected group of patients with uncontrolled asthma before undergoing bariatric surgery.
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Affiliation(s)
- Yasemin Türk
- Department of Pulmonology, Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
| | - Astrid van Huisstede
- Department of Pulmonology, Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Christian Taube
- Department of Pulmonology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
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van Mil S, van Huisstede A, Klop B, van de Geijn GJ, Jan Braunstahl G, Birnie E, Mannaerts G, Biter L, Castro Cabezas M. Discrepancies in the relationship of BMI and traditional cardiovascular risk factors in subjects with different levels of obesity. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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van Huisstede A, Rudolphus A, van Schadewijk A, Cabezas MC, Mannaerts GHH, Taube C, Hiemstra PS, Braunstahl GJ. Bronchial and systemic inflammation in morbidly obese subjects with asthma: a biopsy study. Am J Respir Crit Care Med 2014; 190:951-4. [PMID: 25317466 DOI: 10.1164/rccm.201407-1225le] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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van Huisstede A, Castro Cabezas M, van de Geijn GJM, Mannaerts GH, Njo TL, Taube C, Hiemstra PS, Braunstahl GJ. Underdiagnosis and overdiagnosis of asthma in the morbidly obese. Respir Med 2013; 107:1356-64. [PMID: 23764128 DOI: 10.1016/j.rmed.2013.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/05/2013] [Accepted: 05/06/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of obesity and asthma has increased concurrently over the last decades, suggesting a link between obesity and asthma. However, asthma might not be adequately diagnosed in this population. AIM To investigate whether not only overdiagnosis but also underdiagnosis of asthma is present in an obese population. METHODS Morbidly obese subjects with or without physician-diagnosed asthma were recruited from a pre-operative screening programme for bariatric surgery, and were characterized using an extensive diagnostic algorithm. RESULTS 473 subjects were screened; 220 met inclusion criteria, and 86 agreed to participate. Among the 32 participating subjects who had a physician diagnosis of asthma, reversible airway obstruction and/or bronchial hyperresponsiveness could only be detected in 19 patients (59%, 95% CI [0.41-0.76]), whereas in 13 patients (41%, 95% CI [0.24-0.50]) the diagnosis of asthma could not be confirmed (overdiagnosis). In contrast, in the remaining 54 patients, 17 (31%, 95% CI [0.20-0.46]) were newly diagnosed with asthma (underdiagnosis). CONCLUSION Besides overdiagnosis, there is also substantial underdiagnosis of asthma in the morbidly obese. Symptoms could be incorrectly ascribed to either obesity or asthma, and therefore also in the morbidly obese the diagnosis of asthma should also be based on pulmonary function testing.
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Affiliation(s)
- Astrid van Huisstede
- Sint Franciscus Gasthuis, Department of Pulmonology, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
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van Huisstede A, Biter LU, Luitwieler R, Castro Cabezas M, Mannaerts G, Birnie E, Taube C, Hiemstra PS, Braunstahl GJ. Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery. Obes Surg 2013; 23:1596-603. [DOI: 10.1007/s11695-013-0928-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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van Huisstede A, Cabezas MC, Birnie E, van de Geijn GJM, Rudolphus A, Mannaerts G, Njo TL, Hiemstra PS, Braunstahl GJ. Systemic inflammation and lung function impairment in morbidly obese subjects with the metabolic syndrome. J Obes 2013; 2013:131349. [PMID: 23509614 PMCID: PMC3595660 DOI: 10.1155/2013/131349] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/06/2013] [Accepted: 01/26/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Obesity and asthma are associated. There is a relationship between lung function impairment and the metabolic syndrome. Whether this relationship also exists in the morbidly obese patients is still unknown. Hypothesis. Low-grade systemic inflammation associated with the metabolic syndrome causes inflammation in the lungs and, hence, lung function impairment. METHODS This is cross-sectional study of morbidly obese patients undergoing preoperative screening for bariatric surgery. Metabolic syndrome was assessed according to the revised NCEP-ATP III criteria. RESULTS A total of 452 patients were included. Patients with the metabolic syndrome (n = 293) had significantly higher blood monocyte (mean 5.3 versus 4.9, P = 0.044) and eosinophil percentages (median 1.0 versus 0.8, P = 0.002), while the total leukocyte count did not differ between the groups. The FEV1/FVC ratio was significantly lower in patients with the metabolic syndrome (76.7% versus 78.2%, P = 0.032). Blood eosinophils were associated with FEV1/FVC ratio (adj. B -0.113, P = 0.018). CONCLUSION Although the difference in FEV1/FVC ratio between the groups is relatively small, in this cross-sectional study, and its clinical relevance may be limited, these data indicate that the presence of the metabolic syndrome may influence lung function impairment, through the induction of relative eosinophilia.
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Affiliation(s)
- Astrid van Huisstede
- Department of Pulmonology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
- *Astrid van Huisstede:
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Sint Franciscus Gasthuis, 3045 PM Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics, Sint Franciscus Gasthuis, 3045 PM Rotterdam, The Netherlands
- Institute of Health Policy and Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
| | | | - Arjan Rudolphus
- Department of Pulmonology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | - Guido Mannaerts
- Department of Surgery, Sint Franciscus Gasthuis, 3045 PM Rotterdam, The Netherlands
| | - Tjin L. Njo
- Department of Clinical Chemistry, Sint Franciscus Gasthuis, 3045 PM Rotterdam, The Netherlands
| | - Pieter S. Hiemstra
- Department of Pulmonology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
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van der Weerd K, Dik WA, Schrijver B, Schweitzer DH, Langerak AW, Drexhage HA, Kiewiet RM, van Aken MO, van Huisstede A, van Dongen JJ, van der Lelij AJ, Staal FJ, van Hagen PM. Morbidly obese human subjects have increased peripheral blood CD4+ T cells with skewing toward a Treg- and Th2-dominated phenotype. Diabetes 2012; 61:401-8. [PMID: 22228716 PMCID: PMC3266399 DOI: 10.2337/db11-1065] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Obesity is associated with local T-cell abnormalities in adipose tissue. Systemic obesity-related abnormalities in the peripheral blood T-cell compartment are not well defined. In this study, we investigated the peripheral blood T-cell compartment of morbidly obese and lean subjects. We determined all major T-cell subpopulations via six-color flow cytometry, including CD8+ and CD4+ T cells, CD4+ T-helper (Th) subpopulations, and natural CD4+CD25+FoxP3+ T-regulatory (Treg) cells. Moreover, molecular analyses to assess thymic output, T-cell proliferation (T-cell receptor excision circle analysis), and T-cell receptor-β (TCRB) repertoire (GeneScan analysis) were performed. In addition, we determined plasma levels of proinflammatory cytokines and cytokines associated with Th subpopulations and T-cell proliferation. Morbidly obese subjects had a selective increase in peripheral blood CD4+ naive, memory, natural CD4+CD25+FoxP3+ Treg, and Th2 T cells, whereas CD8+ T cells were normal. CD4+ and CD8+ T-cell proliferation was increased, whereas the TCRB repertoire was not significantly altered. Plasma levels of cytokines CCL5 and IL-7 were elevated. CD4+ T-cell numbers correlated positively with fasting insulin levels. The peripheral blood T-cell compartment of morbidly obese subjects is characterized by increased homeostatic T-cell proliferation to which cytokines IL-7 and CCL5, among others, might contribute. This is associated with increased CD4+ T cells, with skewing toward a Treg- and Th2-dominated phenotype, suggesting a more anti-inflammatory set point.
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Affiliation(s)
- Kim van der Weerd
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Willem A. Dik
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Benjamin Schrijver
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dave H. Schweitzer
- Department of Internal Medicine, Reinier de Graaf Group of Hospitals, Delft, the Netherlands
| | - Anton W. Langerak
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hemmo A. Drexhage
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rosalie M. Kiewiet
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | | | - Aart-Jan van der Lelij
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank J.T. Staal
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - P. Martin van Hagen
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Corresponding author: P. Martin van Hagen,
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