1
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Govindaraju T, Man M, Owen AJ, Carroll M, Borg BM, Smith CL, Gao CX, Brown D, Poland D, Allgood S, Ikin JF, Abramson MJ, McCaffrey TA, Lane TJ. Does diet quality moderate the long-term effects of discrete but extreme PM 2.5 exposure on respiratory symptoms? A study of the Hazelwood coalmine fire. Environ Res 2024; 252:119014. [PMID: 38685296 DOI: 10.1016/j.envres.2024.119014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
In 2014, a fire at an open cut coalmine in regional Victoria, Australia burned for 6 weeks. Residents of the nearby town of Morwell were exposed to smoke, which included high levels of fine particulate matter (PM2.5). We investigated whether the long-term effects of PM2.5 on respiratory health were moderated by diet quality. A cross-sectional analysis was conducted of data collected 8.5 years after the mine fire from 282 residents of Morwell and 166 residents from the nearby unexposed town of Sale. Primary outcomes were respiratory symptoms. Exposure was coalmine fire-related PM2.5 and diet quality was assessed as Australian Recommended Food Score (ARFS) derived using the Australian Eating Survey (AES). The moderating effect of diet quality on respiratory outcomes associated with PM2.5 was assessed using logistic regression models, adjusting for potential confounders. Diet quality was poor in this sample, with 60% in the lowest category of overall diet quality. Overall diet quality and fruit and vegetable quality significantly attenuated the association between PM2.5 and prevalence of chronic cough and phlegm. Sauce/condiment intake was associated with a greater effect of PM2.5 on COPD prevalence. No other moderating effects were significant. The moderating effects of overall diet quality and vegetable and fruit intake aligned with a priori hypotheses, suggesting potential protective benefits. While more evidence is needed to confirm these findings, improving diets, especially fruit and vegetable intake, may provide some protection against the effects of smoke exposure from fire events.
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Affiliation(s)
- Thara Govindaraju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martin Man
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Carroll
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Brigitte M Borg
- Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Poland
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Shantelle Allgood
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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2
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Lane TJ, Carroll M, Borg BM, McCaffrey TA, Smith CL, Gao CX, Brown D, Poland D, Allgood S, Ikin J, Abramson MJ. Long-term effects of extreme smoke exposure on COVID-19: A cohort study. Respirology 2024; 29:56-62. [PMID: 37681548 DOI: 10.1111/resp.14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND In 2014, the Hazelwood coalmine fire shrouded the regional Australian town of Morwell in smoke and ash for 6 weeks. One of the fire's by-products, PM2.5 , is associated with an increased risk of COVID-19 and severe disease. However, it is unclear whether the effect persisted for years after exposure. In this study, we surveyed a cohort established prior to the pandemic to determine whether PM2.5 from the coalmine fire increased long-term vulnerability to COVID-19 and severe disease. METHODS From August to December 2022, 612 members of the Hazelwood Health Study's adult cohort, established in 2016/17, participated in a follow-up survey that included standardized items to capture COVID-19 cases, as well as questions about hospitalization and vaccinations. Associations were evaluated in crude and adjusted logistic regression models. RESULTS A total of 268 (44%) participants self-reported or met symptom criteria for having had COVID-19 at least once. All models found a positive association, with odds of COVID-19 increasing by between 4% and 30% for a 10 μg/m3 increase in coalmine fire-related PM2.5 exposure. However, the association was significant in only 2 of the 18 models. There were insufficient hospitalizations to examine severity (n = 7; 1%). CONCLUSION The findings are inconclusive on the effect of coalmine fire-related PM2.5 exposure on long-term vulnerability to COVID-19. Given the positive association that was robust to modelling variations as well as evidence for a causal mechanism, it would be prudent to treat PM2.5 from fire events as a long-term risk factor until more evidence accumulates.
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Affiliation(s)
- Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Carroll
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Health, Melbourne, Victoria, Australia
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Poland
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Shantelle Allgood
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Jillian Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sim JPY, Nilsen K, Borg BM, Levvey B, Vazirani J, Ennis S, Plit M, Snell GI, Darley DR, Tonga KO. Oscillometry in Stable Single and Double Lung Allograft Recipients Transplanted for Interstitial Lung Disease: Results of a Multi-Center Australian Study. Transpl Int 2023; 36:11758. [PMID: 38116170 PMCID: PMC10728296 DOI: 10.3389/ti.2023.11758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
Peak spirometry after single lung transplantation (SLTx) for interstitial lung disease (ILD) is lower than after double lung transplantation (DLTx), however the pathophysiologic mechanisms are unclear. We aim to assess respiratory mechanics in SLTx and DLTx for ILD using oscillometry. Spirometry and oscillometry (tremoflo® C-100) were performed in stable SLTx and DLTx recipients in a multi-center study. Resistance (R5, R5-19) and reactance (X5) were compared between LTx recipient groups, matched by age and gender. A model of respiratory impedance using ILD and DLTx data was performed. In total, 45 stable LTx recipients were recruited (SLTx n = 23, DLTx n = 22; males: 87.0% vs. 77.3%; median age 63.0 vs. 63.0 years). Spirometry was significantly lower after SLTx compared with DLTx: %-predicted mean (SD) FEV1 [70.0 (14.5) vs. 93.5 (26.0)%]; FVC [70.5 (16.8) vs. 90.7 (12.8)%], p < 0.01. R5 and R5-19 were similar between groups (p = 0.94 and p = 0.11, respectively) yet X5 was significantly worse after SLTx: median (IQR) X5 [-1.88 (-2.89 to -1.39) vs. -1.22 (-1.87 to -0.86)] cmH2O.s/L], p < 0.01. R5 and X5 measurements from the model were congruent with measurements in SLTx recipients. The similarities in resistance, yet differences in spirometry and reactance between both transplant groups suggest the important contribution of elastic properties to the pathophysiology. Oscillometry may provide further insight into the physiological changes occurring post-LTx.
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Affiliation(s)
- Joan P. Y. Sim
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Kristopher Nilsen
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Brigitte M. Borg
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bronwyn Levvey
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Jaideep Vazirani
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Samantha Ennis
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
| | - Marshall Plit
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Gregory I. Snell
- Lung Transplant and Respiratory Medicine Service, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - David R. Darley
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
| | - Katrina O. Tonga
- Lung Transplant and Thoracic Medicine Unit, St Vincent’s Hospital, Sydney, NSW, Australia
- St Vincent’s Hospital Clinical Campus, Faculty of Medicine and Health, The University of New South Wales, Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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4
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Alotaibi N, Borg BM, Abramson MJ, Paul E, Zwar N, Russell G, Wilson S, Holland AE, Bonevski B, Mahal A, George J. Different Case Finding Approaches to Optimise COPD Diagnosis: Evidence from the RADICALS Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1543-1554. [PMID: 37492489 PMCID: PMC10364814 DOI: 10.2147/copd.s371371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/28/2023] [Indexed: 07/27/2023] Open
Abstract
Aim Diagnosis of COPD in primary care is hindered by underuse of spirometry. Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting. Methods We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants' FEV1 and FEV6 were measured using a handheld spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George's Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD. Results FEV1/FEV6 <0.70 alone showed significant association (p<0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 <0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70). Conclusion Handheld micro-spirometers can facilitate case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.
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Affiliation(s)
- Nawar Alotaibi
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Brigitte M Borg
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eldho Paul
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Grant Russell
- Department of General Practice, Monash University, Melbourne, VIC, Australia
| | - Sally Wilson
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- Department of Infrastructure Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Holland
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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5
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Darley DR, Nilsen K, Vazirani J, Borg BM, Levvey B, Snell G, Plit ML, Tonga KO. Airway oscillometry parameters in baseline lung allograft dysfunction: Associations from a multicenter study. J Heart Lung Transplant 2023; 42:767-777. [PMID: 36681528 DOI: 10.1016/j.healun.2022.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Baseline lung allograft dysfunction (BLAD), the failure to achieve ≥80%-predicted spirometry after lung transplant (LTx), is associated with impaired survival. Physiologic abnormalities in BLAD are poorly understood. Airway oscillometry measures respiratory system mechanics and may provide insight into understanding the mechanisms of BLAD. OBJECTIVES This study aims to describe and measure the association between airway oscillometry parameters [Reactance (Xrs5, Ax), Resistance (Rrs5, Rrs5-19)] (1) stable LTx recipients, comparing those with normal spirometry and those with BLAD; and (2) in recipients with chronic lung allograft dysfunction (CLAD), comparing those with normal baseline spirometry and those with BLAD. METHODS A multi-center cross-sectional study was performed including bilateral LTx between January 2020 and June 2021. Participants performed concurrent airway oscillometry and spirometry. Multivariable logistic regression was performed to measure the association between oscillometry parameters and BLAD. RESULTS A total of 404 LTx recipients performed oscillometry and 253 were included for analysis. Stable allograft function was confirmed in 149 (50.2%) recipients (92 (61.7%) achieving normal spirometry and 57 (38.3%) with BLAD). Among stable LTx recipients, lower Xrs5 Z-Score (aOR 0.50 95% CI 0.37-0.76, p = 0.001) was independently associated with BLAD. CLAD was present in 104 (35.0%) recipients. Among recipients with CLAD, lower Xrs5 Z-Score (aOR 0.73 95% CI 0.56-0.95, p = 0.02) was associated with BLAD. CONCLUSIONS Oscillometry provides novel physiologic insights into mechanisms of BLAD. The independent association between Xrs5 and BLAD, in both stable recipients and those with CLAD suggests that respiratory mechanics, in particular abnormal elastance, is an important physiologic feature. Further longitudinal studies are needed to understand the trajectory of oscillometry parameters in relation to allograft outcomes.
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Affiliation(s)
- David Ross Darley
- Lung Transplant Unit, St Vincent's Hospital Sydney, Darlinghurst NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia.
| | - Kris Nilsen
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - Jaideep Vazirani
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
| | - Bronwyn Levvey
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - G Snell
- Lung Transplant Service, The Alfred Hospital, Melbourne, Australia
| | - Marshall Lawrence Plit
- Lung Transplant Unit, St Vincent's Hospital Sydney, Darlinghurst NSW, Australia; School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia
| | - Katrina O Tonga
- School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, UNSW Medicine & Health, UNSW Sydney, Australia; Thoracic Medicine Department, St Vincent's Hospital Darlinghurst, Sydney, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
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6
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Borg BM, Osadnik C, Adam K, Chapman DG, Farrow CE, Glavas V, Hancock K, Lanteri CJ, Morris EG, Romeo N, Schneider‐Futschik EK, Selvadurai H. Pulmonary function testing during
SARS‐CoV
‐2: An
ANZSRS
/
TSANZ
position statement. Respirology 2022; 27:688-719. [PMID: 35981737 PMCID: PMC9539179 DOI: 10.1111/resp.14340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Brigitte M. Borg
- Respiratory Medicine The Alfred Melbourne Victoria Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Christian Osadnik
- Department of Physiotherapy Monash University Frankston Victoria Australia
- Monash Lung Sleep Allergy & Immunology Monash Health Clayton Victoria Australia
| | - Keith Adam
- Sonic HealthPlus Osborne Park Western Australia Australia
| | - David G. Chapman
- Respiratory Investigation Unit, Department of Respiratory Medicine Royal North Shore Hospital St Leonards New South Wales Australia
- Airway Physiology & Imaging Group, Woolcock Institute of Medical Research The University of Sydney Glebe New South Wales Australia
- Discipline of Medical Science, School of Life Sciences, Faculty of Science University of Technology Sydney Ultimo New South Wales Australia
| | - Catherine E. Farrow
- Airway Physiology & Imaging Group, Woolcock Institute of Medical Research The University of Sydney Glebe New South Wales Australia
- Respiratory Function Laboratory, Department of Respiratory and Sleep Medicine Westmead Hospital Westmead New South Wales Australia
- Westmead Clinical School, Sydney Medical School, Faculty of Medicine and Health Sciences The University of Sydney Sydney New South Wales Australia
| | - Vanda Glavas
- Respiratory SA Kent Town South Australia Australia
| | - Kerry Hancock
- Chandlers Hill Surgery Happy Valley South Australia Australia
| | - Celia J. Lanteri
- Department of Respiratory & Sleep Medicine Austin Health Heidelberg Victoria Australia
- Institute for Breathing and Sleep Austin Health Heidelberg Victoria Australia
| | - Ewan G. Morris
- Department of Respiratory Medicine Waitematā District Health Board Auckland New Zealand
| | - Nicholas Romeo
- Department of Respiratory Medicine Northern Health Epping Victoria Australia
| | - Elena K. Schneider‐Futschik
- Cystic Fibrosis Pharmacology Laboratory, Department of Biochemistry & Pharmacology University of Melbourne Parkville Victoria Australia
- School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences University of Melbourne Parkville Victoria Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine The Children's Hospital, Westmead, Sydney Childrens Hospital Network Sydney NSW Australia
- Discipline of Child and Adolescent Health Sydney Medical School, The University of Sydney Sydney NSW Australia
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7
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O'Sullivan CF, Nilsen K, Borg BM, Ellis MJ, Matsas P, Thien F, Douglass JA, Stuart-Andrews C, King GG, Prisk GK, Thompson BR. Small Airways Dysfunction is Associated with Increased Exacerbations in Patients with Asthma. J Appl Physiol (1985) 2022; 133:629-636. [PMID: 35861519 DOI: 10.1152/japplphysiol.00103.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/22/2022] Open
Abstract
There is poor understanding of why some patients with asthma experience recurrent exacerbations despite high levels of treatment. We compared measurements of peripheral ventilation heterogeneity and respiratory system mechanics in participants with asthma who were differentiated according to exacerbation history, to ascertain whether peripheral airway dysfunction was related to exacerbations. Three asthmatic groups: "Stable" (no exacerbations for >12 months, n=18), "Exacerbation-prone" (≥1 exacerbation requiring systemic corticosteroids within the last 12 months, but stable for ≥1-month, n=9) and "Treated-exacerbation" (exacerbation requiring systemic corticosteroids within the last 1 month, n=12) were studied. All participants were current non-smokers with <10pack/years smoking history. Spirometry, static lung volumes, ventilation heterogeneity from multi-breath nitrogen washout (MBW) and respiratory system mechanics from oscillometry were measured. The Exacerbation-prone group compared to the Stable group had slightly worse spirometry (FEV1 Z-score -3.58(1.13) vs -2.32(1.06), p=0.03), however acinar ventilation heterogeneity (Sacin Z-score 7.43(8.59) vs 3.63(3.88), p=0.006) and respiratory system reactance (Xrs cmH2O.s.L-1 -2.74(3.82) vs -1.32(1.94), p=0.01) were much worse in this group. The Treated-exacerbation group had worse spirometry but similar small airway function, compared with the Stable group. Patients with asthma who exacerbate have worse small airway function as evidenced by increases in Sacin measured by MBW and delta Xrs from oscillometry, both markers of small airway dysfunction, compared with those that do not.
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Affiliation(s)
- Claire F O'Sullivan
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Kris Nilsen
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,School of Health Science, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Matthew J Ellis
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Pam Matsas
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Frank Thien
- Monash University, Melbourne, VIC, Australia.,Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia
| | - Jo A Douglass
- The Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | | | - Gregory G King
- Airway Physiology and Imaging Group, The Woolcock Institute, Sydney, NSW, Australia
| | - Gordon Kim Prisk
- Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Bruce R Thompson
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,School of Health Science, University of Melbourne, Melbourne, VIC, Australia
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8
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Borg BM, Thompson BR. Putting lung function reference equations into context. Breathe (Sheff) 2022; 17:210099. [PMID: 35035558 PMCID: PMC8753635 DOI: 10.1183/20734735.0099-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
Knowing the limitations of reference equations is essential to minimising errors in diagnosis and clinical management. Choice of reference sets may impact access to treatment options where lung function based eligibility criteria exist.https://bit.ly/2WdOFDj
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Affiliation(s)
- Brigitte M Borg
- Respiratory Medicine, The Alfred, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bruce R Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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9
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Lee WK, Smith CL, Gao CX, Borg BM, Nilsen K, Brown D, Makar A, McCrabb T, Thompson BR, Abramson MJ. Reply to: 'Respiratory harms from vaping: Questions for debate and discussion'. Respirology 2021; 27:96-98. [PMID: 34878194 DOI: 10.1111/resp.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Wai Kit Lee
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Youth Mental Health (Orygen), University of Melbourne, Melbourne, Victoria, Australia
| | - Brigitte M Borg
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Kristopher Nilsen
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - David Brown
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Annie Makar
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Tom McCrabb
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia.,School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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10
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Lee JWY, Tay TR, Borg BM, Sheriff N, Vertigan A, Abramson MJ, Hew M. Laryngeal hypersensitivity and abnormal cough response during mannitol bronchoprovocation challenge. Respirology 2021; 27:48-55. [PMID: 34617364 DOI: 10.1111/resp.14165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/13/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Inhalational challenge with dry mannitol powder may potentially induce cough by two mechanisms: airway bronchoconstriction or laryngeal irritation. This prospective observational study investigated laryngeal and bronchial components of cough induced by mannitol challenge. METHODS We recruited consecutive patients referred for clinical mannitol challenge. The Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ) was administered. Throughout testing, coughs were audio-recorded to derive a cough frequency index per time and dose of mannitol. Relationships between cough indices, laryngeal hypersensitivity and bronchial hyperresponsiveness (BHR) were examined. Participants were classified by cough characteristics with k-means cluster analysis. RESULTS Of 90 patients who underwent challenge, 83 completed both the questionnaire and challenge. Cough frequency was greater in patients with abnormal laryngeal hypersensitivity (p = 0.042), but not in those with BHR. There was a moderate negative correlation between coughs per minute and laryngeal hypersensitivity score (r = -0.315, p = 0.004), with lower LHQ scores being abnormal. Cluster analysis identified an older, female-predominant cluster with higher cough frequency and laryngeal hypersensitivity, and a younger, gender-balanced cluster with lower cough frequency and normal laryngeal sensitivity. CONCLUSION Cough frequency during mannitol challenge in our cohort reflected laryngeal hypersensitivity rather than BHR. Laryngeal hypersensitivity was more often present among older female patients. With the incorporation of cough indices, mannitol challenge may be useful to test for laryngeal hypersensitivity as well as BHR.
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Affiliation(s)
- Joy Wei-Yan Lee
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Brigitte M Borg
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Neha Sheriff
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Anne Vertigan
- Speech Pathology Department, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology and Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Paraskeva MA, Borg BM, Paul E, Fuller J, Westall GP, Snell GI. Abnormal one-year post-lung transplant spirometry is a significant predictor of increased mortality and chronic lung allograft dysfunction. J Heart Lung Transplant 2021; 40:1649-1657. [PMID: 34548197 DOI: 10.1016/j.healun.2021.08.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prognostic value of evaluating spirometry at a fixed time point using standardized population reference has not previously been evaluated. Our aim was to assess the association between spirometric phenotype at 12 months (Spiro12M), survival and incidence of chronic lung allograft dysfunction (CLAD) in bilateral lung transplant recipients. METHODS We conducted a retrospective cohort study of bilateral lung transplant recipients transplanted between January 2003 and September 2012. We defined Spiro12M as the mean of the 2 prebronchodilator FEV1 measurements 12-month post-transplant. Normal spirometry was defined as FEV1/FVC ≥0.7 and FEV1≥80% and FVC≥80% predicted population-based values for that recipient. Abnormal spirometry was defined as failure to attain normal function by 12-months. We used a Cox regression model to assess the association between Spiro12M, survival, and CLAD. We used logistic regression to assess potential pretransplant donor and recipient factors associated with abnormal Spiro12M RESULTS: One hundred and eleven (51%) lung transplant recipients normalized their Spiro12M. Normal Spiro12M was associated improved survival (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.41-0.88], p = 0.009. Each 10% decrement in FEV1 increased the risk of death in a stepwise fashion. Additionally, CLAD was reduced in those with normal Spiro12M (HR:0.65, 95%CI:0.46-0.92, p = 0.016). Donor smoking history (OR:2.93, 95% CI:1.21-7.09; p = 0.018) and mechanical ventilation time in hours (OR:1.03, 95% CI:1.004-1.05; p = 0.02) were identified as independent predictors of abnormal Spiro12M. CONCLUSIONS Abnormal Spiro12M is associated with increased mortality and the development of CLAD. The effect is dose dependent with increased dysfunction corresponding to increased risk. This assessment of phenotype at 12-months can easily be incorporated into standard of care.
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Affiliation(s)
- Miranda A Paraskeva
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
| | - Brigitte M Borg
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Eldho Paul
- Department of Clinical Hematology, Alfred Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jeremy Fuller
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Glen P Westall
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Gregory I Snell
- Lung Transplant Service, Alfred Hospital, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
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12
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Sim JPS, Darley DR, Nilsen K, Shirol R, Borg BM, Vazirani J, Levvey B, Snell G, Plit M, Tonga KO. Airway oscillometry after single lung transplantation is characterised by abnormal respiratory reactance. Transplantation 2021. [DOI: 10.1183/13993003.congress-2021.pa3497] [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: 11/05/2022]
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13
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Lee WK, Smith CL, Gao CX, Borg BM, Nilsen K, Brown D, Makar A, McCrabb T, Thompson BR, Abramson MJ. Are e-cigarette use and vaping associated with increased respiratory symptoms and poorer lung function in a population exposed to smoke from a coal mine fire? Respirology 2021; 26:974-981. [PMID: 34227181 DOI: 10.1111/resp.14113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/03/2021] [Accepted: 06/15/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVE E-cigarette use has become increasingly prevalent, but there is some evidence demonstrating potential harms with frequent use. We aimed to identify the profiles of e-cigarette users from a regional community in Australia and investigate the associations of e-cigarettes with respiratory symptoms and lung function. METHODS A total of 519 participants completed a cross-sectional study. Exposure to e-cigarettes was collected via a validated questionnaire. Respiratory symptoms were evaluated via a self-reported questionnaire and lung function measured with spirometry and forced oscillation technique (FOT). Linear and logistic regression models were fitted to investigate the associations between e-cigarettes and outcomes, while controlling for confounders such as tobacco smoking. RESULTS Of the 519 participants, 46 (9%) reported e-cigarette use. Users tended to be younger (mean ± SD 45.2 ± 14.5 vs. 55.3 ± 16.0 years in non-users), concurrently using tobacco products (63% vs. 12% in non-users), have a mental health diagnosis (67% vs. 37% in non-users) and have self-reported asthma (63% vs. 42% in non-users). After controlling for known confounders, chest tightness (OR = 2.4, 95% CI 1.2-4.9, p = 0.02) was associated with e-cigarette use. Spirometry was not different after adjustment for confounding. However, FOT showed more negative reactance and a greater area under the reactance curve in e-cigarette users than non-users. CONCLUSION E-cigarette use was associated with increased asthma symptoms and abnormal lung mechanics in our sample, supporting a potential health risk posed by these products. Vulnerable populations such as young adults and those with mental health conditions have higher usage, while there is high concurrent tobacco smoking.
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Affiliation(s)
- Wai Kit Lee
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Youth Mental Health (Orygen), University of Melbourne, Melbourne, Victoria, Australia
| | - Brigitte M Borg
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Kristopher Nilsen
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - David Brown
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Annie Makar
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia
| | - Thomas McCrabb
- Respiratory Medicine, The Alfred, Melbourne, Victoria, Australia.,School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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14
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Holt NR, Gao CX, Borg BM, Brown D, Broder JC, Ikin J, Makar A, McCrabb T, Nilsen K, Thompson BR, Abramson MJ. Long-term impact of coal mine fire smoke on lung mechanics in exposed adults. Respirology 2021; 26:861-868. [PMID: 34181807 DOI: 10.1111/resp.14102] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE In 2014, a 6-week-long fire at the Hazelwood coal mine exposed residents in the adjacent town of Morwell to high concentrations of fine particulate matter with an aerodynamic diameter < 2.5 μm (PM2.5 ). The long-term health consequences are being evaluated as part of the Hazelwood Health Study. METHODS Approximately 3.5-4 years after the mine fire, adults from Morwell (n = 346) and the comparison town Sale (n = 173) participated in the longitudinal Respiratory Stream of the Study. Individual PM2.5 exposure was retrospectively modelled. Lung mechanics were assessed using the forced oscillation technique (FOT), utilizing pressure waves to measure respiratory system resistance (Rrs) and reactance (Xrs). Multivariate linear regression was used to evaluate associations between PM2.5 and transformed Rrs at 5 Hz, area under the reactance curve (AX5) and Xrs at 5 Hz controlling for key confounders. RESULTS There were clear dose-response relationships between increasing mine fire PM2.5 and worsening lung mechanics, including a reduction in post-bronchodilator (BD) Xrs5 and an increase in AX5. A 10 μg/m3 increase in mine fire-related PM2.5 was associated with a 0.015 (95% CI: 0.004, 0.027) reduction in exponential (Xrs5) post-BD, which was comparable to 4.7 years of ageing. Similarly, the effect of exposure was associated with a 0.072 (0.005, 0.138) increase in natural log (lnAX5) post-BD, equivalent to 3.9 years of ageing. CONCLUSION This is the first study using FOT in adults evaluating long-term respiratory outcomes after medium-term ambient PM2.5 exposure to coal mine fire smoke. These results should inform public health policies and planning for future events.
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Affiliation(s)
- Nicolette R Holt
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthetics, Perioperative Medicine & Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Youth Mental Health (Orygen), University of Melbourne, Melbourne, Victoria, Australia
| | - Brigitte M Borg
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - David Brown
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan C Broder
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jillian Ikin
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Annie Makar
- Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas McCrabb
- Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kris Nilsen
- Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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15
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King SJ, Keating D, Williams E, Paul E, Borg BM, Finlayson F, Button BM, Wilson JW, Kotsimbos T. Lumacaftor/ivacaftor-associated health stabilisation in adults with severe cystic fibrosis. ERJ Open Res 2021; 7:00203-2020. [PMID: 33569502 PMCID: PMC7861032 DOI: 10.1183/23120541.00203-2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/27/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Lumacaftor/ivacaftor (LUM/IVA) has been shown to improve clinical outcomes in cystic fibrosis (CF) patients homozygous for Phe508del with forced expiratory volume in 1 s (FEV1) % pred >40%. We assessed the clinical utility of LUM/IVA in all eligible adult CF patients with FEV1 % pred <40% treated for at least 1 year under a single-centre managed access programme. Methods Following clinical optimisation, eligible patients (n=40) with FEV1 % pred <40% were commenced on LUM/IVA and monitored for tolerance and clinical outcomes, including health service utilisation, pulmonary function, weight and body composition. 24 patients reached 1 year of treatment by the time of evaluation. Six patients discontinued due to adverse events (five for increased airways reactivity) and three underwent lung transplantation. Results In comparison with the year prior to LUM/IVA commencement, significant reductions (median per year) were observed in the treatment year in the number of pulmonary exacerbations requiring hospitalisation (from 3 to 1.5; p=0.0002), hospitalisation days (from 27 to 17; p=0.0002) and intravenous antibiotic (IVAB) usage days (from 45 to 27; p=0.0007). Mean±sd change in FEV1 % pred was −2.10±1.18% per year in the year prior, with the decline reversed in the year following (+1.45±1.13% per year; p=0.035), although there was significant heterogeneity in individual responses. Mean±sd weight gain at 1 year was 2.5±4.1 kg (p=0.0007), comprising mainly fat mass (mean 2.2 kg). The proportion of patients severely underweight (body mass index <18.5 kg·m−2) decreased from 33% at baseline to 13% at 1 year (p=0.003). Conclusion This real-world evaluation study demonstrated benefits over several clinical domains (infective exacerbations requiring hospitalisation, IVABs, pulmonary function decline and nutritional parameters) in CF patients with severe lung disease. In adults with severe cystic fibrosis lung disease, 1 year of treatment with lumacaftor/ivacaftor was associated with reduced infective exacerbations, days of intravenous antibiotics and rate of pulmonary function decline, and improved nutritional statushttps://bit.ly/2I07suR
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Affiliation(s)
- Susannah J King
- Nutrition Dept, Alfred Hospital, Melbourne, Australia.,Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Dietetics, Nutrition and Sport, LaTrobe University, Bundoora, Australia
| | - Dominic Keating
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
| | - Elyssa Williams
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Brigitte M Borg
- Physiology Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Felicity Finlayson
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
| | - Brenda M Button
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia.,Physiotherapy Dept, Alfred Hospital, Melbourne, Australia
| | - John W Wilson
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
| | - Tom Kotsimbos
- Cystic Fibrosis Service, Dept of Respiratory Medicine, Alfred Hospital, Melbourne, Australia.,Dept of Medicine, Monash University, Melbourne, Australia
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16
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Schneider I, Rodwell L, Baum S, Borg BM, Del Colle EA, Ingram ER, Swanney M, Taylor D. Assessing spirometry competence through certification in community-based healthcare settings in Australia and New Zealand: A position paper of the Australian and New Zealand Society of Respiratory Science. Respirology 2020; 26:147-152. [PMID: 33319478 PMCID: PMC7898916 DOI: 10.1111/resp.13987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022]
Abstract
Spirometry has been established as an essential test for diagnosing and monitoring respiratory disease, particularly asthma and COPD, as well as in occupational health surveillance. In Australia and New Zealand, there is currently no pathway for spirometry operators in community‐based healthcare settings to demonstrate spirometry competence. The Australia and New Zealand Society of Respiratory Science (ANZSRS) has identified a need for developing a pathway for operators working in community‐based practices in Australia and New Zealand to demonstrate spirometry competence and certification. Spirometry certification provides evidence to patients, clients, employers and organizations that an individual has participated in an assessment process that qualifies them to perform spirometry to current international spirometry standards set out by the American Thoracic Society and the European Respiratory Society (ATS/ERS). This document describes a competence assessment pathway that incorporates a portfolio and practical assessment. The completion of this pathway and the award of certification confer an individual is competent to perform spirometry for 3 years, after which re‐certification is required. The adoption of this competency assessment and certification process by specialist organizations, and the commitment of operators performing spirometry to undergo this process, will enhance spirometry quality and practice in community‐based healthcare settings.
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Affiliation(s)
- Irene Schneider
- Respiratory Investigation Unit, The Prince Charles Hospital, Brisbane, QLD, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Leanne Rodwell
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Sarah Baum
- Spirometry Training Company (Aust), Sessional Academic, Charles Sturt University, Sydney, NSW, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eleonora A Del Colle
- Respiratory Laboratory Services, Department of Respiratory Medicine, Box Hill Hospital, Melbourne, VIC, Australia.,Pulmetrics Pty Ltd, Melbourne, VIC, Australia
| | - Emily R Ingram
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Maureen Swanney
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Deborah Taylor
- Respiratory Laboratory, Hawke's Bay District Health Board, New Zealand, Hawke's Bay, New Zealand.,Spiro Me Training, Hawke's Bay, New Zealand
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17
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Owen AJ, Abramson MJ, Ikin JF, McCaffrey TA, Pomeroy S, Borg BM, Gao CX, Brown D, Liew D. Recommended Intake of Key Food Groups and Cardiovascular Risk Factors in Australian Older, Rural-Dwelling Adults. Nutrients 2020; 12:nu12030860. [PMID: 32210180 PMCID: PMC7146596 DOI: 10.3390/nu12030860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 01/01/2023] Open
Abstract
This study examined the relationship between diet quality scores and cardiometabolic risk factors in regionally-dwelling older Australian adults with increased cardiovascular risk. This study was a cross-sectional analysis of demographic, anthropometric, and cardiometabolic risk factor data from 458 participants of the Cardiovascular Stream of the Hazelwood Health Study. Participants completed a 120 item semi-quantitative food frequency questionnaire. Multivariable linear regression adjusting for age, sex, smoking, physical activity, education, diabetes, and body mass index was used to examine the relationship between diet and cardiometabolic risk factors. Mean (SD) age of participants was 71 (8) years, and 55% were male. More than half of men and women did not meet recommended intakes of fibre, while 60% of men and 42% of women exceeded recommended dietary sodium intakes. Higher diet quality in terms of intake of vegetables, grains, and non-processed meat, as well as intake of non-fried fish, was associated with more favourable cardiometabolic risk profiles, while sugar-sweetened soft drink intake was strongly associated with adverse cardiometabolic risk factor levels. In older, regionally-dwelling adults, dietary public health strategies that address whole grain products, vegetable and fish consumption, and sugar-sweetened soft-drink intake may be of benefit in reducing cardiometabolic risk.
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Affiliation(s)
- Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
- Correspondence: ; Tel.: +61-3-9903-0045
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
| | - Jill F. Ikin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
| | - Tracy A. McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC 3168, Australia;
| | - Sylvia Pomeroy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
| | - Brigitte M. Borg
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
- Respiratory Medicine, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Caroline X. Gao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia; (M.J.A.); (J.F.I.); (S.P.); (B.M.B.); (C.X.G.); (D.B.); (D.L.)
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18
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Holt NR, Thompson BR, Miller B, Borg BM. Substantial variation exists in spirometry interpretation practices for airflow obstruction in accredited lung function laboratories across Australia and New Zealand. Intern Med J 2019; 49:41-47. [PMID: 30043534 DOI: 10.1111/imj.14047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/25/2018] [Accepted: 07/17/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Spirometry forms the foundation investigation for the diagnosis and monitoring of common pulmonary conditions. However, potential variation in spirometry interpretation for airflow obstruction may impact subsequent clinical management. AIM To audit spirometry interpretation practices for airflow obstruction in Thoracic Society of Australia and New Zealand accredited laboratories. METHODS Thirty-nine accredited complex lung function laboratories were invited to participate in an online survey. The survey enquired about demographics, definition of lower limit of normal range for spirometry parameters, spirometric parameters used for identifying airflow obstruction, spirometric definition of airflow obstruction, definition of significant bronchodilator response and chosen spirometry reference equations. RESULTS Thirty-six laboratories provided complete responses (response rate, 92%). To define the lower limit of normal, 26 of 36 used the 5th percentile, 7 of 36 used a fixed cut-off and 3 used other. Twenty-nine laboratories utilised forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC) as the sole parameter to identify airflow obstruction, 3 of 36 used FEV1 /FVC and FEF25-75% , and 4 used other. To define airflow obstruction, 25 of 36 laboratories used FEV1 /FVC < 5th percentile, 9 of 36 used a fixed cut-off (FEV1 /FVC < 0.7, 6/36; FEV1 /FVC < 0.8, 2/36; FEV1 /FVC < 0.75, 1/36) and 2 of 36 used other. Twenty-six laboratories defined a significant bronchodilator response as an increase of at least 200 mL and 12% in FEV1 and/or FVC, 9 of 36 used ≥200 mL and ≥ 12% increase in FEV1 only, and 1 used other criteria. Reference equations utilised for interpretation of spirometry data included: Quanjer 2012 Global Lung Initiative (16/36), the third National Health and Nutritional Examination Survey (8/36), European Community of Coal and Steel (8/36) and other (4/36). CONCLUSIONS Significant heterogeneity in spirometry interpretation for airflow obstruction exists across Australian and New Zealand accredited lung function laboratories. Lack of standardisation may translate into clinically appreciable differences for the diagnosis and management of common respiratory conditions. Ongoing discussion regarding formal standardisation is required.
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Affiliation(s)
- Nicolette R Holt
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Belinda Miller
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Brigitte M Borg
- Department of Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
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19
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Swanney MP, O'Dea CA, Ingram ER, Rodwell LT, Borg BM. Spirometry training courses: Content, delivery and assessment - a position statement from the Australian and New Zealand Society of Respiratory Science. Respirology 2017; 22:1430-1435. [PMID: 28681980 DOI: 10.1111/resp.13133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/02/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
Spirometry training courses are provided by health services and training organizations to enable widespread use of spirometry testing for patient care or for monitoring health. The primary outcome of spirometry training courses should be to enable participants to perform spirometry to international best practice, including testing of subjects, quality assurance and interpretation of results. Where valid results are not achieved or quality assurance programmes identify errors in devices, participants need to be able to adequately manage these issues in accordance with best practice. It is important that potential participants are confident in the integrity of the course they attend and that the course meets their expectations in terms of training. This position statement lists the content that the Australian and New Zealand Society of Respiratory Science (ANZSRS) has identified as required in a spirometry training course to adequately meet the primary outcomes mentioned above. The content requirements outlined in this position statement are based on the current international spirometry standards set out by the American Thoracic Society and European Respiratory Society. Furthermore, recommendations around course delivery for theoretical and practical elements of spirometry testing and post-course assessment are outlined in this statement.
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Affiliation(s)
- Maureen P Swanney
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Christopher A O'Dea
- Department of Respiratory Medicine, Princess Margaret Hospital, Perth, WA, Australia
| | - Emily R Ingram
- Respiratory Physiology Laboratory, Christchurch Hospital, Christchurch, New Zealand
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
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Abramson MJ, Kaushik S, Benke GP, Borg BM, Smith CL, Dharmage SC, Thompson BR. Symptoms and lung function decline in a middle-aged cohort of males and females in Australia. Int J Chron Obstruct Pulmon Dis 2016; 11:1097-103. [PMID: 27307725 PMCID: PMC4887046 DOI: 10.2147/copd.s103817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The European Community Respiratory Health Survey is a major international study designed to assess lung health in adults. This Australian follow-up investigated changes in symptoms between sexes and the roles of asthma, smoking, age, sex, height, and change in body mass index (ΔBMI) on lung function decline (LFD), which is a major risk factor for chronic obstructive pulmonary disease (COPD). METHODS LFD was measured as the rate of decline over time in FEV1 (mL/year) (ΔFEV1) and FVC (ΔFVC) between 1993 and 2013. Multiple linear regression was used to estimate associations between risk factors and LFD, separately for males and females. Multiple logistic regression was used to assess sex differences and changes in respiratory symptoms over time. RESULTS In Melbourne, 318 subjects (53.8% females) participated. The prevalence of most respiratory symptoms had either remained relatively stable over 20 years or decreased (significantly so for wheeze). The exception was shortness of breath after activity, which had increased. Among the 262 subjects who completed spirometry, current smoking declined from 20.2% to 7.3%. Overall mean (± standard deviation) FEV1 declined by 23.1 (±17.1) and FVC by 22.9 (±20.2) mL/year. Predictors of ΔFEV1 in males were age, maternal smoking, and baseline FEV1; and in females they were age, ΔBMI, baseline FEV1, and pack-years in current smokers. Decline in FVC was predicted by baseline FVC, age, and ΔBMI in both sexes; however, baseline FVC predicted steeper decline in females than males. CONCLUSION Most respiratory symptoms remained stable or decreased over time in both sexes. Age, baseline lung function, and change in BMI were associated with the rate of decline in both sexes. However, obesity and personal smoking appear to put females at higher risk of LFD than males. Health promotion campaigns should particularly target females to prevent COPD.
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Affiliation(s)
- Michael J Abramson
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
| | - Sonia Kaushik
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
| | - Geza P Benke
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
| | - Brigitte M Borg
- Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine L Smith
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce R Thompson
- Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Jurgilaitis A, Enquist H, Andreasson BP, Persson AIH, Borg BM, Caroff P, Dick KA, Harb M, Linke H, Nüske R, Wernersson LE, Larsson J. Time-resolved X-ray diffraction investigation of the modified phonon dispersion in InSb nanowires. Nano Lett 2014; 14:541-546. [PMID: 24387246 DOI: 10.1021/nl403596b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The modified phonon dispersion is of importance for understanding the origin of the reduced heat conductivity in nanowires. We have measured the phonon dispersion for 50 nm diameter InSb (111) nanowires using time-resolved X-ray diffraction. By comparing the sound speed of the bulk (3880 m/s) and that of a classical thin rod (3600 m/s) to our measurement (2880 m/s), we conclude that the origin of the reduced sound speed and thereby to the reduced heat conductivity is that the C44 elastic constant is reduced by 35% compared to the bulk material.
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Affiliation(s)
- A Jurgilaitis
- Department of Physics and ‡MAX IV Laboratory, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
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Jurgilaitis A, Enquist H, Harb M, Dick KA, Borg BM, Nüske R, Wernersson LE, Larsson J. Measurements of light absorption efficiency in InSb nanowires. Struct Dyn 2014; 1:014502. [PMID: 26913673 PMCID: PMC4711595 DOI: 10.1063/1.4833559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/31/2013] [Indexed: 06/02/2023]
Abstract
We report on measurements of the light absorption efficiency of InSb nanowires. The absorbed 70 fs light pulse generates carriers, which equilibrate with the lattice via electron-phonon coupling. The increase in lattice temperature is manifested as a strain that can be measured with X-ray diffraction. The diffracted X-ray signal from the excited sample was measured using a streak camera. The amount of absorbed light was deduced by comparing X-ray diffraction measurements with simulations. It was found that 3.0(6)% of the radiation incident on the sample was absorbed by the nanowires, which cover 2.5% of the sample.
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Affiliation(s)
- A Jurgilaitis
- Department of Physics, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
| | - H Enquist
- MAX IV laboratory, Lund University , P.O. Box 118, Lund, Sweden
| | - M Harb
- Department of Physics, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
| | | | - B M Borg
- Department of Physics, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
| | - R Nüske
- Department of Physics, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
| | - L-E Wernersson
- Department of Electrical and Information Technology, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
| | - J Larsson
- Department of Physics, Lund University , P.O. Box 118, SE-221 00 Lund, Sweden
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Borg BM, Hartley MF, Bailey MJ, Thompson BR. Adherence to acceptability and repeatability criteria for spirometry in complex lung function laboratories. Respir Care 2013; 57:2032-8. [PMID: 22709916 DOI: 10.4187/respcare.01724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few published data exist for adherence rates to spirometry acceptability and repeatability criteria in clinical respiratory laboratories. This study quantified adherence levels in this setting and observed changes in adherence levels as a result of feedback and ongoing training. METHODS Two tertiary hospital-based, lung function laboratories (L1 and L2) participated. Approximately 100 consecutive, FVC spirometry sessions were reviewed for each year from 2004 to 2008 at L1 and for years 2004 and 2008 at L2. Each spirometric effort and session was interrogated for adherence to the acceptability and repeatability criteria of international spirometry standards of the time. Feedback of audit results and refresher training were provided at L1 throughout the study; in addition, a quality rating scale was implemented in 2006. No formal feedback or follow-up training was provided at L2. RESULTS We reviewed 707 test sessions over the 5 years. There was no difference in adherence rates to acceptability and repeatability criteria between sites in 2004 (L1 61%, L2 59%, P = .89). There was, however, a significant difference between sites in 2008 (L1 92%, L2 65%, P < .001). No difference was seen at L2 between 2004 and 2008 (P = .26), while L1 experienced a significant increase in adherence levels between 2004 and 2008 (61% to 92% P < .001). CONCLUSIONS Clinical respiratory laboratories met published spirometry acceptability and repeatability criteria only 60% of the time in the first audit period. This improved with regular review, feedback, and implementation of a rating scale. Auditing of spirometry quality, feedback, and implementation of test rating scales need to be incorporated as an integral component of laboratory quality assurance programs to improve adherence to international acceptability and repeatability criteria.
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Affiliation(s)
- Brigitte M Borg
- Department of Allergy, Monash University Medical School, Melbourne, Victoria, Australia
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Borg BM, Thompson BR. Expiratory reserve volume maneuver may be the preferred method for some patients during spirometry testing. The authors respond. Respir Care 2013; 58:e15. [PMID: 23776964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kelly VJ, Brown NJ, Sands SA, Borg BM, King GG, Thompson BR. Effect of airway smooth muscle tone on airway distensibility measured by the forced oscillation technique in adults with asthma. J Appl Physiol (1985) 2012; 112:1494-503. [PMID: 22362406 DOI: 10.1152/japplphysiol.01259.2011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Airway distensibility appears to be unaffected by airway smooth muscle (ASM) tone, despite the influence of ASM tone on the airway diameter-pressure relationship. This discrepancy may be because the greatest effect of ASM tone on airway diameter-pressure behavior occurs at low transpulmonary pressures, i.e., low lung volumes, which has not been investigated. Our study aimed to determine the contribution of ASM tone to airway distensibility, as assessed via the forced oscillation technique (FOT), across all lung volumes with a specific focus on low lung volumes. We also investigated the accompanying influence of ASM tone on peripheral airway closure and heterogeneity inferred from the reactance versus lung volume relationship. Respiratory system conductance and reactance were measured using FOT across the entire lung volume range in 22 asthma subjects and 19 healthy controls before and after bronchodilator. Airway distensibility (slope of conductance vs. lung volume) was calculated at residual volume (RV), functional residual capacity (FRC), and total lung capacity. At baseline, airway distensibility was significantly lower in subjects with asthma at all lung volumes. After bronchodilator, distensibility significantly increased at RV (64.8%, P < 0.001) and at FRC (61.8%, P < 0.01) in subjects with asthma but not in control subjects. The increased distensibility at RV and FRC in asthma were not associated with the accompanying changes in the reactance versus lung volume relationship. Our findings demonstrate that, at low lung volumes, ASM tone reduces airway distensibility in adults with asthma, independent of changes in airway closure and heterogeneity.
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Affiliation(s)
- Vanessa J Kelly
- Department of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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Abstract
BACKGROUND The statement of the American Thoracic Society and European Respiratory Society on the measurement of static lung volumes (SLV) suggests a preferred and alternate method for measuring and calculating SLV. OBJECTIVE To determine if differences in functional residual capacity (FRC), vital capacity (VC), residual volume (RV), and total lung capacity (TLC), obtained using preferred and alternate measurement and calculation methodologies, exist in a clinical setting. METHODS Patients attending for SLV at a hospital-based laboratory were recruited. Following spirometry, SLV was measured via body plethysmography, using the preferred and alternate methods in random order. Volumes were calculated using the preferred and alternate calculation methods. Subjects were classified according to standard ventilatory function interpretative strategies. Differences of the means between the measurement methods, and calculation methods were assessed. RESULTS One hundred eight data sets were analyzed. Significant, but small differences (< 150 mL) in the means for VC and TLC, and RV and TLC were found in the normal and restricted groups, respectively. No significant differences in SLV parameters were found in subjects with air-flow obstruction. Twelve of the 108 changed ventilatory function classification between methods, with the alternate method delivering a lower inspiratory capacity and TLC without a change in RV in 66% of this subgroup. Identical results were obtained when data were analyzed using both calculation methods. CONCLUSIONS Differences in FRC, VC, RV, and TLC obtained using the preferred and alternate measurement methodologies exist in the clinical setting in select classification groups and individuals. Differing calculation methods dependent on measurement method used may be unnecessary.
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Affiliation(s)
- Brigitte M Borg
- Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.
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Paraskeva MA, Borg BM, Naughton MT. Spirometry. Aust Fam Physician 2011; 40:216-219. [PMID: 21597532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Spirometry measures the flow and volume of air entering and leaving the lungs. It is used to assess ventilatory function and differentiates between normality and diseases causing obstructive and possibly restrictive defects.
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Affiliation(s)
- Miranda A Paraskeva
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria.
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Borg BM, Hartley MF, Fisher MT, Thompson BR. Spirometry training does not guarantee valid results. Respir Care 2010; 55:689-694. [PMID: 20507650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Many healthcare professionals performing spirometry in primary care have had less than half a day's training in spirometry practice, and the validity of the test results is questionable. Longer training periods, with or without follow-up training, may improve test validity. OBJECTIVE To determine if a 14-hour spirometry training course provides sufficient skill to produce valid results, and if follow-up training improves test validity. METHODS Nurses and physiotherapists from rural health facilities chosen by their local area health service undertook a 14-hour spirometry course facilitated by respiratory scientists with at least 5 years experience. Participants consented to on-site reviews at 5, 7, and 9 months after the course. Participants were assessed for adherence to American Thoracic Society (ATS) acceptability and repeatability criteria by undertaking an assessment of spirometry on a naïve subject and a retrospective review of a selection of spirometry results at each site at each visit. Further education was provided following the reviews at 5 and 7 months. RESULTS Fifteen participants from 10 sites were available for all 3 visits. The prospective phase revealed poor adherence to ATS criteria at 5 months, though this improved over the study period with follow-up training (40% at 5 months, 67% at 7 months, 87% at 9 months). The retrospective review showed that 37%, 60%, and 58% of the tests at 5, 7, and 9 months, respectively, met the ATS criteria and had correctly selected the best test. CONCLUSION A 14-hour spirometry training course alone does not provide sufficient skill to perform spirometry to ATS criteria, and short-term follow-up is an essential component for improving test validity.
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Affiliation(s)
- Brigitte M Borg
- Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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Egard M, Johansson S, Johansson AC, Persson KM, Dey AW, Borg BM, Thelander C, Wernersson LE, Lind E. Vertical InAs nanowire wrap gate transistors with f(t) > 7 GHz and f(max) > 20 GHz. Nano Lett 2010; 10:809-812. [PMID: 20131812 DOI: 10.1021/nl903125m] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this letter we report on high-frequency measurements on vertically standing III-V nanowire wrap-gate MOSFETs (metal-oxide-semiconductor field-effect transistors). The nanowire transistors are fabricated from InAs nanowires that are epitaxially grown on a semi-insulating InP substrate. All three terminals of the MOSFETs are defined by wrap around contacts. This makes it possible to perform high-frequency measurements on the vertical InAs MOSFETs. We present S-parameter measurements performed on a matrix consisting of 70 InAs nanowire MOSFETs, which have a gate length of about 100 nm. The highest unity current gain cutoff frequency, f(t), extracted from these measurements is 7.4 GHz and the maximum frequency of oscillation, f(max), is higher than 20 GHz. This demonstrates that this is a viable technique for fabricating high-frequency integrated circuits consisting of vertical nanowires.
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Affiliation(s)
- M Egard
- Solid State Physics, Lund University, Box 118, 221 00 Lund, Sweden.
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Borg BM, Reid DW, Walters EH, Johns DP. Bronchodilator reversibility testing: laboratory practices in Australia and New Zealand. Med J Aust 2004; 180:610-3. [PMID: 15200356 DOI: 10.5694/j.1326-5377.2004.tb06121.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Accepted: 03/08/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the variation in the methods used to assess and interpret the reversibility of airflow limitation in lung-function laboratories throughout Australia and New Zealand. DESIGN A postal survey performed in 2000, requesting details of methods used to assess and interpret bronchodilator reversibility. SETTING AND PARTICIPANTS 60 lung-function laboratories identified from the Australian and New Zealand Society of Respiratory Science mailing list. MAIN OUTCOME MEASURES Bronchodilator agent, dose, mode of administration, time to repeat spirometry and definition of a significant response. RESULTS 37 laboratories responded (response rate, 64%). Thirty-three laboratories used salbutamol as their routine bronchodilator agent. Twenty-four laboratories used a metered-dose inhaler (MDI) with (21) or without (3) a spacer device as the preferred mode of bronchodilator administration. There was wide variation in the bronchodilator dose administered (median, 400 micro g; range, 200-800 micro g salbutamol for MDIs) and the time to repeat spirometry following bronchodilator administration (median, 10 min; range, 4-20 min). Ten laboratories used criteria consistent with either the National Asthma Council or Thoracic Society of Australia and New Zealand COPDX guidelines to define a significant bronchodilator response, and two used American Thoracic Society criteria. The remaining 25 respondents listed a variety of other criteria. CONCLUSION The methods used to assess and interpret acute bronchodilator reversibility in lung-function laboratories in Australia and New Zealand vary considerably. This may have a significant effect on the diagnosis and management of patients. Laboratories should report the method used to assess bronchodilator response.
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Affiliation(s)
- Brigitte M Borg
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital and Monash University Medical School, Melbourne, VIC
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