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Halvard Hansen ES, Kaiser H, Hansen KT, Bønnelykke K, Chawes B, Backer V, Torp-Pedersen C, Ulrik CS, Brustad N. Association between Apgar scores within normal range and development of asthma, allergic rhinitis and eczema in childhood: A Danish nationwide register study. Allergy 2024. [PMID: 38676401 DOI: 10.1111/all.16143] [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: 01/17/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Erik Sören Halvard Hansen
- Respiratory Research Unit Hvidovre, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Department of Respiratory Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Hannah Kaiser
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology Head & Neck Surgery and audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | | | - Charlotte Suppli Ulrik
- Respiratory Research Unit Hvidovre, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Nicklas Brustad
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte University Hospital, Copenhagen, Denmark
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Rønn C, Kamstrup P, Heerfordt CK, Sivapalan P, Eklöf J, Boel JB, Ostergaard C, Dessau RB, Moberg M, Janner J, Ulrik CS, Jensen JUS. Inhaled corticosteroids and Stenotrophomonas maltophilia in outpatients with chronic obstructive pulmonary disease: a retrospective cohort study. BMJ Open Respir Res 2024; 11:e001929. [PMID: 38460975 DOI: 10.1136/bmjresp-2023-001929] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/16/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVES Inhaled corticosteroids (ICS) are widely used in patients with chronic obstructive pulmonary disease (COPD). However, ICS are associated with an increased risk of adverse effects.We aimed to determine whether an association between a lower respiratory tract culture with Stenotrophomonas maltophilia and increasing ICS dosing in patients with COPD exists. DESIGN An observational cohort study of outpatients with COPD in Denmark between 2010 and 2018.ICS exposure was categorised into four groups based on average daily consumption 1 year prior to inclusion: no use, low ICS dose (≤400 µg), moderate ICS dose (400-800 µg) and high ICS dose (>800 µg). Dose-response relationship was investigated by a multivariable Cox proportional hazards regression. RESULTS Of the total 22 689 patients, 459 had lower respiratory tract cultures positive for S. maltophilia. The HR of S. maltophilia increased with increasing daily ICS dose: low ICS dose HR 2.6 (95% CI 1.6 to 4.0), moderate ICS dose HR 3.0 (95% CI 1.9 to 4.6) and high ICS dose HR 5.7 (95% CI 3.8 to 8.5). CONCLUSIONS We found that ICS was associated with a high, dose-dependent increased hazard of S. maltophilia in outpatients with COPD. High dose users had a nearly six times increased hazard compared with non-users of ICS. When appropriate, attempts at de-escalating ICS treatment should be made.
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Affiliation(s)
- Christian Rønn
- Section of Respiratory Medicine, Department of Internal Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Internal Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Christian Kjer Heerfordt
- Section of Respiratory Medicine, Department of Internal Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Internal Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Internal Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Jonas Bredtoft Boel
- Department of Clinical Microbiology, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Christian Ostergaard
- Department of Clinical Microbiology, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mia Moberg
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Internal Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Brünés N, Lindstroem MB, Ulrik CS, Andersen O, Lisby M, Godtfredsen NS, Hansen TL, Pisinger C, Graven V, Marsaa K, Thomsen LH. Opportunistic screening for COPD among socially marginalized patients. BMC Pulm Med 2024; 24:113. [PMID: 38443835 PMCID: PMC10916054 DOI: 10.1186/s12890-024-02927-9] [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: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease associated with premature death. Tobacco exposure is the main risk factor, but lower socioeconomic status, early life insults, and occupational exposures are also important risk factors. Socially marginalized people, facing homelessness, substance use disorder, and mental illness, are likely to have a higher risk of developing COPD, and, furthermore, experience barriers to healthcare access and consequently poorer outcomes. OBJECTIVE This study aims to assess COPD prevalence and the impact of opportunistic screening among hospitalized patients who are in contact with hospital social nurses. These patients constitute a group of patients with a high prevalence of psychiatric and somatic diseases, substance use, low life expectancy, and are socially marginalized. METHODS The present prospective longitudinal study includes a clinical examination at baseline. Participants will have spirometry done and be interviewed regarding risk factors, socioeconomic conditions, and respiratory symptoms. The 5-year follow-up assessment incorporates data from baseline and register data over the 5 years, including information on morbidity, use of COPD medication, hospital contacts, mortality, and socioeconomic factors. ANTICIPATED RESULTS Referral for further diagnostic work-up and management after the screening, including COPD treatment and smoking cessation support, is expected to improve survival rates. The study is still enrolling patients. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov , NCT04754308 with study status: "enrolling".
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Affiliation(s)
- Nina Brünés
- Department of Quality and Patient Care, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Lisby
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Health, Aarhus, Denmark
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Leth Hansen
- Department of Quality and Patient Care, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Copenhagen University Hospital- Frederiksberg, Frederiksberg, Denmark
- Tryg Foundation, Virum, Denmark
| | - Vibeke Graven
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kristoffer Marsaa
- Department of Multidisease, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Laura Hohwü Thomsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
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Duus LS, Vesterlev D, Nielsen AB, Lassen MH, Sivapalan P, Ulrik CS, Lapperre T, Browatzki A, Estépar RSJ, Nardelli P, Jensen JUS, Estépar RSJ, Biering-Sørensen T. COPD: pulmonary vascular volume associated with cardiac structure and function. Int J Cardiovasc Imaging 2024; 40:579-589. [PMID: 38040946 PMCID: PMC10951014 DOI: 10.1007/s10554-023-03027-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Early recognition of cardiac dysfunction in patients with chronic obstructive pulmonary disease (COPD) may prevent future cardiac impairment and improve prognosis. Quantitative assessment of subsegmental and segmental vessel volume by Computed Tomographic (CT) imaging can provide a surrogate of pulmonary vascular remodeling. We aimed to examine the relationship between lung segmental- and subsegmental vessel volume, and echocardiographic measures of cardiac structure and function in patients with COPD. METHODS We studied 205 participants with COPD, included in a large cohort study of cardiovascular disease in COPD patients. Participants had an available CT scan and echocardiogram. Artificial intelligence (AI) algorithms calculated the subsegmental vessel fraction as the vascular volume in vessels below 10 mm2 in cross-sectional area, indexed to total intrapulmonary vessel volume. Linear regressions were conducted, and standardized ß-coefficients were calculated. Scatterplots were created to visualize the continuous correlations between the vessel fractions and echocardiographic parameters. RESULTS We found that lower subsegmental vessel fraction and higher segmental vessel volume were correlated with higher left ventricular (LV) mass, LV diastolic dysfunction, and inferior vena cava (IVC) dilatation. Subsegmental vessel fraction was correlated with right ventricular (RV) remodeling, while segmental vessel fraction was correlated with higher pulmonary pressure. Measures of LV mass and right atrial pressure displayed the strongest correlations with pulmonary vasculature measures. CONCLUSION Pulmonary vascular remodeling in patients with COPD, may negatively affect cardiac structure and function. AI-identified remodeling in pulmonary vasculature may provide a tool for early identification of COPD patients at higher risk for cardiac impairment.
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Affiliation(s)
- Lisa Steen Duus
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
- Applied Chest Imaging Laboratory, Dept. of Radiology, Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Ditte Vesterlev
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Bjerg Nielsen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Applied Chest Imaging Laboratory, Dept. of Radiology, Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Mats Højbjerg Lassen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Depart. of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Herlev and Gentofte, Denmark
| | - Charlotte Suppli Ulrik
- Depart. of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Therese Lapperre
- Depart. of Respiratory Medicine, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
- Depart. Of Respiratory Medicine, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Andrea Browatzki
- Depart. of Respiratory and Infectious Diseases, North Zealand Hospital, Frederikssund and Hilleroed, Denmark
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Dept. of Radiology, Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Dept. of Radiology, Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Jens-Ulrik Staehr Jensen
- Depart. of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, Herlev and Gentofte, Denmark
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Dept. of Radiology, Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Tor Biering-Sørensen
- Dept. of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Dept. of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Renzi-Lomholt M, Ulrik CS, Rastogi D, Stæhr Jensen JU, Håkansson KEJ. Impact of family socioeconomic position on childhood asthma outcomes, severity, and specialist referral - a Danish nationwide study. Chron Respir Dis 2024; 21:14799731241231816. [PMID: 38378166 PMCID: PMC10880522 DOI: 10.1177/14799731241231816] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic illness in children, carrying a major burden. Socioeconomic position (SEP) affects adult asthma outcomes, but its impact on childhood asthma, particularly in primary versus specialist care, has not been studied thoroughly. METHODS In a Danish cohort consisting of all children aged 2-17 years redeeming inhaled corticosteroids in 2015, parental SEP impact on asthma outcomes was investigated. Workforce attachment, income, education, and metropolitan residence were chosen as covariates in logistic regression. Outcomes were uncontrolled (excessive use of short-acting beta2-agonists), exacerbating (oral corticosteroid use or hospitalization), and severe asthma (according to GINA 2020). RESULTS The cohort comprised 29,851 children (median age 8.0, 59% boys). 16% had uncontrolled asthma, 8% had ≥1 exacerbation. Lower income and metropolitan residence correlated with higher odds of poor control, exacerbations, and severe asthma. Lower education correlated with worse asthma outcomes. Education and income were protective factors in primary care, but not in specialist care. Metropolitan residence was the sole factor linked to specialist care referral for severe asthma. CONCLUSION Low parental SEP and metropolitan residence associated with poor asthma outcomes. However, specialist care often mitigated these effects, though such care was less likely for at-risk children in non-metropolitan areas.
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Affiliation(s)
- Martino Renzi-Lomholt
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jens Ulrik Stæhr Jensen
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Respiratory Section, Department of Internal Medicine, Copenhagen University Hospital - Gentofte, Gentofte, Denmark
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6
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Waeijen-Smit K, Crutsen M, Keene S, Miravitlles M, Crisafulli E, Torres A, Mueller C, Schuetz P, Ringbæk TJ, Fabbian F, Mekov E, Harries TH, Lun CT, Ergan B, Esteban C, Quintana Lopez JM, López-Campos JL, Chang CL, Hancox RJ, Shafuddin E, Ellis H, Janson C, Suppli Ulrik C, Gudmundsson G, Epstein D, Dominguez J, Lacoma A, Osadnik C, Alia I, Spannella F, Karakurt Z, Mehravaran H, Utens C, de Kruif MD, Ko FWS, Trethewey SP, Turner AM, Bumbacea D, Murphy PB, Vermeersch K, Zilberman-Itskovich S, Steer J, Echevarria C, Bourke SC, Lane N, de Batlle J, Sprooten RTM, Russell R, Faverio P, Cross JL, Prins HJ, Spruit MA, Simons SO, Houben-Wilke S, Franssen FME. Global mortality and readmission rates following COPD exacerbation-related hospitalisation: a meta-analysis of 65 945 individual patients. ERJ Open Res 2024; 10:00838-2023. [PMID: 38410700 PMCID: PMC10895439 DOI: 10.1183/23120541.00838-2023] [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: 11/13/2023] [Accepted: 12/16/2023] [Indexed: 02/28/2024] Open
Abstract
Background Exacerbations of COPD (ECOPD) have a major impact on patients and healthcare systems across the world. Precise estimates of the global burden of ECOPD on mortality and hospital readmission are needed to inform policy makers and aid preventive strategies to mitigate this burden. The aims of the present study were to explore global in-hospital mortality, post-discharge mortality and hospital readmission rates after ECOPD-related hospitalisation using an individual patient data meta-analysis (IPDMA) design. Methods A systematic review was performed identifying studies that reported in-hospital mortality, post-discharge mortality and hospital readmission rates following ECOPD-related hospitalisation. Data analyses were conducted using a one-stage random-effects meta-analysis model. This study was conducted and reported in accordance with the PRISMA-IPD statement. Results Data of 65 945 individual patients with COPD were analysed. The pooled in-hospital mortality rate was 6.2%, pooled 30-, 90- and 365-day post-discharge mortality rates were 1.8%, 5.5% and 10.9%, respectively, and pooled 30-, 90- and 365-day hospital readmission rates were 7.1%, 12.6% and 32.1%, respectively, with noticeable variability between studies and countries. Strongest predictors of mortality and hospital readmission included noninvasive mechanical ventilation and a history of two or more ECOPD-related hospitalisations <12 months prior to the index event. Conclusions This IPDMA stresses the poor outcomes and high heterogeneity of ECOPD-related hospitalisation across the world. Whilst global standardisation of the management and follow-up of ECOPD-related hospitalisation should be at the heart of future implementation research, policy makers should focus on reimbursing evidence-based therapies that decrease (recurrent) ECOPD.
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Affiliation(s)
- Kiki Waeijen-Smit
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Mieke Crutsen
- Pulmonary Function and Exercise Testing Laboratory, MUMC+, Maastricht, the Netherlands
| | - Spencer Keene
- Department of Research and Development, Ciro, Horn, the Netherlands
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical Pharmacy and Toxicology, MUMC+, Maastricht, the Netherlands
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Ernesto Crisafulli
- Respiratory Medicine Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona and University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Institución Catalana de Investigación y Estudios Avanzados, CIBERES, Barcelona, Spain
| | - Christian Mueller
- Cardiovascular Research Institute Base, Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Thomas J Ringbæk
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Fabio Fabbian
- Department of Medical Sciences, Faculty of Medicine, Pharmacy and Prevention, University of Ferrara, University Hospital of Ferrara, Ferrara, Italy
| | - Evgeni Mekov
- Department of Occupational Diseases, Medical University Sofia, Sofia, Bulgaria
| | - Timothy H Harries
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Chung-Tat Lun
- Department of Medicine and ICU, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, Hong Kong
| | - Begum Ergan
- Dokuz Eylul University, Faculty of Medicine, Department of Pulmonary and Critical Care, Division of Critical Care, Izmir, Turkey
| | - Cristóbal Esteban
- Respiratory Department, Hospital Galdakao, Galdakao, Spain
- Instituto BioCruces-Bizkaia, Barakaldo, Spain
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas, Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud, Bizkaia, Spain
| | - Jose M Quintana Lopez
- Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas, Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud, Bizkaia, Spain
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
- CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Catherina L Chang
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Robert J Hancox
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Hollie Ellis
- Department of Respiratory Medicine, Waikato Hospital, Hamilton, New Zealand
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Gunnar Gudmundsson
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - José Dominguez
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain
| | - Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERES, Barcelona, Spain
| | | | - Inmaculada Alia
- Intensive Care Units, Hospital Universitario de Getafe, CIBERES, Getafe, Spain
| | - Francesco Spannella
- Internal Medicine and Geriatrics, Hypertension Excellence Centre of the European Society of Hypertension, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University Politecnica delle Marche, Ancona, Italy
| | - Zuhal Karakurt
- Respiratory Critical Care Unit, University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hossein Mehravaran
- Pulmonary and Critical Care Division, Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Cecile Utens
- Libra, Rehabilitation and Audiology, Eindhoven, the Netherlands
| | - Martijn D de Kruif
- Department of Pulmonary Medicine, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Fanny Wai San Ko
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Samuel P Trethewey
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
- University of Exeter, Exeter, UK
| | - Alice M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dragos Bumbacea
- Department of Pneumology and Acute Respiratory Care, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Patrick B Murphy
- Lane Fox Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, King's College, London, UK
| | - Kristina Vermeersch
- Department of Chronic Diseases, Metabolism and Ageing, Research Group BREATHE, KU Leuven, Leuven, Belgium
| | - Shani Zilberman-Itskovich
- Nephrology Division, Assaf-Harofeh (Shamir) Medical Center, Be'er Ya'akov, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - John Steer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Carlos Echevarria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Stephen C Bourke
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Nicholas Lane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Respiratory Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Jordi de Batlle
- Group of Translational Research in Respiratory Medicine, Institut de Recerca Biomèdica de Lleida (Fundació Dr Pifarré), Lleida, Spain
- CIBERES, Madrid, Spain
| | - Roy T M Sprooten
- Department of Respiratory Medicine, MUMC+, Maastricht, The Netherlands
| | - Richard Russell
- School of Immunology and Microbial Sciences, Guy's Campus, Kings College, London, UK
| | - Paola Faverio
- School of Medicine and Surgery, University of Milan Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Jane L Cross
- Faculty of Medicine and Health, University of East Anglia, Norwich, UK
| | - Hendrik J Prins
- Department of PMR, Libra, Rehabilitation and Audiology, Eindhoven, The Netherlands
- Department of PMR, Anna Hospital, Geldrop, The Netherlands
- Department of PMR, Catharina Hospital, Eindhoven, The Netherlands
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | | | - Frits M E Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Baastrup Soendergaard M, Hansen S, Bjerrum AS, von Bülow A, Haakansson KEJ, Hilberg O, Ingebrigtsen TS, Johnsen CR, Lock-Johansson S, Makowska Rasmussen L, Schmid JM, Ulrik CS, Porsbjerg C. Tobacco Exposure and Efficacy of Biologic Therapy in Patients With Severe Asthma: A Nationwide Study From the Danish Severe Asthma Register. J Allergy Clin Immunol Pract 2024; 12:146-155.e5. [PMID: 37832820 DOI: 10.1016/j.jaip.2023.10.012] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Randomized trials of biologics in severe, uncontrolled asthma have excluded patients with a cumulative tobacco exposure of more than 10 pack-years. Therefore, our knowledge of the impact of smoking exposure on the clinical effects of biologics in severe asthma remains incomplete. However, because many patients with asthma are current or former smokers, investigating the potential impacts of tobacco exposure on the effects of biologic treatment is clinically important. OBJECTIVE To investigate the impact of smoking history and tobacco exposure on the effectiveness of biologic therapy in real-life patients with severe asthma. METHODS We used data from a complete nationwide cohort of patients with severe asthma who were receiving biologics, the Danish Severe Asthma Register. We divided patients according to smoking history and cumulative tobacco exposure and analyzed data at baseline and after 12 months of biologic treatment. RESULTS A total of 724 bio-naive patients were identified in the Danish Severe Asthma Register, 398 of whom had never been smokers (55%), 316 were previous smokers (44%), and 10 were current smokers (1%). Within the group of current and former smokers, 37% had 1 to 9 pack-years of tobacco exposure, 26% had 10 to 19 pack-years, and 37% had 20 or more pack-years of tobacco exposure. Patients with tobacco exposure had similar reductions in the number of exacerbations, reductions in maintenance oral corticosteroid use, and improvements in asthma symptoms compared with patients with 0 pack-years. CONCLUSION Former smoking history and lifetime tobacco exposure do not have an impact on the efficacy of biologics in patients with severe asthma.
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Affiliation(s)
| | - Susanne Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Frederiksberg Hospital, Copenhagen, Denmark
| | - Anne-Sofie Bjerrum
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Anna von Bülow
- Department of Respiratory Medicine, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | | | - Ole Hilberg
- Sygehus Lillebaelt-Vejle Sygehus, Vejle, Denmark
| | | | | | | | | | - Johannes Martin Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Celeste Porsbjerg
- Department of Respiratory Medicine, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
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8
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Perez-de-Llano L, Scelo G, Canonica GW, Chen W, Henley W, Larenas-Linnemann D, Peters MJ, Pfeffer PE, Tran TN, Ulrik CS, Popov TA, Sadatsafavi M, Hew M, Máspero J, Gibson PG, Christoff GC, Fitzgerald JM, Torres-Duque CA, Porsbjerg CM, Papadopoulos NG, Papaioannou AI, Heffler E, Iwanaga T, Al-Ahmad M, Kuna P, Fonseca JA, Al-Lehebi R, Rhee CK, Koh MS, Cosio BG, Perng Steve DW, Mahboub B, Menzies-Gow AN, Jackson DJ, Busby J, Heaney LG, Patel PH, Wang E, Wechsler ME, Altraja A, Lehtimäki L, Bourdin A, Bjermer L, Bulathsinhala L, Carter V, Murray R, Beastall A, Denton E, Price DB. Impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in patients with severe asthma. Ann Allergy Asthma Immunol 2023:S1081-1206(23)01508-9. [PMID: 38151100 DOI: 10.1016/j.anai.2023.12.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND There is little agreement on clinically useful criteria for identifying real-world responders to biologic treatments for asthma. OBJECTIVE To investigate the impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in adults with severe asthma. METHODS This was a longitudinal, cohort study across 22 countries participating in the International Severe Asthma Registry (https://isaregistries.org/) between May 2017 and January 2023. Change in 4 asthma domains (exacerbation rate, asthma control, long-term oral corticosteroid [LTOCS] dose, and lung function) was assessed from biologic initiation to 1 year post-treatment (minimum 24 weeks). Pre- to post-biologic changes for responders and nonresponders were described along a categorical gradient for each domain derived from pre-biologic distributions (exacerbation rate: 0 to 6+/y; asthma control: well controlled to uncontrolled; LTOCS: 0 to >30 mg/d; percent-predicted forced expiratory volume in 1 second [ppFEV1]: <50% to ≥80%). RESULTS Percentage of biologic responders (ie, those with a category improvement pre- to post-biologic) varied by domain and increased with greater pre-biologic impairment, increasing from 70.2% to 90.0% for exacerbation rate, 46.3% to 52.3% for asthma control, 31.1% to 58.5% for LTOCS daily dose, and 35.8% to 50.6% for ppFEV1. The proportion of patients having improvement post-biologic tended to be greater for anti-IL-5/5R compared with for anti-IgE for exacerbation, asthma control, and ppFEV1 domains, irrespective of pre-biologic impairment. CONCLUSION Our results provide realistic outcome-specific post-biologic expectations for both physicians and patients, will be foundational to inform future work on a multidimensional approach to define and assess biologic responders and response, and may enhance appropriate patient selection for biologic therapies. TRIAL REGISTRATION The ISAR database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization studies (ENCEPP/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EUPAS38288) and with all applicable local and international laws and regulation, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=38289). Governance was provided by ADEPT (registration number: ADEPT1220).
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Affiliation(s)
- Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - William Henley
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Health Statistics Group, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jorge Máspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Argentina
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - J Mark Fitzgerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad de La Sabana, Chia, Colombia
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom; Lung Division, Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Pujan H Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, Colorado
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Ruth Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
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Savran O, Suppli Ulrik C. Inhaled Corticosteroid Exposure and Risk of Cataract in Patients with Asthma and COPD: A Systematic Review and Meta-Analysis. J Ophthalmol 2023; 2023:8209978. [PMID: 37899845 PMCID: PMC10602708 DOI: 10.1155/2023/8209978] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 08/28/2023] [Accepted: 10/14/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose Both systemic and inhaled corticosteroids may increase the risk of cataract in patients with both chronic obstructive pulmonary disease (COPD) and asthma. Our aim was to assess the degree of association between cataract and corticosteroid exposure in patients with asthma and COPD. Methods A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The odds ratio estimates were extracted from each article. A random effects model was applied for estimate pooling in separate meta-analyses according to study design. Meta-regression was performed to assess the dose-response relationship between corticosteroid exposure and the risk of cataract development. Results A total of 19 studies met the criteria for inclusion in this review, of which 12 studies provided effect estimates for pooled analyses. All but one of the included observational studies reported a significant association between use of corticosteroids and cataract development in cohorts of asthma and/or COPD patients. Pooled analyses revealed on average a doubled risk of cataract in corticosteroid-exposed asthma and COPD patients. Studies have shown that daily high-dose inhaled corticosteroid (ICS) ≥ 1000 μg is associated with a significant risk of developing cataract and by that predispose to subsequent cataract surgery, although one study showed that systemic corticosteroids increase cataract risk more than ICS. Conclusion ICS treatment in asthma and COPD patients is a risk factor for cataract development. Our results emphasize a previously underestimated potential long-term risk of treatment with ICS and underline the importance of targeting ICS treatment, and not least dosing, to improve the risk-benefit ratio of maintenance treatment in both asthma and COPD.
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Affiliation(s)
- Osman Savran
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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10
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Mosbech CH, Godtfredsen NS, Ulrik CS, Westergaard CG. Biomarker-guided withdrawal of inhaled corticosteroids in asthma patients with a non-T2 inflammatory phenotype - a randomized controlled trial study protocol. BMC Pulm Med 2023; 23:372. [PMID: 37794472 PMCID: PMC10552380 DOI: 10.1186/s12890-023-02679-y] [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: 08/22/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Non-T2 asthma is characterized by the absence of elevated type 2 inflammatory biomarkers such as blood-eosinophils, total and allergen-specific Immunoglobulin E and Fractional exhaled Nitric Oxide (FeNO). According to guidelines, inhaled corticosteroids (ICS) are the cornerstone of asthma management. However, ICS treatment is associated with a risk of local side effects, including hoarseness and thrush, and long-term high-dose therapy may cause systemic adverse effects. Furthermore, whereas treatment with ICS is highly effective in T2 asthma, studies have shown a markedly reduced ICS efficacy in patients with a lower degree of T2 inflammation, thus posing a clinical challenge in this subgroup of patients. Hence, owing to the ICS dosage step-up approach in current clinical guidelines, patients with low T2 biomarkers are at risk of being exposed to high doses of ICS, and by that at risk of side effects. Thus, an ICS-treatment regime guided by biomarkers that reflects the inflammatory phenotype is warranted in order to reduce the corticosteroid burden in patients with non-T2 asthma. This study combines a panel of non-T2 inflammatory markers (low periostin, low blood-eosinophils, and low FeNO), to determine if this group of patients can maintain asthma control during ICS withdrawal. METHODS This is an ongoing prospective multicenter open-label randomized, controlled trial aiming to assess if ICS can be safely tapered in patients with non-T2 asthma. The patients are randomized 1:1 to either standard of care or an ICS tapering regimen (n = 55 in each group) where the initial ICS dose is reduced by 50% for 8 weeks followed by total ICS removal. The primary endpoint is change in asthma control questionnaire (ACQ) from baseline to post-tapered ICS. The secondary endpoints are time from baseline to drop-out caused by loss of asthma control, changes in serum-periostin, blood-eosinophils, FeNO, Forced Expiratory Volume in 1 s (FEV1) and in sputum-eosinophils. DISCUSSION This study aims to provide data on ICS tapering in non-T2 asthma patients and to contribute to a more individualized and corticosteroid-sparing treatment regime in this group of patients. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03141424. Registration date: May 5th, 2017.
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Affiliation(s)
| | - Nina Skavlan Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Kettegaard Allé 30, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Kettegaard Allé 30, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Christian Grabow Westergaard
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Kettegaard Allé 30, Hvidovre, Denmark
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11
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Hansen H, Torre A, Kallemose T, Ulrik CS, Godtfredsen NS. Pulmonary telerehabilitation vs. conventional pulmonary rehabilitation - a secondary responder analysis. Thorax 2023; 78:1039-1042. [PMID: 37451863 PMCID: PMC10511950 DOI: 10.1136/thorax-2023-220065] [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] [Indexed: 07/18/2023]
Abstract
Home-based pulmonary telerehabilitation (PTR) has been proposed to be equivalent to supervised outpatient pulmonary rehabilitation (PR) but available randomised trials have failed to reach the minimal important changes (MIC). The purpose of this study was to analyse the proportion of MIC responders and non-responders on short-term (10 weeks from baseline) and long-term (62 weeks from baseline) in total and between groups in 134 patients with COPD randomised (1:1) to either home-based PTR or traditional hospital-based outpatient PR. Difference between PTR and PR on 6MWD response proportion could not be shown at 10 (OR=0.72, CI=0.34 to 1.51, p=0.381) or 62 weeks (OR=1.12, CI=0.40 to 3.14, p=0.834). While the evidence and knowledge of PTR accumulate, outpatient supervised PR for now remains the standard of care, with home-based PTR as a strong secondary option for those unable to attend out-patient programmes.
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Affiliation(s)
- Henrik Hansen
- Respiratory Research Unit, Hvidovre Hospital Department of Respiratory Medicine, Hvidovre, Denmark
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | - Andre Torre
- Clinical research center, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical research center, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Skavlan Godtfredsen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Kobenhavn, Denmark
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12
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Savran O, Bønnelykke K, Ulrik CS. Relationship between early life asthma and chronic airway disease in adult life - in search for disease trajectories over the life span- the RELATE study based on the Kongsberg cohort. BMC Pulm Med 2023; 23:363. [PMID: 37770870 PMCID: PMC10540471 DOI: 10.1186/s12890-023-02661-8] [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: 07/07/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Chronic airway disease in adults may have its origin in early life. The purpose of this study is to investigate the long-term prognosis of severe childhood asthma in search for an association between asthma in early life and obstructive lung disease in adulthood. METHODS This study is based on the Kongsberg cohort, which includes approximately 5000 children with severe asthma with a 4-month stay at the asthma care facility in Kongsberg, Norway during the years 1950 to 1979. An on average 60-year observational study based on a follow-up examination will be performed including questionnaires, blood samples, and tests of lung function and bronchial responsiveness. Blood samples will be stored in a biobank. In addition, we will conduct further analyses of the cohort based on nationwide register data, including socio-economic parameters and mortality. DISCUSSION Chronic airway disease is associated with substantial burden for both the individual patient and society. Our knowledge of early life origins of chronic airway disease later in life has been increasing in recent decades but is still limited. By exploring early life risk factors for chronic airway disease in adulthood, we may gain insights paving the way for future reduction in the burden of chronic airway diseases.
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Affiliation(s)
- Osman Savran
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
| | - Klaus Bønnelykke
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Prospective Studies On Asthma in Childhood (COPSAC), Copenhagen University Hospital Gentofte, Gentofte, Denmark
| | - Charlotte Suppli Ulrik
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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13
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Rønn C, Kamstrup P, Eklöf J, Toennesen LL, Boel JB, Andersen CO, Dessau RB, Wilcke JT, Sivapalan P, Ulrik CS, Jensen JUS. Mortality and exacerbations associated with Stenotrophomonas maltophilia in chronic obstructive pulmonary disease. A regional cohort study of 22,689 outpatients. Respir Res 2023; 24:232. [PMID: 37752596 PMCID: PMC10523807 DOI: 10.1186/s12931-023-02544-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES The clinical significance of Stenotrophomonas maltophilia in patients with COPD is poorly understood. We aimed to determine whether a lower respiratory tract culture positive for S. maltophilia in COPD patients was independently associated with increased risk of death and hospitalisation for exacerbation of COPD. METHODS An observational cohort study following outpatients with COPD in Eastern Denmark between 2010 and 2018, with a follow-up period of five years. Presence of S. maltophilia was treated as a time-varying exposure, where patients were considered exposed at the time of the first isolation of S. maltophilia from the lower respiratory tract. The hazard ratio (HR) of death and hospitalisation for acute exacerbations of COPD was assessed using a Cox proportional hazards regression. RESULTS Of the total 22,689 patients 459 (2.0%) had a lower respiratory sample positive for S. maltophilia. A total of 7,649 deaths (S. maltophilia positive: 243 (52.9%) and S. maltophilia negative: 7,406 (34.4%)) and 24,912 hospitalisations for exacerbation of COPD (S. maltophilia positive: 1,100 in 459 patients and S. maltophilia negative: 23,821 in 22,230 patients) were registered during the study period. We found that a lower respiratory tract culture positive for S. maltophilia was associated with both increased mortality: HR 3.3 (95% CI 2.6-4.3), and hospitalisation for exacerbation of COPD: HR 3.4 (95% CI 2.8-4.1). CONCLUSIONS A lower respiratory tract culture positive for S. maltophilia in COPD patients was associated with a substantially increased mortality and hospitalisation for exacerbation of COPD. Randomised controlled trials are proposed to determine whether S. maltophilia should be the target of antibiotic treatment.
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Affiliation(s)
- Christian Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark.
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Louise Lindhardt Toennesen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Jonas Bredtoft Boel
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev, Herlev, Denmark
| | | | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jon Torgny Wilcke
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Cabrera Guerrero S, Håkansson KEJ, Backer V, Ulrik CS, Rastogi D. Childhood Asthma and Parental Antidepressant Use in a Nationwide Danish Cohort. J Asthma Allergy 2023; 16:821-831. [PMID: 37576930 PMCID: PMC10422996 DOI: 10.2147/jaa.s421169] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
Background Paediatric asthma is associated with caregiver depression, which in turn is associated with poor asthma control. Although sociodemographic risk factors are associated with parental depression among children with asthma, the contribution of these factors to caregiver depression in free-to-access universal healthcare settings is unknown. Methods The association between childhood asthma and parental antidepressant use was investigated in a Danish nationwide cohort of children aged 2-17 years that redeemed inhaled corticosteroids in 2015. The odds of antidepressant use were estimated in comparison to control families that were matched 1:1 on the number of siblings, residence, income, and education. Results Among the families of 28,595 children with actively treated asthma, 12% of mothers and 6.2% of fathers were on antidepressant therapy, compared to 9.3% and 5.3% in controls (p<0.001). Paediatric asthma was associated with increased odds of parental antidepressant use (OR 1.29 (1.23-1.35)), even after adjusting for parental asthma. Poor asthma control, but not higher asthma severity, was associated with higher odds of antidepressant use (1.43 (1.31-1.56)). Compared with the controls, families with two or more children with asthma had higher OR (1.42 (1.29-1.56)) than those with a single child (OR 1.27 (1.21-1.34)). Low socioeconomic status was associated with parental antidepressant use. Conclusion Caregiver depression in a Danish cohort is more prevalent among mothers than among fathers and is associated with poor asthma control in children. Antidepressant use among caregivers was associated with total family asthma burden and was independent of socioeconomic status.
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Affiliation(s)
- Silvia Cabrera Guerrero
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
| | | | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, Washington, DC, USA
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Vicedo-Cabrera AM, Melén E, Forastiere F, Gehring U, Katsouyanni K, Yorgancioglu A, Ulrik CS, Hansen K, Powell P, Ward B, Hoffmann B, Andersen ZJ. Climate change and respiratory health: a European Respiratory Society position statement. Eur Respir J 2023; 62:2201960. [PMID: 37661094 DOI: 10.1183/13993003.01960-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/05/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Erik Melén
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy
- Science Policy and Epidemiology Environmental Research Group King's College London, London UK
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Klea Katsouyanni
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Arzu Yorgancioglu
- Celal Bayar University Medical Faculty Department of Pulmonology, Manisa, Turkey
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Hansen
- European Lung Foundation, Sheffield, UK
- Kristiania University College, Technology, Oslo, Norway
| | | | - Brian Ward
- European Respiratory Society, Brussels, Belgium
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Zorana Jovanovic Andersen
- Section of Environment and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hansen ESH, Aasbjerg K, Moeller AL, Meaidi A, Gade E, Ulrik CS, Torp-Pedersen C, Backer V. Hormonal Contraceptives Are Associated With an Increase in Incidence of Asthma in Women. J Allergy Clin Immunol Pract 2023; 11:2484-2490.e3. [PMID: 37178764 DOI: 10.1016/j.jaip.2023.04.038] [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] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Use of exogenous female sex hormones is associated with the development of asthma, but the question of whether the effect is protective or harmful remains unresolved. OBJECTIVE To investigate whether initiation of hormonal contraceptive (HC) treatment was associated with development of asthma. METHODS We performed a register-based, exposure-matched cohort study including women who initiated HC treatment of any kind between 10 and 40 years of age and compared the incidence of asthma with women who did not initiate HCs. Asthma was defined as 2 redeemed prescriptions of inhaled corticosteroids within 2 years. Data were analyzed using Cox regression models adjusted for income and urbanization. RESULTS We included 184,046 women with a mean age of 15.5 years (SD 1.5 y), in which 30,669 initiated HC treatment and 153,377 did not. We found that initiation of HCs was associated with an increased hazard ratio (HR) of developing new asthma by 1.78 (95% CI 1.58-2.00; P < .001). The cumulative risk of new asthma was 2.7% after 3 years among users of HCs compared with 1.5% in nonusers. In the different subtypes of HCs, second- and third-generation contraceptives carried significant associations (second-generation HR 1.76; 95% CI 1.52-2.03; P < .001; third-generation HR 1.62 95% CI 1.23-2.12; P < .001). The association with increased incidence was seen only in women younger than 18 years. CONCLUSIONS In this study, first-time users of HCs had an increased incidence of asthma compared with nonusers. Clinicians prescribing HCs should be aware that airway symptoms may develop.
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Affiliation(s)
- Erik Soeren Halvard Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark; Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Kristian Aasbjerg
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Amalie Lykkemark Moeller
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Cancer Surveillance and Pharmacoepidemiology Department, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Amani Meaidi
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Gade
- The Fertility Partnership-Stork Fertility Clinic, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hilleroed, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Cancer Surveillance and Pharmacoepidemiology Department, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Otorhinolaryngology, Rigshospitalet, University of Copenhagen, Denmark
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Rovsing AH, Savran O, Ulrik CS. Magnesium sulfate treatment for acute severe asthma in adults-a systematic review and meta-analysis. Front Allergy 2023; 4:1211949. [PMID: 37577333 PMCID: PMC10420062 DOI: 10.3389/falgy.2023.1211949] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Add-on magnesium sulfate (MgSO4) for refractory asthma exacerbation has been much debated. The aim of this review and meta-analysis is, therefore, to provide an update on the current evidence for the efficacy of MgSO4 in exacerbations of asthma in adults refractory to standard of care treatment. Methods A systematic review was performed in accordance with the PRISMA guidelines. The search was performed in the PubMed database (updated April 2023). For the meta-analysis, a random-effects model was applied using the metaphor package for RStudio (RStudio, Inc.). Results A total of 17 randomized controlled trials were included. Three of the nine studies addressing treatment with intravenous (IV) MgSO4 found a significant effect on lung function compared to placebo. Of the eight studies investigating hospital admission rate, only two found a significant effect of MgSO4. Six of the nine studies investigating treatment with nebulized MgSO4 compared to placebo found a favorable effect on forced expiratory volume in 1. second (FEV1) and peak expiratory flow rate (PEF). Only two of the five studies investigating the effect on hospital admission rate found an effect of MgSO4. Comparing effect sizes in a meta-analysis revealed a greater effect on PEF in asthma patients treated with nebulized MgSO4 (MD, 23.57; 95% CI, -2.48 to 49.62, p < 0.01) compared to placebo. The analysis of patients treated with i.v. MgSO4 compared to placebo showed no statistically significant difference (MD, 5.49; 95% CI, -18.67 to 29.65, p = 0.10). Conclusion Up to two out of three studies revealed an effect of MgSO4 treatment for asthma exacerbation when assessed by FEV1/PEF, but fewer studies were positive for the outcome of hospital admissions.
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Affiliation(s)
- Alma Holm Rovsing
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Osman Savran
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
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Kamstrup P, Rastoder E, Hellmann PH, Sivapalan P, Larsen EL, Vestbo J, Ulrik CS, Goetze JP, Knop FK, Jensen JUS. Effect of 10-Day Treatment with 50 mg Prednisolone Once-Daily on Haemostasis in Healthy Men-A Randomised Placebo-Controlled Trial. Biomedicines 2023; 11:2052. [PMID: 37509691 PMCID: PMC10377059 DOI: 10.3390/biomedicines11072052] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Synthetic corticosteroids are widely used due to their anti-inflammatory and immunosuppressant effects. Their use has been associated with venous thromboembolism, but it is unknown whether thromboembolism has a causal relationship with corticosteroid treatment. In a randomised, double-blind, placebo-controlled trial in normal to overweight healthy men, the effect of the corticosteroid prednisolone on haemostasis using either 50 mg prednisolone or matching placebo once daily for ten days was investigated. The primary outcome was a change from baseline in the viscoelastic measurement maximal amplitude of clot in kaolin-activated thromboelastography (TEG). Changes from baseline in other TEG measurements, D-dimer, von Willebrand factor (VWF) antigen, and ristocetin cofactor activity (RCo), antithrombin, protein C, prothrombin, fibrinogen, INR, APTT, and platelet count were secondary outcomes. Thirty-four men participated in this study. Compared to placebo, prednisolone treatment did not affect maximal amplitude of clot (difference -0.77 (95% confidence interval (CI) -2.48, 0.94) mm, p = 0.37, missing: n = 2), but it altered VWF antigen (28%, p = 0.0004), VWF:RCo (19%, p = 0.0006), prothrombin (5%, p = 0.05), protein C (31%, p < 0.0001), antithrombin (5%, p = 0.013), and fibrinogen (-15%, p = 0.004). Thus, prednisolone treatment did not alter TEG-assessed maximal amplitude of clot, despite that it affected prothrombotic markers (increased prothrombin, VWF antigen, VWF:RCo, prothrombin, and decreased fibrinogen) and increased antithrombotic markers (protein C and antithrombin).
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Ema Rastoder
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Pernille Høgh Hellmann
- Center for Clinical Metabolic Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
| | - Emil List Larsen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jørgen Vestbo
- Allergi og Lungeklinikken Vanløse, 2720 Vanløse, Denmark
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Filip Krag Knop
- Center for Clinical Metabolic Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Jens Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Jordan A, Toennesen LL, Eklöf J, Sivapalan P, Meteran H, Bønnelykke K, Ulrik CS, Stæhr Jensen JU. Psychiatric Adverse Effects of Montelukast-A Nationwide Cohort Study. J Allergy Clin Immunol Pract 2023; 11:2096-2103.e1. [PMID: 36948487 DOI: 10.1016/j.jaip.2023.03.010] [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] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/13/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Recent observational studies suggest that the leukotriene receptor antagonist montelukast may have neuropsychiatric adverse effects; however, results are conflicting. OBJECTIVE To assess whether montelukast exposure in adults with asthma is associated with onset of neuropsychiatric adverse events using data from the Danish nationwide health registers. METHODS Individuals 18 years old or older with either 1 or more prescription redemption of inhaled corticosteroids or with at least 1 hospital contact with asthma as the main diagnosis between January 1, 2011, and December 31, 2018, were included. Montelukast exposure was assessed as a time-dependent variable. The 2 outcomes of interest were use of neuropsychiatric medicine including antidepressants, antipsychotics, anxiolytics, lithium, and medication used for attention-deficit/hyperactivity disorder (outcome 1), and hospital contacts with a neuropsychiatric diagnosis (outcome 2), within 90 days of exposure to montelukast. RESULTS Initiation of montelukast was significantly associated with outcome 1: use of neuropsychiatric medicine (hazard ratio [95% confidence interval]) 1.14 [1.08-1.20]; P < .0001). In the assessment of outcome 2: hospital contacts with a neuropsychiatric diagnosis, a significant risk associated with montelukast initiation was found only in the youngest age groups (hazard ratio [95% confidence interval] 1.28 [1.12-1.47], P < .001 and 1.16 [1.02-1.31]; P < .05, for age group 18-29 y and 30-44 y, respectively). Age-stratified analyses showed that the risk of both outcomes increased with decreasing age, with the highest risk seen in patients aged 18 to 29 years. CONCLUSIONS Among younger individuals, montelukast use was significantly associated with an increased risk of neuropsychiatric events such as use of neuropsychiatric medicine and hospital treatment. Clinicians should increase awareness of such adverse effects when prescribing montelukast.
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Affiliation(s)
- Alexander Jordan
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Louise Lindhardt Toennesen
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
| | - Josefin Eklöf
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark; Department of Respiratory Medicine, Zealand University Hospital-Roskilde, Copenhagen, Denmark
| | - Howraman Meteran
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Copenhagen University Hospital-Gentofte, Copenhagen, Denmark
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Kamstrup P, Sivapalan P, Rønn C, Rastoder E, Modin D, Kristensen AK, Bendstrup E, Sørensen R, Biering-Sørensen T, Ulrik CS, Vestbo J, Jensen JU. Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study. Respir Res 2023; 24:172. [PMID: 37370121 DOI: 10.1186/s12931-023-02472-9] [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] [Received: 03/24/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) have a high incidence of cardiovascular disease including thromboembolisms. Fibrin degradation products, like D-dimer, have been associated with death from all causes in healthy individuals and COPD patients. We aimed to determine the (i) association between D-dimer levels and all-cause mortality and time being alive and out of a hospital, (ii) possible modifying effect of anticoagulant treatment,, and (iii) distribution of D-dimer in patients with moderate to severe COPD. METHODS Results of routinely measured stable phase D-dimer samples from COPD-outpatients at Copenhagen University Hospital - Herlev and Gentofte, COPD-outpatient clinic were collected using the Danish registries. These were used to examine whether COPD-patients with a D-dimer level in the upper quartile, had a higher risk of death from all causes within 365 days. RESULTS In the unadjusted Cox proportional hazards regression we found an association between high D-dimer and all-cause mortality: Hazard ratio (HR): 2.3 (95% Confidence Interval (CI) 1.1-4.7). In the fully adjusted regression, the HR was 1.8 (CI 0.8-3.9). We did not find any interaction between D-dimer and anticoagulant or antiplatelet therapy. For the secondary outcome, proportion of days alive and out of hospital in 365 days (pDAOH), the unadjusted multiple linear regression had an association between high D-dimer level and pDAOH: -2.7% points (pp) (CI -3.9 pp - -1.5 pp), which was attenuated to -1,7pp (-2.9pp - -0.4pp) in the fully adjusted regression. CONCLUSIONS In patients with moderate to severe COPD, patients with a high level of D-dimer were more likely to die; however, the signal was not strong in the adjusted analyses and our results do not support unselected risk stratification with D-dimer in COPD-outpatients.
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Christian Rønn
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Ema Rastoder
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Anna Kjaer Kristensen
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Elisabeth Bendstrup
- Department Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, 8000, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, 8200, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, 2100, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, 2650, Denmark
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
| | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Copenhagen University Hospital Herlev and Gentofte, Hellerup, 2900, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, 2200, Denmark.
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Håkansson KEJ, Guerrero SC, Backer V, Ulrik CS, Rastogi D. Burden and unmet need for specialist care in poorly controlled and severe childhood asthma in a Danish nationwide cohort. Respir Res 2023; 24:173. [PMID: 37370052 PMCID: PMC10304602 DOI: 10.1186/s12931-023-02482-7] [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: 12/15/2022] [Accepted: 06/21/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly understood. METHODS A Danish nationwide cohort of children and adolescents aged 2-17 years with persistent asthma, defined as repeated redemption of inhaled corticosteroids (ICS) during 2015, were followed for two years, to identify at-risk children and adolescents comprising those with severe asthma (classified according to GINA 2020 guidelines), poor control (defined as use of 400/600 (ages 2-11/12 +) annual doses of short-acting bronchodilators), or frequent exacerbations (defined as use of oral steroids or hospitalization), and access to specialist care. The population is chosen due to detailed medical records in the setting of universal health care. RESULTS The cohort comprised of 29,851 children and adolescents (59% boys), with a median age of 9 years. While 17% of children were on high dose ICS, 22% were on daily ICS below GINA low dose cut-off. Prevalence of severe asthma (3.0-6.5%) was lower than poor asthma control (6.4-25%); both declined from childhood to adolescence. Exacerbations occurred in 7.1-9.0% of children, with median number of exacerbations being 1 (IQR 1-1). Despite being classified as having mild-to-moderate asthma, 15% had poor asthma control and 3.8% experienced exacerbation(s), respectively. While 61% of children with severe asthma and 58% with exacerbation-prone disease were in specialist care, only 24% with uncontrolled disease were receiving specialist care. Of children and adolescents using high-dose ICS, 71% were managed in primary care, while the use of additional controllers was more common in specialist care. CONCLUSIONS Throughout childhood and adolescence, there was a high prevalence of severe asthma and poor control, although their prevalence declined with age. We demonstrate a large unmet need for specialist care among children with at-risk asthma, particularly among those with poorly controlled asthma, even in a system with free-to-access, tax-funded healthcare.
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Affiliation(s)
- Kjell Erik Julius Håkansson
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Silvia Cabrera Guerrero
- Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- Pediatrics, Genomics and Precision Medicine, George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA.
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Yifei Huang E, Hansen AV, Tidemandsen C, la Cour Freiesleben N, Nielsen HS, Backer V, Ulrik CS. Anxiety and depression in women with asthma prior to fertility treatment. Eur Clin Respir J 2023; 10:2221376. [PMID: 37313367 PMCID: PMC10259298 DOI: 10.1080/20018525.2023.2221376] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Objective We investigate symptoms of anxiety and depression among women with asthma prior to fertility treatment. Methods This is a cross-sectional study of women screened for eligibility to the PRO-ART study (RCT of omalizumab versus placebo in asthmatic women undergoing fertility treatment (NCT03727971)). All participants were scheduled for in vitro fertilization (IVF) treatment at four public fertility clinics in Denmark. Data on demographics and asthma control (ACQ-5) were obtained. Symptoms of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS-A and D, respectively) and defined as being present on both subscales if a score >7 was obtained. Spirometry, diagnostic asthma test, and measurement of fractional exhaled nitric oxide (FeNO) were conducted. Results A total of 109 women with asthma were included (mean age 31.8 ± 4.6 and BMI 25.5 ± 4.6). Most women had male factor infertility (36.4%) or unexplained infertility (35.5%). Twenty-two percent of the patients reported uncontrolled asthma (ACQ-5 score > 1.5). The mean HADS-A and HADS-D scores were 6.0 ± 3.8 (95% CI 5.3-6.7) and 2.5 ± 2.2 (95% CI 2.1-3.0), respectively. Thirty (28.0%) women reported anxiety symptoms, and four (3.7%) had concomitant depressive symptoms. Uncontrolled asthma was significantly associated with both depressive (p = 0.04) and anxiety symptoms (p = 0.03). Conclusions More than 25% of women with asthma prior to fertility treatment had self-reported symptoms of anxiety, and just below 5% had self-reported depressive symptoms, possibly related to uncontrolled asthma.
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Affiliation(s)
- Emilia Yifei Huang
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
| | - Anne Vejen Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
| | - Casper Tidemandsen
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
| | - Nina la Cour Freiesleben
- Department of Obstetrics and Gynaecology, the Fertility Clinic, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynaecology, the Fertility Clinic, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Otorhinolaryngology and Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital – Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Håkansson KEJ, Løkke A, Ibsen R, Hilberg O, Backer V, Ulrik CS. Beyond direct costs: individual and societal financial burden of asthma in young adults in a Danish nationwide study. BMJ Open Respir Res 2023; 10:10/1/e001437. [PMID: 37156597 PMCID: PMC10174025 DOI: 10.1136/bmjresp-2022-001437] [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] [Received: 09/01/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION As a common chronic disease seen across all ages, asthma has the potential to incur high societal and individual costs from both direct healthcare costs and loss of productivity. Most previous studies use smaller, selected populations to assess the cost of asthma, possibly reducing generalisability. We, therefore, aimed to assess the total, nationwide economic burden of asthma by severity from both an individual and a societal perspective. METHODS The annual cost of asthma was assessed in a Danish nationwide cohort of patients aged 18-45 during 2014-2016 as excess healthcare costs, loss of income and welfare expenditure compared with controls (matched 1:4) using national registries. Asthma severity was defined as mild-to-moderate (steps 1-3 or step 4 without exacerbations) or severe (step 4 with exacerbations or step 5). RESULTS Across 63 130 patients (mean age 33, 55% female), the annual excess cost of asthma compared with controls was predicted to €4095 (95% CI €3856 to €4334) per patient. Beyond direct costs related to treatment and hospitalisations (€1555 (95% CI €1517 to €1593)), excess indirect costs related to loss of income (€1060 (95% CI €946 to €1171)) and welfare expenditure (eg, sick pay and disability pensions) (€1480 (95% CI €1392 to €1570)) were seen. Crude pooling of excess costs resulted in an annual societal cost of €263 million for all included patients.Severe asthma (4.5%) incurred 4.4 times higher net costs (€15 749 (95% CI 13 928 to €17 638)) compared with mild-to-moderate disease (€3586 (95% CI €3349 to €3824)). Furthermore, patients with severe asthma experienced an annual loss of income of €3695 (95% CI €4106 to €3225) compared with controls. CONCLUSION In young adults with asthma, a significant societal and individual financial burden of disease was seen across severities. Expenditure was mainly driven by loss of income and welfare utilisation, rather than direct healthcare costs.
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Affiliation(s)
| | - Anders Løkke
- Department of Medicine, Little Belt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Ole Hilberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Sygehus Lillebalt Vejle Sygehus, Vejle, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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24
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Bousquet J, Shamji MH, Anto JM, Schünemann HJ, Canonica GW, Jutel M, Del Giacco S, Zuberbier T, Pfaar O, Fonseca JA, Sousa-Pinto B, Klimek L, Czarlewski W, Bedbrook A, Amaral R, Ansotegui IJ, Bosnic-Anticevich S, Braido F, Loureiro CC, Gemicioglu B, Haahtela T, Kulus M, Kuna P, Kupczyk M, Matricardi PM, Regateiro FS, Samolinski B, Sofiev M, Toppila-Salmi S, Valiulis A, Ventura MT, Barbara C, Bergmann KC, Bewick M, Blain H, Bonini M, Boulet LP, Bourret R, Brusselle G, Brussino L, Buhl R, Cardona V, Casale T, Cecchi L, Charpin D, Cherrez-Ojeda I, Chu DK, Cingi C, Costa EM, Cruz AA, Devillier P, Dramburg S, Fokkens WJ, Gotua M, Heffler E, Ispayeva Z, Ivancevich JC, Joos G, Kaidashev I, Kraxner H, Kvedariene V, Larenas-Linnemann DE, Laune D, Lourenço O, Louis R, Makela M, Makris M, Maurer M, Melén E, Micheli Y, Morais-Almeida M, Mullol J, Niedoszytko M, O'Hehir R, Okamoto Y, Olze H, Papadopoulos NG, Papi A, Patella V, Pétré B, Pham-Thi N, Puggioni F, Quirce S, Roche N, Rouadi PW, Sá-Sousa A, Sagara H, Sastre J, Scichilone N, Sheikh A, Sova M, Ulrik CS, Taborda-Barata L, Todo-Bom A, Torres MJ, Tsiligianni I, Usmani OS, Valovirta E, Vasankari T, Vieira RJ, Wallace D, Waserman S, Zidarn M, Yorgancioglu A, Zhang L, Chivato T, Ollert M. Patient-centred digital biomarkers for allergic respiratory diseases and asthma: the ARIA-EAACI approach. Allergy 2023. [PMID: 37042071 DOI: 10.1111/all.15740] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023]
Abstract
Biomarkers for the diagnosis, treatment and follow-up of patients with rhinitis and/or asthma are urgently needed. Although some biologic biomarkers exist in specialist care for asthma, they cannot be largely used in primary care. There are no validated biomarkers in rhinitis or allergen immunotherapy (AIT) that can be used in clinical practice. The digital transformation of health and health care (including mHealth) places the patient at the centre of the health system and is likely to optimise the practice of allergy. ARIA (Allergic Rhinitis and its Impact on Asthma) and EAACI (European Academy of Allergy and Clinical Immunology) developed a Task Force aimed at proposing patient-reported outcome measures (PROMs) as digital biomarkers that can be easily used for different purposes in rhinitis and asthma. It first defined control digital biomarkers that should make a bridge between clinical practice, randomised controlled trials, observational real-life studies and allergen challenges. Using the MASK-air app as a model, a daily electronic combined symptom-medication score for allergic diseases (CSMS) or for asthma (e-DASTHMA), combined with a monthly control questionnaire, were embedded in a strategy similar to the diabetes approach for disease control. To mimic real-life, it secondly proposed quality-of-life digital biomarkers including daily EQ-5D visual analogue scales and the bi-weekly RhinAsthma Patient Perspective (RAAP). The potential implications for the management of allergic respiratory diseases were proposed.
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Affiliation(s)
- Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- University Hospital Montpellier, France
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Joao A Fonseca
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Anna Bedbrook
- MASK-air, Montpellier, France
- ARIA, Montpellier, France
| | - Rita Amaral
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - Fulvio Braido
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lotz, Poland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lotz, Poland
| | - Paolo M Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (ICBR) Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
- Institute of Sciences of Food Production, National Research Council (Ispa-CNR), Bari, Italy
| | - Cristina Barbara
- Portuguese NaTional Programme for Respiratory Diseases, Direção -Geral da Saúde, Faculdade de Medicina de Lisboa, Instituto de Saúde Ambiental, Lisbon, Portugal
| | - Karl C Bergmann
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Michael Bewick
- University of Central Lancashire Medical School, Preston, UK
| | - Hubert Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France
| | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy
- Department of Neurological, ENT and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli - IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino, Torino, Italy
- Mauriziano Hospital, Torino, Italy
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
- ARADyAL Research Network, Barcelona, Spain
| | - Thomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Guayas, Ecuador
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact & Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, ENT Department, Eskisehir, Turkey
| | - Elisio M Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing, University of Porto (Porto4Ageing), Portugal
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, Bahia, Brazil
| | - Philippe Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Intensive Care Medicine, Charité Medical University, Berlin, Germany
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Zhanat Ispayeva
- Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology of the Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Helga Kraxner
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
| | - Violeta Kvedariene
- Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU, Liège, Liège, Belgium
- GIGA I3 Research Group, University of Liège, Liège, Belgium
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Michael Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sach´s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | | | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology, Alfred Health and Department of Immunology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Yoshitaka Okamoto
- Chiba Rosai Hospital, Chiba, Japan
- Chiba University Hospital, Chiba, Japan
| | - Heidi Olze
- Department of Otorhinolaryngology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, "Santa Maria della Speranza" Hospital, Battipaglia, Salerno, Italy
- Agency of Health ASL, Salerno, Italy
- Postgraduate Programme in Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liège, Belgium
| | - Nhân Pham-Thi
- Ecole Polytechnique de Palaiseau, Palaiseau, France
- IRBA (Institut de Recherche Bio-Médicale des Armées), Brétigny sur Orge, France
- Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Spain
| | - Nicolas Roche
- Pneumologie, AP-HP, Centre Université de Paris, Hôpital Cochin, Paris, France
| | - Philip W Rouadi
- Department of Otolaryngology, Head and Neck Surgery, Eye and Ear, University Hospital, Beirut, Lebanon
- Department of Otolaryngology, Head and Neck Surgery, Dar Al Shifa Hospital-, Salmiya, Kuwait
| | - Ana Sá-Sousa
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Autonoma University of Madrid, Madrid, Spain
| | | | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Milan Sova
- Department of Respiratory Medicine and Tuberculosis, University Hospital Brno, Czech Republic
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
- Institute of Cinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis Taborda-Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
- UBIAir - Clinical & Experimental Lung Centre and CICS-UBI Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Ana Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maria J Torres
- Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Omar S Usmani
- Royal Brompton Hospital, Airways Disease Section, London, UK
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku, Turku, Finland
| | - Tuula Vasankari
- FIHLA, Finnish Lung Health Association, Helsinki, Finland
- Department of Clinical Medicine, Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Rafael José Vieira
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE- Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Dana Wallace
- Nova Southeastern University, College of Allopathic Medicine, Fort Lauderdale, Florida, USA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, Ontario, Canada
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Slovenia
- University of Ljubljana, Ljubljana, Slovenia
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Manisa, Turkey
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, Beijing, China
| | - Tomas Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Centre, Odense University Hospital, Research Center for Anaphylaxis (ORCA), Odense, Odense, Denmark
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25
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Sousa-Pinto B, Jácome C, Pereira AM, Regateiro FS, Almeida R, Czarlewski W, Kulus M, Shamji MH, Boulet LP, Bonini M, Brussino L, Canonica GW, Cruz AA, Gemicioglu B, Haahtela T, Kupczyk M, Kvedariene V, Larenas-Linnemann D, Louis R, Niedoszytko M, Pham-Thi N, Puggioni F, Romantowski J, Sastre J, Scichilone N, Taborda-Barata L, Ventura MT, Vieira RJ, Agache I, Bedbrook A, Bergmann KC, Amaral R, Azevedo LF, Bosnic-Anticevich S, Brusselle G, Buhl R, Cecchi L, Charpin D, Loureiro CC, de Blay F, Del Giacco S, Devillier P, Jassem E, Joos G, Jutel M, Klimek L, Kuna P, Laune D, Luna Pech J, Makela M, Morais-Almeida M, Nadif R, Neffen HE, Ohta K, Papadopoulos NG, Papi A, Pétré B, Pfaar O, Yeverino DR, Cordeiro CR, Roche N, Sá-Sousa A, Samolinski B, Sheikh A, Ulrik CS, Usmani OS, Valiulis A, Vandenplas O, Vieira-Marques P, Yorgancioglu A, Zuberbier T, Anto JM, Fonseca JA, Bousquet J. Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study. Lancet Digit Health 2023; 5:e227-e238. [PMID: 36872189 DOI: 10.1016/s2589-7500(23)00020-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA). METHODS We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician. FINDINGS We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78). INTERPRETATION e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation. FUNDING None.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Margarida Pereira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra and Institute of Immunology, and Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Rute Almeida
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marek Kulus
- Department of Pediatric Respiratory Diseases and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College & National Institutes for Health Imperial Biomedical Research Centre, London, UK
| | | | - Matteo Bonini
- Department of Cardiovascular and Respiratory Sciences, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurological, Ear, Nose, and Throat, and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; National Heart and Lung Institute, Imperial College London, London, UK
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - G Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Alvaro A Cruz
- Fundaçao ProAR, Federal University of Bahia and Global Alliance Against Chronic Respiratory Diseases and WHO Planning Group, Salvador, Bahia, Brazil
| | - Bilun Gemicioglu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Maciej Kupczyk
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Desirée Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | - Renaud Louis
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire Liege, and GIGA Infection, Immunity, Inflammation Laboratories research group, University of Liege, Liege, Belgium
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Nhân Pham-Thi
- Institut de Recherche bio-Médicale des Armées, Bretigny sur Orge, France; École Polytechnique de Palaiseau, Palaiseau, France; Université Paris Cité, Paris, France
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Joaquin Sastre
- Allergy Service, Fundacion Jimenez Diaz, Faculty of Medicine Universidad Autonoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Luis Taborda-Barata
- University of Beira Interior Air, Clinical & Experimental Lung Centre and Centro de Investigação em Ciências da Saúde-University of Beira Interior Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Immunoallergology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - Rafael José Vieira
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ioana Agache
- Faculty of Medicine, Transylvania University Brasov, Brasov, Romania
| | - Anna Bedbrook
- Allergic Rhinitis and its Impact on Asthma, Montpellier, France
| | - Karl C Bergmann
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Rita Amaral
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicine Group, Woolcock Institute of Medical Research, The University of Sydney, and Sydney Local Health District, Sydney, NSW, Australia
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Roland Buhl
- Department of Pulmonary Medicine, Mainz University Hospital, Mainz, Germany
| | - Lorenzo Cecchi
- Struttura Organizzativa Semplice Allergology and Clinical Immunology Unita Sanitaria Locale, Toscana Centro, Prato, Italy
| | - Denis Charpin
- Clinique des Bronches, Allergie et Sommeil, Hôpital Nord, Marseille, France
| | - Claudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Frédéric de Blay
- Allergy Division, Chest Disease Department, University Hospital of Strasbourg, Strasbourg, France; Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital Duilio Casula, University of Cagliari, Cagliari, Italy
| | - Philippe Devillier
- Virologie et Immunologie Moléculaires Suresnes, Unités Mixtes de Recherche 0892, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | - Ewa Jassem
- Medical University of Gdańsk, Department of Pneumonology, Gdansk, Poland
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland; All-Medicine Medical Research Institute, Wroclaw, Poland
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany; Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | | | | | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Rachel Nadif
- Université Paris-Saclay, Université Versailles-St Quentin, Université Paris-Sud, Paris, France; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France
| | - Hugo E Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
| | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan; JATA Fukujuji Hospital, Tokyo, Japan
| | | | - Alberto Papi
- Respiratory Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Benoit Pétré
- Department of Public Health, University of Liege, Liege, Belgium
| | - Oliver Pfaar
- Section of Rhinology and Allergy, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Daniela Rivero Yeverino
- Allergy and Clinical Immunology Department, Hospital Universitario de Puebla, Puebla, Mexico
| | | | - Nicolas Roche
- Pneumologie, Assistance Publique - Hôpitaux de Paris, Centre Université de Paris Cité, Hôpital Cochin, Paris, France
| | - Ana Sá-Sousa
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal; Patient Centred Innovation and Technology, Centro de Investigação em Tecnologias e Serviços de Saúde, Centre for Health Technology and Services Research, University of Porto, Porto, Portugal
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark; Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health Sciences and Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL, Namur, Belgium; Université Catholique de Louvain, Yvoir, Belgium
| | - Pedro Vieira-Marques
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Türkiye
| | - Torsten Zuberbier
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany
| | - Josep M Anto
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Barcelona, Spain
| | - João A Fonseca
- MEDicina da Comunidade, Informação e Decisão em Saúde, Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde, Rede de Investigação em Saúde, Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Bousquet
- Institute of Allergology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology, Allergology and Immunology, Berlin, Germany; Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, Villejuif, France; University Hospital Montpellier, Montpellier, France.
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Dalbøge A, Albert Kolstad H, Ulrik CS, Sherson DL, Meyer HW, Ebbehøj N, Sigsgaard T, Zock JP, Baur X, Schlünssen V. The Relationship Between Potential Occupational Sensitizing Exposures and Asthma: An Overview of Systematic Reviews. Ann Work Expo Health 2023; 67:163-181. [PMID: 36472234 DOI: 10.1093/annweh/wxac074] [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] [Received: 07/13/2022] [Accepted: 10/05/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim was to identify, appraise, and synthesize the scientific evidence of the relationship between potential occupational sensitizing exposures and the development of asthma based on systematic reviews. METHODS The study was conducted as an overview of systematic reviews. A systematic literature search was conducted for systematic reviews published up to 9 February 2020. Eligibility study criteria included persons in or above the working age, potential occupational sensitizing exposures, and outcomes defined as asthma. Potential occupational sensitizing exposures were divided into 23 main groups comprising both subgroups and specific exposures. Two reviewers independently selected studies, extracted study data, assessed study quality, and evaluated confidence in study results and level of evidence of the relationship between potential occupational sensitizing exposures and asthma. RESULTS Twenty-seven systematic reviews were included covering 1242 studies and 486 potential occupational sensitizing exposures. Overall confidence in study results was rated high in three systematic reviews, moderate in seven reviews, and low in 17 reviews. Strong evidence for the main group of wood dusts and moderate evidence for main groups of mites and fish was found. For subgroups/specific exposures, strong evidence was found for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals, whereas moderate evidence was found for 52 subgroups/specific exposures. CONCLUSIONS This overview identified hundreds of potential occupational sensitizing exposures suspected to cause asthma and evaluated the level of evidence for each exposure. Strong evidence was found for wood dust in general and for toluene diisocyanates, Aspergillus, Cladosporium, Penicillium, and work tasks involving exposure to laboratory animals.
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Affiliation(s)
- Annett Dalbøge
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - David Lee Sherson
- Department of Occupational and Environmental Medicine, Odense University Hospital, 5000 Odense, Denmark.,Department of Pulmonary Medicine, Odense University Hospital, 5000 Odense, Denmark
| | - Harald William Meyer
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Niels Ebbehøj
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
| | - Jan-Paul Zock
- National Institute for Public Health and the Environment (RIVM), Bilthoven, 3721 MA, The Netherlands
| | - Xaver Baur
- Institut für Arbeitsmedizin, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Vivi Schlünssen
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark.,Department of Public Health, Environment, Occupation, and Health, Danish Ramazzini Centre, Aarhus University, 8000 Aarhus, Denmark
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Backer V, Cardell LO, Lehtimäki L, Toppila-Salmi S, Bjermer L, Reitsma S, Hellings PW, Weinfeld D, Aanæs K, Ulrik CS, Braunstahl GJ, Aarli BB, Danielsen A, Kankaanranta H, Steinsvåg S, Bachert C. Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions. Front Allergy 2023; 4:1052386. [PMID: 36895864 PMCID: PMC9989256 DOI: 10.3389/falgy.2023.1052386] [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] [Received: 09/23/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines. Methods Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions. Results Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified. Conclusion This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.
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Affiliation(s)
- Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Lars Olaf Cardell
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Toppila-Salmi
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sietze Reitsma
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Peter W Hellings
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.,Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden
| | - Kasper Aanæs
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bernt Bøgvald Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arild Danielsen
- Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverre Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway
| | - Claus Bachert
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Sandau C, Hansen EF, Ringbæk TJ, Kallemose T, Bove DG, Poulsen I, Nørholm V, Pedersen L, Jensen JUS, Ulrik CS. Automated Oxygen Administration Alleviates Dyspnea in Patients Admitted with Acute Exacerbation of COPD: A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:599-614. [PMID: 37096159 PMCID: PMC10122478 DOI: 10.2147/copd.s397782] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
Objective Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD). Method and Patients A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient's peripheral oxygen saturation (SpO2), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO2 levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes. Results Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients' perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of -3 (p=0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all p-values≤0.05) as well as in the Visual Analogue Scale - Dyspnea (VAS-D) within the past three days (p=0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all p-values>0.05). Conclusion AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.
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Affiliation(s)
- Charlotte Sandau
- Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Correspondence: Charlotte Sandau, Email
| | - Ejvind Frausing Hansen
- Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Dorthe Gaby Bove
- University College Absalon, Centre for Nursing, Roskilde, Denmark
| | - Ingrid Poulsen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Research Unit Nursing and Health Care, Aarhus University, Aarhus, Denmark
| | - Vibeke Nørholm
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Bispebjerg Hospital, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Respiratory Medicine Section, Department of Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, København, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine and Endocrinology, Pulmonary Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Renzi-Lomholt M, Håkansson KEJ, Suppli Ulrik C. Adherence to inhaled corticosteroids in relation to quality of life and symptoms of anxiety and depression in asthma. Eur Clin Respir J 2023; 10:2149920. [DOI: 10.1080/20018525.2022.2149920] [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] [Indexed: 11/25/2022] Open
Affiliation(s)
- Martino Renzi-Lomholt
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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30
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Hansen NB, Henriksen M, Dall CH, Vest S, Larsen L, Suppli Ulrik C, Backer V. Physical activity, physical capacity and sedentary behavior among asthma patients. Eur Clin Respir J 2022; 9:2101599. [PMID: 36105719 PMCID: PMC9467604 DOI: 10.1080/20018525.2022.2101599] [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] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND: Although exercise and daily physical activity (PA) have long been known to benefit patients with chronic disorders, knowledge is limited regarding asthma. OBJECTIVE: In a Danish setting, our aim was to measure physical activity, sedentary behavior, and physical capacity among patients with asthma. We hypothesized that people with severe asthma would be less active and more sedentary than their mild-moderate counterparts. METHODS: Adults with asthma were recruited through respiratory outpatient clinics and subsequently examined twice, 4 weeks apart. At each visit, participants underwent a series of lung function tests, questionnaires, and maximum oxygen uptake testing (VO2max). Between the visits, participants wore an accelerometer continuously for 4 weeks, measuring sedentary time and daily steps. Sixty patients, 27 with mild-moderate asthma (GINA 1–3) and 33 with severe asthma (GINA 4–5), completed both visits and had valid accelerometer measurements. RESULTS: No significant differences between the two groups were found in sedentary time, number of steps or VO2max. VO2max was significantly correlated with FeNO (r = −0.30, p < 0.05), Short Form-12 Mental Health (r = 0.37, p < 0.05), Asthma Control Questionnaire (r = −0.35, p < 0.05), and Mini Asthma Quality of Life Questionnaire (r = 0.36, p < 0.05). CONCLUSION: No differences were observed between patients with mild-moderate and severe asthma regarding sedentary behavior, daily steps or level of cardiopulmonary fitness. Furthermore, patients with the highest VO2max had the higher quality of life scores. Abbreviations: VO2max: Maximal Oxygen Uptake; CPET: Cardiopulmonary Exercise Testing; BMI: Body Mass Index; FEV1: Forced Expired Volume in the First Second; FVC: Forced Vital Capacity; PEF: Peak Expiratory Flow; EIB: Exercise-Induced Bronchoconstriction; COPD: Chronic Obstructive Pulmonary Disease; ACQ: Asthma Control Questionnaire; Mini-AQLQ: Mini Asthma Quality of Life Questionnaire; SF-12: Short Form 12 Health Survey; SNOT-22: Sino-Nasal Outcome Test 22; GINA: The Global Initiative for Asthma; CRP: C-reactive Protein; Hgb:Hemoglobin count; EOS: Eosinophil count; EVH: Eucapnic Voluntary Hyperventilation; FeNO: Fractional Exhaled Nitric Oxide; PA: Physical Activity ERS: European Respiratory Society; ATS: American Thoracic Society; CRS: Chronic Rhinosinusitis; AHR: Airway Hyperresponsiveness
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Affiliation(s)
- Nikolaj Brix Hansen
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Christian Have Dall
- The Parker Institute, Copenhagen University Hospital - Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Susanne Vest
- Department of Respiratory and Infection Medicine, North Zealand Hospital, Hilleroed, Denmark
| | - Lotte Larsen
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Vibeke Backer
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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31
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Neale CD, Christensen PE, Dall C, Ulrik CS, Godtfredsen N, Hansen H. Sleep Quality and Self-Reported Symptoms of Anxiety and Depression Are Associated with Physical Activity in Patients with Severe COPD. Int J Environ Res Public Health 2022; 19:16804. [PMID: 36554684 PMCID: PMC9778999 DOI: 10.3390/ijerph192416804] [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] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Sleep quantity, quality and symptoms of depression or anxiety potentially affect the level of daily physical activity (PAL) and plausibly counteracts benefits from pulmonary rehabilitation programs. Their collective impact on PAL is sparsely investigated, particularly in patients with severely progressed chronic obstructive pulmonary disease (COPD). Aim: To investigate if sleep quantity, quality and symptoms from self-reported hospital anxiety and depression scores (HADS) are associated with PAL. Methods: In this exploratory cross-sectional study data were analysed from 148 participants with COPD; GOLD grade II-IV; GOLD group B to D (52% female, mean 69.7 ± SD of 8.4 years, FEV1% predicted 33.6 ± 10.9, 6MWD 327 ± 122 m, CAT 20 ± 7 points), eligible for conventional outpatient hospital-based pulmonary rehabilitation. Participants had sleep and PAL measured 24 h per day for five consecutive days with an activPAL monitor. Adjusted negative binomial regression was applied to investigate the associations with PAL. Results: Participants walked median (25th, 75th percentile) of 2358 (1325.75; 3822.25) steps per day and 14% walked >5000 steps per day on average. Time in bed (TIB) were a median (25th, 75th percentile) of 8.3 (7.1; 9.7) hours and numbers of nocturnal sleeping bouts (NSB) were 1.5 (0.8; 3), Anxiety (HADS-A) and depression (HADS-D) scores were median (25th, 75th percentile) of 5 (3; 8) points and 3 (2; 6) points, respectively, whereof 29% (HADS-A) and 15% (HADS-D) reported scores ≥8 points indicating significant symptoms. The fully adjusted rate ratio (RR) for steps per day for TIB (hours) [RR 0.97 (95% CI: 0.92; 1.02)], NSB (numbers) [RR 1.02 (95% CI: 0.97; 1.07)] were not significantly associated with number of steps per day, while there was a significantly association with number of steps per day for HADS-A [RR 1.04 (95% CI: 1.01; 1.07)] and HADS-D [RR 0.95 (95% CI: 0.91; 0.99)]. Conclusion: This exploratory cross-sectional study found a statistically significant association between HADS-A and HADS-D with numbers of steps per day in patients with severe COPD.
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Affiliation(s)
- Christopher D. Neale
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, 2400 Copenhagen, Denmark
| | | | - Christian Dall
- Department of Physical and Occupational Therapy, Copenhagen University Hospital, 2400 Copenhagen, Denmark
- Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Nina Godtfredsen
- Institute for Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
| | - Henrik Hansen
- Respiratory Research Unit and Department of Respiratory Medicine, Copenhagen University Hospital, 2650 Hvidovre, Denmark
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32
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Rønn C, Sivapalan P, Eklöf J, Kamstrup P, Biering-Sørensen T, Bonnesen B, Harboe ZB, Browatzki A, Kjærgaard JL, Meyer CN, Jensen TT, Johansson SL, Bendstrup E, Ulrik CS, Stæhr Jensen JU. Hospitalization for chronic obstructive pulmonary disease and pneumonia: association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients. Clin Microbiol Infect 2022; 29:523-529. [PMID: 36503112 DOI: 10.1016/j.cmi.2022.11.029] [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] [Received: 07/29/2022] [Revised: 10/18/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES International guidelines only advocate the use of inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) experiencing recurring exacerbations and eosinophilic inflammation. However, ICSs are commonly used in patients with COPD and without exacerbations and signs of eosinophilic inflammation, thus possibly increasing the risk of hospitalization for pneumonia. Thus, we aimed to determine the risk of hospitalization for pneumonia associated with increasing cumulated ICS doses among patients with COPD to establish whether there is dose dependency. METHODS A retrospective cohort study included all patients with COPD treated at a respiratory outpatient clinic in Denmark. The patients were divided into four groups based on their average daily ICS exposure. The dose-response relationship was investigated using a multivariable Cox proportional hazard regression analysis. RESULTS In total, 52 100 patients were included, who were divided into the no-use (n = 15 755), low-dose (n = 12 050), moderate-dose (n = 12 488), and high-dose (n = 11 807) groups. ICS use was strongly associated with hospitalization for pneumonia (hazard ratio [HR], 1.3; CI, 1.2-1.3) (ICS vs. no ICS). The risk of hospitalization for pneumonia increased with every dosing group step: low dose: HR, 1.1 (CI, 1.0-1.2); moderate dose: HR, 1.2 (CI, 1.1-1.3), and high dose: HR, 1.5 (CI, 1.4-1.6); "no use" was the reference. Sensitivity analyses confirmed these findings. CONCLUSIONS In the dose-response relationship analysis, ICS dose were associated with a substantially increased risk of hospitalization for pneumonia of up to 50%. Our data support that ICSs should be administered at the lowest possible dose and only to patients with COPD who have a documented need.
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Affiliation(s)
- Christian Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark.
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Josefin Eklöf
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Gentofte, Hellerup, Denmark; Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Barbara Bonnesen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Zitta Barrella Harboe
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerod, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Jakob Lyngby Kjærgaard
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark
| | - Christian Niels Meyer
- Department of Pulmonary Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Suppli Ulrik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital - Gentofte, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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33
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Christensen J, Davidoski FS, Skaarup KG, Lassen MCH, Alhakak AS, Sengeløv M, Nielsen AB, Johansen ND, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Kristiansen OP, Nielsen OW, Ulrik CS, Sivapalan P, Gislason G, Iversen K, Jensen JUS, Schou M, Hviid A, Krause TG, Biering-Sørensen T. Cardiac Characteristics of the First Two Waves of COVID-19 in Denmark and the Prognostic Value of Echocardiography: The ECHOVID-19 Study. Cardiology 2022; 148:48-57. [PMID: 36455539 DOI: 10.1159/000528308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/11/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION COVID-19 has spread globally in waves, and Danish treatment guidelines have been updated following the first wave. We sought to investigate whether the prognostic values of echocardiographic parameters changed with updates in treatment guidelines and the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, 20E (EU1) and alpha (B.1.1.7), and further to compare cardiac parameters between patients from the first and second wave. METHODS A total of 305 patients hospitalized with COVID-19 were prospectively included, 215 and 90 during the first and second wave, respectively. Treatment in the study was defined as treatment with remdesivir, dexamethasone, or both. Patients were assumed to be infected with the dominant SARS-CoV-2 variant at the time of their hospitalization. RESULTS Mean age for the first versus second wave was 68.7 ± 13.6 versus 69.7 ± 15.8 years, and 55% versus 62% were males. Left ventricular (LV) systolic and diastolic function was worse in patients hospitalized during the second wave (LV ejection fraction [LVEF] for first vs. second wave = 58.5 ± 8.1% vs. 52.4 ± 10.6%, p < 0.001; and global longitudinal strain [GLS] = 16.4 ± 4.3% vs. 14.2 ± 4.3%, p < 0.001). In univariable Cox regressions, reduced LVEF (hazard ratio [HR] = 1.07 per 1% decrease, p = 0.002), GLS (HR = 1.21 per 1% decrease, p < 0.001), and tricuspid annular plane systolic excursion (HR = 1.18 per 1 mm decrease, p < 0.001) were associated with COVID-related mortality, but only GLS remained significant in fully adjusted analysis (HR = 1.14, p = 0.02). CONCLUSION Reduced GLS was associated with COVID-related mortality independently of wave, treatment, and the SARS-CoV-2 variant. LV function was significantly impaired in patients hospitalized during the second wave.
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Affiliation(s)
- Jacob Christensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Filip Søskov Davidoski
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | | | | | - Alia Sead Alhakak
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Morten Sengeløv
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Anne Bjerg Nielsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jørn Carlsen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ole Peter Kristiansen
- Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Department of Respiratory Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Respiratory Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
| | | | | | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
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34
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Sousa‐Pinto B, Anto A, Berger M, Dramburg S, Pfaar O, Klimek L, Jutel M, Czarlewski W, Bedbrook A, Valiulis A, Agache I, Amaral R, Ansotegui IJ, Bastl K, Berger U, Bergmann KC, Bosnic‐Anticevich S, Braido F, Brussino L, Cardona V, Casale T, Canonica GW, Cecchi L, Charpin D, Chivato T, Chu DK, Cingi C, Costa EM, Cruz AA, Devillier P, Durham SR, Ebisawa M, Fiocchi A, Fokkens WJ, Gemicioğlu B, Gotua M, Guzmán M, Haahtela T, Ivancevich JC, Kuna P, Kaidashev I, Khaitov M, Kvedariene V, Larenas‐Linnemann DE, Lipworth B, Laune D, Matricardi PM, Morais‐Almeida M, Mullol J, Naclerio R, Neffen H, Nekam K, Niedoszytko M, Okamoto Y, Papadopoulos NG, Park H, Passalacqua G, Patella V, Pelosi S, Pham‐Thi N, Popov TA, Regateiro FS, Reitsma S, Rodriguez‐Gonzales M, Rosario N, Rouadi PW, Samolinski B, Sá‐Sousa A, Sastre J, Sheikh A, Ulrik CS, Taborda‐Barata L, Todo‐Bom A, Tomazic PV, Toppila‐Salmi S, Tripodi S, Tsiligianni I, Valovirta E, Ventura MT, Valero AA, Vieira RJ, Wallace D, Waserman S, Williams S, Yorgancioglu A, Zhang L, Zidarn M, Zuberbier J, Olze H, Antó JM, Zuberbier T, Fonseca JA, Bousquet J. Real-world data using mHealth apps in rhinitis, rhinosinusitis and their multimorbidities. Clin Transl Allergy 2022; 12:e12208. [PMID: 36434742 PMCID: PMC9673175 DOI: 10.1002/clt2.12208] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/02/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022] Open
Abstract
Digital health is an umbrella term which encompasses eHealth and benefits from areas such as advanced computer sciences. eHealth includes mHealth apps, which offer the potential to redesign aspects of healthcare delivery. The capacity of apps to collect large amounts of longitudinal, real-time, real-world data enables the progression of biomedical knowledge. Apps for rhinitis and rhinosinusitis were searched for in the Google Play and Apple App stores, via an automatic market research tool recently developed using JavaScript. Over 1500 apps for allergic rhinitis and rhinosinusitis were identified, some dealing with multimorbidity. However, only six apps for rhinitis (AirRater, AllergyMonitor, AllerSearch, Husteblume, MASK-air and Pollen App) and one for rhinosinusitis (Galenus Health) have so far published results in the scientific literature. These apps were reviewed for their validation, discovery of novel allergy phenotypes, optimisation of identifying the pollen season, novel approaches in diagnosis and management (pharmacotherapy and allergen immunotherapy) as well as adherence to treatment. Published evidence demonstrates the potential of mobile health apps to advance in the characterisation, diagnosis and management of rhinitis and rhinosinusitis patients.
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Affiliation(s)
- Bernardo Sousa‐Pinto
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Center for Health Technology and Services Research, University of PortoPortoPortugal,RISE – Health Research NetworkUniversity of PortoPortoPortugal
| | | | - Markus Berger
- Department of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria,Department for Oto‐Rhino‐Laryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Stephanie Dramburg
- Pediatric Pulmonology, Immunology and Intensive Care MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck SurgerySection of Rhinology and AllergyUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck SurgeryUniversitätsmedizin MainzMainzGermany,Center for Rhinology and AllergologyWiesbadenGermany
| | - Marek Jutel
- Department of Clinical ImmunologyWrocław Medical UniversityALL‐MED Medical Research InstituteWroclawPoland
| | | | - Anna Bedbrook
- MASK‐airMontpellierFrance,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany
| | - Arunas Valiulis
- Institute of Clinical Medicine and Institute of Health SciencesMedical Faculty of Vilnius UniversityVilniusLithuania
| | | | - Rita Amaral
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Center for Health Technology and Services Research, University of PortoPortoPortugal,RISE – Health Research NetworkUniversity of PortoPortoPortugal
| | | | - Katharina Bastl
- Department for Oto‐Rhino‐Laryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Uwe Berger
- Department for Oto‐Rhino‐Laryngology, Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Karl C. Bergmann
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Sinthia Bosnic‐Anticevich
- Quality Use of Respiratory Medicine GroupWoolcock Institute of Medical ResearchThe University of SydneySydneyNew South WalesAustralia
| | - Fulvio Braido
- Department of Internal Medicine (DiMI), University of GenoaIRCCS Ospedale Policlinico San MartinoGenovaItaly
| | - Luisa Brussino
- Department of Medical SciencesAllergy and Clinical Immunology UnitUniversity of Torino & Mauriziano HospitalTorinoItaly
| | - Victoria Cardona
- Allergy SectionDepartment of Internal MedicineHospital Vall d'Hebron & ARADyAL Research NetworkBarcelonaSpain
| | - Thomas Casale
- Division of Allergy/immunologyUniversity of South FloridaTampaFloridaUSA
| | - G. Walter Canonica
- Department of Biomedical SciencesHumanitas UniversityPieve Emanuele, Milan & Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Lorenzo Cecchi
- SOS Allergology and Clinical ImmunologyUSL Toscana CentroPratoItaly
| | - Denis Charpin
- Clinique des bronches, allergie et sommeilHôpital NordMarseilleFrance
| | - Tomás Chivato
- School of MedicineUniversity CEU San PabloMadridSpain
| | - Derek K. Chu
- Department of Health Research Methods, Evidence and Impact & Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Cemal Cingi
- Eskisehir Osmangazi UniversityMedical FacultyENT DepartmentEskisehirTurkey
| | - Elisio M. Costa
- UCIBIOREQUINTEFaculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing)PortoPortugal
| | - Alvaro A. Cruz
- Fundaçao ProARFederal University of Bahia and GARD/WHO Planning GroupSalvadorBahiaBrazil
| | - Philippe Devillier
- VIM Suresnes, UMR 0892, Pôle des Maladies des Voies Respiratoires, Hôpital FochUniversité Paris‐SaclaySuresnesFrance
| | - Stephen R. Durham
- Allergy and Clinical ImmunologyNational Heart and Lung InstituteImperial College LondonLondonUK
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and RheumatologyNHO Sagamihara National HospitalSagamiharaJapan
| | - Alessandro Fiocchi
- Division of AllergyDepartment of Pediatric Medicine ‐ The Bambino Gesù Children's Research HospitalIRCCSRomeItaly
| | - Wytske J. Fokkens
- Department of OtorhinolaryngologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | - Bilun Gemicioğlu
- Department of Pulmonary DiseasesIstanbul University‐CerrahpasaCerrahpasa Faculty of MedicineIstanbulTurkey
| | - Maia Gotua
- Center of Allergy and ImmunologyGeorgian Association of Allergology and Clinical ImmunologyTbilisiGeorgia
| | | | - Tari Haahtela
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | | | - Piotr Kuna
- Division of Internal Medicine, Asthma and AllergyBarlicki University HospitalMedical University of LodzLodzPoland
| | | | - Musa Khaitov
- National Research CenterInstitute of ImmunologyFederal Medicobiological AgencyLaboratory of Molecular ImmunologyMoscowRussia,Pirogov Russian National Research Medical UniversityMoscowRussia
| | - Violeta Kvedariene
- Institute of Biomedical SciencesDepartment of PathologyFaculty of MedicineVilnius University and Institute of Clinical Medicine, Clinic of Chest Diseases and Allergology, Faculty of Medicine, Vilnius UniversityVilniusLithuania
| | | | - Brian Lipworth
- Scottish Centre for Respiratory ResearchCardiovascular & Diabetes MedicineMedical Research InstituteNinewells HospitalUniversity of DundeeDundeeUK
| | | | - Paolo M. Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care MedicineCharité Universitätsmedizin BerlinBerlinGermany
| | | | - Joaquim Mullol
- Rhinology Unit & Smell ClinicENT DepartmentHospital Clínicand Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of BarcelonaBarcelonaSpain
| | | | - Hugo Neffen
- Director of Center of Allergy, Immunology and Respiratory DiseasesSanta FeArgentina
| | - Kristoff Nekam
- Hospital of the Hospitaller Brothers in BudaBudapestHungary
| | | | | | | | - Hae‐Sim Park
- Department of Allergy and Clinical ImmunologyAjou University School of MedicineSuwonSouth Korea
| | - Giovanni Passalacqua
- Allergy and Respiratory DiseasesIRCCS Polyclinic Hospital San MartinoUniversity of GenoaGenovaItaly
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine"Santa Maria della Speranza" Hospital, Battipagliaand Agency of Health ASLSalernoItaly
| | | | - Nhân Pham‐Thi
- Ecole Polytechnique PalaiseauIRBA (Institut de Recherche bio‐Médicale des Armées)BretignyFrance
| | - Ted A. Popov
- University Hospital 'Sv Ivan Rilski'SofiaBulgaria
| | - Frederico S. Regateiro
- Allergy and Clinical Immunology UnitCentro Hospitalar e Universitário de CoimbraCoimbra and Institute of ImmunologyFaculty of MedicineUniversity of CoimbraCoimbraPortugal,Coimbra Institute for Clinical and Biomedical Research (iCBR)Faculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Sietze Reitsma
- Department of OtorhinolaryngologyAmsterdam University Medical CentresAmsterdamThe Netherlands
| | | | | | - Philip W. Rouadi
- Department of Otolaryngology‐Head and Neck SurgeryEye and Ear University HospitalBeirutLebanon,Department of Otorhinolaryngology‐Head and Neck SurgeryDar Al Shifa HospitalSalmiyaKuwait
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards, Allergology and ImmunologyMedical University of WarsawWarsawPoland
| | - Ana Sá‐Sousa
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Center for Health Technology and Services Research, University of PortoPortoPortugal,RISE – Health Research NetworkUniversity of PortoPortoPortugal
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, CIBERESFaculty of MedicineAutonoma University of MadridMadridSpain
| | - Aziz Sheikh
- Usher InstituteThe University of EdinburghEdinburghUK
| | - Charlotte Suppli Ulrik
- Department of Respiratory MedicineCopenhagen University Hospital‐HvidovreCopenhagenDenmark,Institute of Cinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Luis Taborda‐Barata
- Department of Immunoallergology, Cova da Beira University Hospital Centreand UBIAir ‐ Clinical & Experimental Lung Centre and CICS‐UBI Health Sciences Research CentreUniversity of Beira InteriorCovilhãPortugal
| | - Ana Todo‐Bom
- Allergy and Clinical Immunology UnitCentro Hospitalar e Universitário de CoimbraCoimbra and Institute of ImmunologyFaculty of MedicineUniversity of CoimbraCoimbraPortugal
| | - Peter Valentin Tomazic
- Department of General ORL, H&NSMedical University of GrazENT‐University Hospital GrazGrazAustria
| | - Sanna Toppila‐Salmi
- Skin and Allergy HospitalHelsinki University HospitalUniversity of HelsinkiHelsinkiFinland
| | | | - Ioanna Tsiligianni
- Health Planning UnitDepartment of Social MedicineFaculty of MedicineUniversity of CreteGreece and International Primary Care Respiratory Group IPCRGAberdeenScotland
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical ImmunologyUniversity of Turku and Terveystalo Allergy ClinicTurkuFinland
| | | | - Antonio A. Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory ImmunoallergyIDIBAPSUniversity of BarcelonaBarcelonaSpain
| | - Rafael José Vieira
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Center for Health Technology and Services Research, University of PortoPortoPortugal,RISE – Health Research NetworkUniversity of PortoPortoPortugal
| | - Dana Wallace
- Nova Southeastern UniversityFort LauderdaleFloridaUSA
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and AllergyMcMaster UniversityHamiltonOntarioCanada
| | - Sian Williams
- International Primary Care Respiratory Group IPCRGLarbertScotland
| | - Arzu Yorgancioglu
- Department of Pulmonary DiseasesCelal Bayar University, Faculty of MedicineManisaTurkey
| | - Luo Zhang
- Department of Otolaryngology Head and Neck SurgeryBeijing TongRen Hospital and Beijing Institute of OtolaryngologyBeijingChina
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic DiseasesGolnikSlovenia,University of LjubljanaFaculty of MedicineLjubljanaSlovenia
| | - Jaron Zuberbier
- Department of OtorhinolaryngologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Heidi Olze
- Department of OtorhinolaryngologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Josep M. Antó
- ISGlobal, Barcelona Institute for Global HealthBarcelonaSpain,IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain,Universitat Pompeu Fabra (UPF)BarcelonaSpain,CIBER Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - Torsten Zuberbier
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - João A. Fonseca
- MEDCIDS ‐ Department of Community Medicine, Information and Health Decision SciencesFaculty of MedicineUniversity of PortoPortoPortugal,CINTESIS – Center for Health Technology and Services Research, University of PortoPortoPortugal,RISE – Health Research NetworkUniversity of PortoPortoPortugal
| | - Jean Bousquet
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and ImmunologyBerlinGermany,Institute of AllergologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany,University Hospital MontpellierMontpellierFrance
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Håkansson KE, Ulrik CS. [Not Available]. Ugeskr Laeger 2022; 184:V205122. [PMID: 36305264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Kjell Ej Håkansson
- Lungemedicinsk Forskningsenhed 237, Københavns Universitetshospital - Hvidovre Hospital
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36
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Eklöf J, Alispahic IA, Sivapalan P, Wilcke T, Seersholm N, Armbruster K, Kjærgaard JL, Saeed MI, Nielsen TL, Browatzki A, Overgaard RH, Fenlev CS, Harboe ZB, Andreassen HF, Lapperre TS, Pedersen L, Johnsen S, Ulrik CS, Janner J, Moberg M, Heidemann M, Weinreich UM, Vijdea R, Linde H, Titlestad I, Johansson SL, Rosenvinge FS, Østergaard C, Ghathian KSA, Gundersen L, Christensen CW, Bangsborg J, Jensen TT, Sørensen VM, Ellingsgaard T, Datcu R, Coia JE, Bodtger U, Jensen JUS. Targeted AntiBiotics for Chronic pulmonary diseases (TARGET ABC): can targeted antibiotic therapy improve the prognosis of Pseudomonas aeruginosa-infected patients with chronic pulmonary obstructive disease, non-cystic fibrosis bronchiectasis, and asthma? A multicenter, randomized, controlled, open-label trial. Trials 2022; 23:817. [PMID: 36167555 PMCID: PMC9513970 DOI: 10.1186/s13063-022-06720-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa infection is seen in chronic pulmonary disease and is associated with exacerbations and poor long-term prognosis. However, evidence-based guidelines for the management and treatment of P. aeruginosa infection in chronic, non-cystic fibrosis (CF) pulmonary disease are lacking. The aim of this study is to investigate whether targeted antibiotic treatment against P. aeruginosa can reduce exacerbations and mortality in patients with chronic obstructive pulmonary disease (COPD), non-CF bronchiectasis, and asthma. METHODS This study is an ongoing multicenter, randomized, controlled, open-label trial. A total of 150 patients with COPD, non-CF bronchiectasis or asthma, and P. aeruginosa-positive lower respiratory tract samples will be randomly assigned with a 1:1 ratio to either no antibiotic treatment or anti-pseudomonal antibiotic treatment with intravenous beta-lactam and oral ciprofloxacin for 14 days. The primary outcome, analyzed with two co-primary endpoints, is (i) time to prednisolone and/or antibiotic requiring exacerbation or death, in the primary or secondary health sector, within days 20-365 from study allocation and (ii) days alive and without exacerbation within days 20-365 from the study allocation. DISCUSSION This trial will determine whether targeted antibiotics can benefit future patients with chronic, non-CF pulmonary disease and P. aeruginosa infection in terms of reduced morbidity and mortality, thus optimizing therapeutic approaches in this large group of chronic patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03262142 . Registered on August 25, 2017.
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Affiliation(s)
- Josefin Eklöf
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Imane Achir Alispahic
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Pradeesh Sivapalan
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark
| | - Torgny Wilcke
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Karin Armbruster
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Lyngby Kjærgaard
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mohamad Isam Saeed
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thyge Lynghøj Nielsen
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Browatzki
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Holmen Overgaard
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Camilla Sund Fenlev
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zitta Barella Harboe
- Department of Respiratory and Infectious Diseases, Frederikssund and Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helle Frost Andreassen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Therese Sophie Lapperre
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Stine Johnsen
- Department of Respiratory Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mia Moberg
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Heidemann
- Department of Respiratory Medicine, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, University of Aalborg, Aalborg, Denmark
| | - Roxana Vijdea
- Department of Respiratory Medicine, Aalborg University Hospital, University of Aalborg, Aalborg, Denmark
| | - Hans Linde
- Department of Clinical Microbiology, Aalborg University Hospital, University of Aalborg, Aalborg, Denmark
| | - Ingrid Titlestad
- Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Respiratory Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Khaled Saoud Ali Ghathian
- Department of Clinical Microbiology, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lise Gundersen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Torben Tranborg Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Vibeke Muff Sørensen
- Department of Internal Medicine, Section of Respiratory Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Thilde Ellingsgaard
- Department of Internal Medicine, Section of Respiratory Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | - Raluca Datcu
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Uffe Bodtger
- Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark.,Department of Respiratory Medicine, Naestved Hospital, University of Southern Denmark, Naestved, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,PERSIMUNE: Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Olsen FJ, Lassen MCH, Skaarup KG, Christensen J, Davidovski FS, Alhakak AS, Sengeløv M, Nielsen AB, Johansen ND, Graff C, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Lindholm MG, Wiese L, Kristiansen OP, Nielsen OW, Lindegaard B, Tønder N, Ulrik CS, Lamberts M, Sivapalan P, Gislason G, Iversen K, Jensen JUS, Schou M, Svendsen JH, Aalen JM, Smiseth OA, Remme EW, Biering-Sørensen T. Myocardial Work in Patients Hospitalized With COVID-19: Relation to Biomarkers, COVID-19 Severity, and All-Cause Mortality. J Am Heart Assoc 2022; 11:e026571. [PMID: 36129046 DOI: 10.1161/jaha.122.026571] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background COVID-19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID-19. We hypothesized that GWI was associated with disease severity and all-cause death in patients with COVID-19. Methods and Results In a multicenter study of patients admitted with COVID-19 (n=305), 249 underwent pressure-strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT-proBNP [N-terminal pro-B-type natriuretic peptide]), disease severity (oxygen requirement and CRP [C-reactive protein]), and all-cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%; P=0.018). A curvilinear association to NT-proBNP was observed, with increasing NT-proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100-mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow-up (median, 58 days). In multivariable Cox regression, GWI was associated with all-cause death (hazard ratio, 1.08 [95% CI, 1.01-1.15], per 100-mm Hg% decrease), but did not increase C-statistics when added to clinical parameters. Conclusions In patients admitted with COVID-19, our findings indicate that NT-proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all-cause death, but did not provide prognostic information beyond readily available clinical parameters. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04377035.
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Madurka I, Vishnevsky A, Soriano JB, Gans SJ, Ore DJS, Rendon A, Ulrik CS, Bhatnagar S, Krishnamurthy S, Mc Harry K, Welte T, Fernandez AA, Mehes B, Meiser K, Gatlik E, Sommer U, Junge G, Rezende E, Fernandez AA, Bagu AM, Amido FH, Costa MB, Brigante JA, Franco G, Ahmed NJ, Zerega N, Bacci MR, Fernandes CC, Ragognete HG, de Carvalho Rezende EA, Jaoude CVG, de Olivera EP, Malacize VQ, Stadnik CMB, Ramos EA, Kist GR, Barbosa GR, Filik H, Nalin S, Ulrik CS, Tidemandsen C, Hakansson K, Benfield T, Pedersen KBH, Welte T, Bachman M, Stoll M, Olzik I, Scharf N, Shearman N, Pink I, Frey A, Schulze P, Sayehli CM, Weismann D, Klinker H, Goebeler ME, Maier L, Geismann F, Hanses F, Zeller J, Hupf J, Lubnow M, Sag S, Ripfel S, Pabel S, Bauernfeind S, Leisner U, Hitzenbichler F, Madurka I, Iharos D, Toth KK, Hejja M, Esze T, Bhatnagar S, Mohan A, Pandit A, Kumar B, Ratre BK, Tiwari P, Singh R, Vig S, Bhopale S, Bhan S, Budhraja A, Agrawal A, Krishnamurthy S, Srikanth A, Kaneesan K, Unnithan MRJ, Srinivasan N, Velayuthaswamy N, Gounder SKM, Vaidyanathan V, Saha A, Bhattacharjee A, Datta A, Rendon A, Ortiz AC, Moncivais BS, Rodriguez BNL, Ramirez EJR, Perez ROF, Perez DLC, Osornio JS, Ortega MLM, Medina MAJ, Gans SJ, VanDen Berg JW, Boom L, Panhuis E, Lancee G, Lammens M, Boeve-Epping N, Ore DJS, Bustios ERM, Flores EMZ, Farronay MIM, Orihuela BG, del Pino RM, Vishnevsky AY, Morozov E, Repnikov I, Kiseleva M, Kotov ME, Terskikh MM, Zykov VA, Smolyarchuk EA, Kurguzova D, Garkavi DA, Messnikov O, Kharlamova S, Bondareva YA, Sementsov KV, Katagarov DN, Belekhov GA, Alferov SP, Martynenko TI, Vasileva E, Lazarenko IV, Gatalsky KK, Rudikh OV, Ganova OS, Paraeva OS, Pashkevich VV, Vishneva EM, Martynov AV, Isakova AP, Egorova EA, Gaygolnik TV, Pinzhina VN, Hinovker VV, Abramov VG, Ignatova GL, Blinova EV, Grebneva IV, Rodionova OV, Antonov VN, Trufanov KV, Krylov AA, Radchenko EN, McHarry K, Snyman E, Soriano J, Serrano DR, Vergara AM, Marcos MC, Viladomiu AS, Cardozo C, Garcia F. DFV890: a new oral NLRP3 inhibitor—tested in an early phase 2a randomised clinical trial in patients with COVID-19 pneumonia and impaired respiratory function. Infection 2022; 51:641-654. [PMID: 36104613 PMCID: PMC9473473 DOI: 10.1007/s15010-022-01904-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023]
Abstract
Background Coronavirus-associated acute respiratory distress syndrome (CARDS) has limited effective therapy to date. NLRP3 inflammasome activation induced by SARS-CoV-2 in COVID-19 contributes to cytokine storm. Methods This randomised, multinational study enrolled hospitalised patients (18–80 years) with COVID-19-associated pneumonia and impaired respiratory function. Eligible patients were randomised (1:1) via Interactive Response Technology to DFV890 + standard-of-care (SoC) or SoC alone for 14 days. Primary endpoint was APACHE II score at Day 14 or on day-of-discharge (whichever-came-first) with worst-case imputation for death. Other key assessments included clinical status, CRP levels, SARS-CoV-2 detection, other inflammatory markers, in-hospital outcomes, and safety. Findings Between May 27, 2020 and December 24, 2020, 143 patients (31 clinical sites, 12 countries) were randomly assigned to DFV890 + SoC (n = 71) or SoC alone (n = 72). Primary endpoint to establish clinical efficacy of DFV890 vs. SoC, based on combined APACHE II score, was not met; LSM (SE), 8·7 (1.06) vs. 8·6 (1.05); p = 0.467. More patients treated with DFV890 vs. SoC showed ≥ 1-level improvement in clinical status (84.3% vs. 73.6% at Day 14), earlier clearance of SARS-CoV-2 (76.4% vs. 57.4% at Day 7), and mechanical ventilation-free survival (85.7% vs. 80.6% through Day 28), and there were fewer fatal events in DFV890 group (8.6% vs. 11.1% through Day 28). DFV890 was well tolerated with no unexpected safety signals. Interpretation DFV890 did not meet statistical significance for superiority vs. SoC in primary endpoint of combined APACHE II score at Day 14. However, early SARS-CoV-2 clearance, improved clinical status and in-hospital outcomes, and fewer fatal events occurred with DFV890 vs. SoC, and it may be considered as a protective therapy for CARDS. Trial registration ClinicalTrials.gov, NCT04382053. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01904-w.
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Skaarup KG, Lassen MCH, Espersen C, Lind JN, Johansen ND, Sengeløv M, Alhakak AS, Nielsen AB, Ravnkilde K, Hauser R, Schöps LB, Holt E, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Bodtger U, Lindholm MG, Wiese L, Kristiansen OP, Walsted ES, Nielsen OW, Lindegaard B, Tønder N, Jeschke KN, Ulrik CS, Lamberts M, Sivapalan P, Pallisgaard J, Gislason G, Iversen K, Jensen JUS, Schou M, Skaarup SH, Platz E, Biering-Sørensen T. Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study. J Ultrasound 2022; 25:457-467. [PMID: 34213740 PMCID: PMC8249836 DOI: 10.1007/s40477-021-00605-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/06/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE). METHODS A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores). RESULTS Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines: HR = 1.14, 95% CI (1.03, 1.26) per 1 B-line increase), positive B-line score: HR = 9.79, 95% CI (1.87, 51.35), and LUS-score: HR = 1.51, 95% CI (1.10, 2.07), per 1-point increase). The B-line score and LUS-score remained significantly associated with VTE in sensitivity analyses. CONCLUSION In hospitalized COVID-19 patients, pathological LUS findings were common, and the total number of B-lines, B-line score, and LUS-score were all associated with VTE. These findings indicate that the LUS examination may be useful in risk stratification and the clinical management of COVID-19. These findings should be considered hypothesis generating. CLINICALTRIALS GOV ID NCT04377035.
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Affiliation(s)
- Kristoffer Grundtvig Skaarup
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Mats Christian Højbjerg Lassen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Caroline Espersen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Jannie Nørgaard Lind
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Morten Sengeløv
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Alia Saed Alhakak
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Anne Bjerg Nielsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Kirstine Ravnkilde
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Raphael Hauser
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Liv Borum Schöps
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Eva Holt
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Reza Jabbari
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Jørn Carlsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Hellerup, Denmark
| | - Uffe Bodtger
- Department of Respiratory and Internal Medicine, Næstved-Slagelse Hospital, University of Southern Denmark, Odense, Denmark
| | - Matias Greve Lindholm
- Department of Cardiology, Zealand University Hospital Roskilde, University of Copenhagen, Hellerup, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases; Zealand University Hospital Roskilde, University of Copenhagen, Hellerup, Denmark
| | - Ole Peter Kristiansen
- Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Hellerup, Denmark
| | - Emil Schwarz Walsted
- Department of Respiratory Medicine, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Hellerup, Denmark
| | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Hellerup, Denmark
| | - Birgitte Lindegaard
- Department of Respiratory Medicine and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hellerup, Denmark
| | - Niels Tønder
- Department of Cardiology, Nordsjællands Hospital, University of Copenhagen, Hellerup, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Amager Hvidovre Hospital, University of Copenhagen, Hellerup, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Amager Hvidovre Hospital, University of Copenhagen, Hellerup, Denmark
| | - Morten Lamberts
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Jannik Pallisgaard
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Gunnar Gislason
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Kasper Iversen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Jens Ulrik Stæhr Jensen
- Department of Medicine, Herlev & Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Morten Schou
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark
| | - Søren Helbo Skaarup
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Hellerup, Denmark.
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Tidemandsen C, Egerup P, Ulrik CS, Backer V, Westergaard D, Mikkelsen AP, Lidegaard Ø, Nielsen HS. Asthma Is Associated With Pregnancy Loss and Recurrent Pregnancy Loss: A Nationwide Cohort Study. J Allergy Clin Immunol Pract 2022; 10:2326-2332.e3. [PMID: 35643278 DOI: 10.1016/j.jaip.2022.04.044] [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] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women with asthma appear to have an increased risk of pregnancy loss (PL). The impact of asthma on recurrent pregnancy loss (RPL), defined as 3 consecutive losses, is, however, unknown. OBJECTIVE The aim of this study was to investigate whether having asthma before or during the fertile age is associated with PL and RPL. METHODS Based on Danish national health registers, we identified all women aged 6 to 45 years with at least 2 filled prescriptions of an antiasthma drug during the period 1977 to 2019. Women with asthma were compared with women without asthma. Pregnancy outcomes were retrieved for both groups from national health registers. Logistic regression with adjustment for the year of birth and educational level provided odds ratios (ORs) for the number of PLs. Subgroup analyses were conducted for early-onset (age 6-15 years), adult-onset (age 16-39 years), and late-onset (age 40-45 years) asthma. Lastly, we compared uncontrolled asthma (defined as ≥ 400 doses of a short-acting beta-2 agonist in a year) to controlled asthma (defined as < 400 doses of a short-acting beta-2 agonist in a year). RESULTS In a population of 1,309,786 women, we identified 128,553 women with asthma and 1,297,233 women without asthma. Compared with nonasthmatic women, women with asthma had ORs for 1, 2, and 3 or more PLs of 1.05 (95% CI 1.03-1.07), 1.09 (95% CI 1.05-1.13), and 1.18 (95% CI1.11-1.24), respectively, and for RPL of 1.19 (95% CI 1.12-1.27). In women with early-onset asthma, the OR of 3 or more PLs was 1.47 (95% CI 1.24-1.72). For women classified as having uncontrolled asthma compared with controlled asthma, we found a significant OR of 1.60 (95% CI 1.16-2.16) for 3 or more PLs. CONCLUSIONS We found a significant positive association between asthma and number of PLs and RPLs. Early-onset asthma and uncontrolled asthma were more strongly associated with PL than adult-onset and late-onset asthma and controlled asthma.
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Affiliation(s)
- Casper Tidemandsen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark.
| | - Pia Egerup
- Department Obstetrics and Gynecology, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Vibeke Backer
- Institute of Clinical Medicine, University of Copenhagen, Denmark; Centre for Physical Activity Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of ENT, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - David Westergaard
- Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark; Novo Nordisk Foundation Center for Protein Research, University of Copenhagen, Copenhagen, Denmark; Methods and Analysis, Statistics Denmark, Copenhagen, Denmark
| | - Anders Pretzmann Mikkelsen
- Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department Obstetrics and Gynecology, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark; Institute of Clinical Medicine, University of Copenhagen, Denmark
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Kamstrup P, Sand JMB, Ulrik CS, Janner J, Rønn CP, Rønnow SR, Leeming DJ, Jensen SG, Wilcke T, Mathioudakis AG, Miravitlles M, Lapperre T, Bendstrup E, Frikke-Schmidt R, Murray DD, Itenov T, Bossios A, Nielsen SD, Vestbo J, Biering-Sørensen T, Karsdal M, Jensen JU, Sivapalan P. Biomarkers of Clot Activation and Degradation and Risk of Future Major Cardiovascular Events in Acute Exacerbation of COPD: A Cohort Sub-Study in a Randomized Trial Population. Biomedicines 2022; 10:biomedicines10082011. [PMID: 36009558 PMCID: PMC9405886 DOI: 10.3390/biomedicines10082011] [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: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022] Open
Abstract
Cardiovascular diseases are common in patients with chronic obstructive pulmonary disease (COPD). Clot formation and resolution secondary to systemic inflammation may be a part of the explanation. The aim was to determine whether biomarkers of clot formation (products of von Willebrand Factor formation and activation) and clot resolution (product of fibrin degeneration) during COPD exacerbation predicted major cardiovascular events (MACE). The cohort was based on clinical data and biobank plasma samples from a trial including patients admitted with an acute exacerbation of COPD (CORTICO-COP). Neo-epitope biomarkers of formation and the activation of von Willebrand factor (VWF-N and V-WFA, respectively) and cross-linked fibrin degradation (X-FIB) were assessed using ELISAs in EDTA plasma at the time of acute admission, and analyzed for time-to-first MACE within 36 months, using multivariable Cox proportional hazards models. In total, 299/318 participants had samples available for analysis. The risk of MACE for patients in the upper quartile of each biomarker versus the lower quartile was: X-FIB: HR 0.98 (95% CI 0.65–1.48), VWF-N: HR 1.56 (95% CI 1.07–2.27), and VWF-A: HR 0.78 (95% CI 0.52–1.16). Thus, in COPD patients with an acute exacerbation, VWF-N was associated with future MACE and warrants further studies in a larger population.
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Affiliation(s)
- Peter Kamstrup
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Correspondence:
| | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Julie Janner
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Christian Philip Rønn
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
| | | | | | - Sidse Graff Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
| | - Torgny Wilcke
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Alexander G. Mathioudakis
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | - Therese Lapperre
- Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen, Denmark
- Department of Pulmonary Medicine, Antwerp University Hospital, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, 2610 Antwerp, Belgium
| | - Elisabeth Bendstrup
- Department Respiratory Disease and Allergy, Aarhus University Hospital, 8000 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Daniel D. Murray
- Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Theis Itenov
- Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Viro-Immunology Research Unit, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Jørgen Vestbo
- The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9PL, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | | | - Jens-Ulrik Jensen
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Copenhagen University Hospital Herlev-Gentofte, 2900 Hellerup, Denmark
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Schultz CUB, Tupper OD, Ulrik CS. Static lung volumes and diffusion capacity in adults 30 years after being diagnosed with asthma. Asthma Res Pract 2022; 8:4. [PMID: 35922867 PMCID: PMC9351093 DOI: 10.1186/s40733-022-00086-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background Long-term follow-up studies of adults with well-characterized asthma are sparse. We aimed to explore static lung volumes and diffusion capacity after 30 + years with asthma. Methods A total of 125 adults with an objectively verified diagnosis of asthma between 1974–1990 at a Danish respiratory outpatient clinic completed a follow-up visit 2017–19. All participants (age range 44–88 years) completed a comprehensive workup and were, based on these assessments, classified as having either active asthma or being in complete remission. The examination program included measurements of static lung volumes and diffusion capacity. Results Participants with active asthma were hyperinflated (residual volume/total lung capacity ratio 0.43, 95% CI 0.41—0.45) (RV/TLC ratio) compared with those in remission (RV/TLC ratio 0.38, 95% CI 0.36—0.41) (p < 0.03). A tendency towards higher diffusion capacity per liter lung volume was seen in participants with active asthma (KCO 100% predicted, 95% CI 97—104) compared with those in remission (KCO 94% pred., 95% CI 89—99) (P = 0.10). Longer asthma duration was associated with a higher KCO 0.47% pred./year (95% CI 0.14—0.80), adjusted for age and smoking. Patients on GINA step 4 and 5 treatment were more hyperinflated (\documentclass[12pt]{minimal}
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\begin{document}$$\Delta$$\end{document}Δ RV 14% pred., 95% CI 3—27) and had higher airway resistance (mean 53% pred., 95% CI 9—97) than participants on lower GINA steps. Patients with uncontrolled disease had substantially higher airway resistance (72% pred. 95% CI 20—124) than well-controlled patients. Conclusion Thirty years after a confirmed diagnosis of asthma, those continuing to have active asthma and those having severe asthma, have higher diffusion capacity and more hyperinflation than patients in remission.
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Affiliation(s)
| | - Oliver Djurhuus Tupper
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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43
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Soendergaard MB, Hansen S, Bjerrum AS, Hilberg O, Lock-Johansson S, Haakansson KEJ, Ingebrigtsen TS, Johnsen CR, Rasmussen LM, von Bülow A, Assing KD, Schmid JM, Ulrik CS, Porsbjerg C. Complete response to anti-IL5 biologics in a real-life setting. ERJ Open Res 2022; 8:00238-2022. [PMID: 36199589 PMCID: PMC9530888 DOI: 10.1183/23120541.00238-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
Abstract
Background Phase III regulatory trials show that anti-interleukin (IL)-5 biologics efficiently reduce exacerbations and the use of maintenance oral corticosteroids (mOCS) in patients with severe eosinophilic asthma. However, patients eligible for these trials differ significantly compared with real-life severe asthma populations. Therefore, our aim was to explore efficacy in a real-life setting. The Danish Severe Asthma Register (DSAR) is a complete, nationwide register that comprises all Danish patients on biological therapy for severe asthma. Methods This prospective study identified patients in the DSAR who were complete responders to anti-IL-5 biologics after 1 year of treatment. A complete response was defined as resolution of the parameter setting the indication, i.e. recurrent exacerbations and/or use of mOCS. Results A total of 289 out of 502 (58%) patients were complete responders to anti-IL-5 biologics after 12 months. Complete responders had greater improvements in forced expiratory volume in 1 s and Asthma Control Questionnaire (ACQ) score compared with noncomplete responders (Δ 210 versus 30 mL; p<0.0001 and Δ −1.04 versus −0.68; p=0.016, respectively). A complete response was predicted by age at onset, less severe disease at baseline (i.e. no mOCS and lower ACQ score) and higher blood eosinophils. Conclusions More than half of Danish patients treated with anti-IL-5 biologics for severe asthma achieve a complete response to treatment, thereby becoming free from asthma exacerbations and the need for mOCS. Complete responders also achieved superior effects on lung function and symptoms compared with noncomplete responders. More than half of all Danish patients with severe asthma receiving anti-IL-5 in a real-life setting achieve a complete response to treatment, i.e. they become free from exacerbations and the need for oral corticosteroidshttps://bit.ly/3zMMB75
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44
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Ali Z, Egeberg A, Thyssen JP, Ulrik CS, Thomsen SF. Adults with concomitant atopic dermatitis and asthma have more frequent urgent health care utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: A nationwide cohort study. J Eur Acad Dermatol Venereol 2022; 36:2406-2413. [PMID: 35796157 DOI: 10.1111/jdv.18415] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) and asthma often co-occur in the same patient, and health care utilization is related to disease severity of these diseases. OBJECTIVE To investigate differences in healthcare utilization in adults with concomitant AD and asthma compared to patients with asthma or AD only. METHODS All Danish adults with a hospital-diagnosis of AD, asthma or concomitant AD and asthma recorded in national registries were included. Health care utilization data were obtained in 3-month intervals from two year prior to index date (the date of the first hospital diagnosis), and to five years after. RESULTS A total of 12,409 patients with AD were included (11,590 with AD only and 819 with concomitant AD and asthma), and 65,539 with asthma only. Adults with concomitant AD and asthma had higher risk of hospitalization for AD (OR 1.38, 95% CI (1.15-1.67), p=0.001) and asthma (OR 1.16, 95% CI (1.00-1.35), p=0.047) compared to patients with only AD and asthma, respectively. These patients also had fewer visits in outpatient clinics for AD (OR 0.10, 95% CI (0.08-0.12), p<0.001) and asthma (OR 0.34, 95% CI (0.29-0.39), P<0.001) compared to patients with only AD or asthma. Outpatient clinic visits for rhinitis were more frequent among patients with concomitant AD and asthma compared to patients with only AD or asthma. CONCLUSION Adults with concomitant AD and asthma had different patterns of healthcare utilization compared to adults with AD or asthma alone, suggesting that improvements in management and monitoring may reduce unscheduled health care visits, and lower healthcare costs.
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Affiliation(s)
- Z Ali
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - A Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - J P Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - C S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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45
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Håkansson KEJ, Backer V, Ulrik CS. Disease Control, Not Severity, Drives Job Absenteeism in Young Adults with Asthma - A Nationwide Cohort Study. J Asthma Allergy 2022; 15:827-837. [PMID: 35755419 PMCID: PMC9231418 DOI: 10.2147/jaa.s360776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The impact of asthma and disease control on job absenteeism in young adults is sparsely investigated and conflicting evidence exist. Based on a nationwide cohort, the present study aims to describe the overall job absenteeism across asthma severities and describe the possible influence of asthma control. Methods REASSESS is a nationwide cohort of Danish asthma patients aged 18–45 using controller medication between 2014 and 2018, followed retrospectively for up to 15 years using national databases. Impact of asthma was investigated using negative binomial regression adjusted for age, sex, Charlson score and level of education and presented as adjusted incidence rate ratios with 95% confidence intervals. Results A total of 60,534 patients with asthma (median age 33 (25, 39), 55% female, 19% uncontrolled disease and 5.7% possible severe asthma) were followed for 12.7 (6.5–14.8) years. The prevalence of any absenteeism was more common in both mild-to-moderate and possible severe asthma compared to the background population (67%, 80% and 62%, respectively; p < 0.0001). Compared to the background population, mild-to-moderate and possible severe asthma were more likely to have temporary sick leave (1.37 (1.33–1.42); 1.78 (1.62–1.96)), unemployment (1.11 (1.07–1.14); 1.26 (1.15–1.38)) and obtain disability benefits (1.67 (1.66–1.67); 2.64 (2.63–2.65)). Uncontrolled asthma had increased temporary sick leave (1.42 (1.34–1.50)), unemployment (1.40 (1.32–1.48)) and disability (1.26 (1.26–1.27)) when compared to controlled disease. Significant increases in absenteeism could be measured already at ≥100 annual doses of rescue medication (1.09 (1.04–0.1.14)), patients’ first moderate or severe exacerbation (1.31 (1.15–1.49) and 1.31 (1.24–1.39), respectively). Further increases in absenteeism were observed with increasing rescue medication use and severe exacerbations. Conclusion Across severities, job absenteeism is increased among patients with asthma compared to the background population. Increases in absenteeism was seen already at ≥100 annual doses of rescue medication, representing a substantial, and probably preventable, reduction in productivity among young adults.
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Affiliation(s)
| | - Vibeke Backer
- Center for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Roche N, Crichton ML, Goeminne PC, Cao B, Humbert M, Shteinberg M, Antoniou KM, Suppli Ulrik C, Parks H, Wang C, Vandendriessche T, Qu J, Stolz D, Brightling C, Welte T, Aliberti S, Simonds AK, Tonia T, Chalmers JD. Update March 2022: management of hospitalised adults with coronavirus disease-19 (COVID-19): a European Respiratory Society living guideline. Eur Respir J 2022; 60:13993003.00803-2022. [PMID: 35710264 PMCID: PMC9363848 DOI: 10.1183/13993003.00803-2022] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 12/15/2022]
Abstract
Since the identification of SARS-CoV-2 at the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has affected more than 410 million people worldwide and killed almost 6 million [1, 2]. The predecessors of COVID-19, i.e. the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) outbreaks, had been relatively self-limiting, preventing clinicians and researchers from establishing evidence-based specific therapeutic strategies [3]. Conversely, COVID-19 rapidly proved to be extremely fast spreading, which led stakeholders to encourage, guide, build or fund multidirectional therapeutic research strategies based on both repurposing and development of new agents [4–8]. In parallel, considerable efforts were directed at describing the disease and understanding the underlying mechanisms [9–13]. As a result, there has been a huge generation of evidence, as highlighted by the impressive number of COVID-19 publications (more than 200 000 since the end of 2019). As a consequence, it proved rapidly impossible for any clinician, researcher or decision-maker to gather and analyse all the corresponding literature to derive appropriate guidance [14]. The first step of such a process is to select the relevant high-quality research that can be used to answer the question(s) of interest [15]. Even if limiting the search to clinical trials, systematic reviews and meta-analyses, almost 4000 papers appear in the PubMed database, as of mid-February 2022. In June and July 2020, the European Respiratory Society (ERS) and the American Thoracic Society (ATS) released early guidance on several aspects of COVID-19 management (i.e. rehabilitation, palliative care and acute management); at that time, direct specific evidence was sparse or absent [16–18]. Simultaneously, the ERS launched a living guideline on the management of COVID-19. The format was that of a “short” guideline, as per ERS standards [19, 20], in that the purpose was to release the first iteration within 12 months. However, the number of PICO (Population, Intervention, Comparator, Outcomes) questions to be addressed (n=12) already exceeded markedly what the ERS considers as being feasible during such a short timeframe (i.e. n=1–2), which was a direct consequence of the high number of unanswered issues in the field of acute COVID-19 management, all corresponding to outstanding clinical needs. The first version of these guidelines was published in March 2021 and addressed the following potential therapeutic options: corticosteroids, interleukin (IL)-6 receptor antagonists, hydroxychloroquine, azithromycin and both combined, colchicine, lopinavir-ritonavir, remdesivir, interferon-β, anticoagulation and non-invasive ventilatory support [6, 21]. An update of the mortality meta-analyses for corticosteroids, hydroxychloroquine, azithromycin, remdesivir, anti-IL-6 monoclonal antibodies, colchicine, lopinavir/ritonavir and interferon-β was published in December 2021 [22]. The ERS COVID-19 guidelines make recommendations for corticosteroids, anti-IL-6 monoclonal antibodies, baricitinib, anticoagulation and non-invasive respiratory support for hospitalised patients with COVID-19 https://bit.ly/3QgHH7U
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Affiliation(s)
- Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
| | | | | | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Saclay; Inserm UMR_S 999, Le Kremlin Bicêtre, France
| | - Michal Shteinberg
- Pulmonology institute and CF Center, Carmel Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre Hospital, Hvidovre, Denmark
| | | | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | | | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | | | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | - Stefano Aliberti
- University of Milan, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anita K Simonds
- Respiratory and Sleep Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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Espersen C, Platz E, Alhakak AS, Sengeløv M, Simonsen JØ, Johansen ND, Davidovski FS, Christensen J, Bundgaard H, Hassager C, Jabbari R, Carlsen J, Kirk O, Lindholm MG, Kristiansen OP, Nielsen OW, Jeschke KN, Ulrik CS, Sivapalan P, Iversen K, Stæhr Jensen JU, Schou M, Skaarup SH, Højbjerg Lassen MC, Skaarup KG, Biering-Sørensen T. Lung ultrasound findings following COVID-19 hospitalization: A prospective longitudinal cohort study. Respir Med 2022; 197:106826. [PMID: 35453059 PMCID: PMC8976570 DOI: 10.1016/j.rmed.2022.106826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 12/12/2022]
Abstract
Background Lung ultrasound (LUS) is a useful tool for diagnosis and monitoring in patients with active COVID-19-infection. However, less is known about the changes in LUS findings after a hospitalization for COVID-19. Methods In a prospective, longitudinal study in patients with COVID-19 enrolled from non-ICU hospital units, adult patients underwent 8-zone LUS and blood sampling both during the hospitalization and 2–3 months after discharge. LUS images were analyzed blinded to clinical variables and outcomes. Results A total of 71 patients with interpretable LUS at baseline and follow up (mean age 64 years, 61% male, 24% with acute respiratory distress syndrome (ARDS)) were included. The follow-up LUS was performed a median of 72 days after the initial LUS performed during hospitalization. At baseline, 87% had pathologic LUS findings in ≥1 zone (e.g. ≥3 B-lines, confluent B-lines or subpleural or lobar consolidation), whereas 30% had pathologic findings at follow-up (p < 0.001). The total number of B-lines and LUS score decreased significantly from hospitalization to follow-up (median 17 vs. 4, p < 0.001 and 4 vs. 0, p < 0.001, respectively). On the follow-up LUS, 28% of all patients had ≥3 B-lines in ≥1 zone, whereas in those with ARDS during the baseline hospitalization (n = 17), 47% had ≥3 B-lines in ≥1 zone. Conclusion LUS findings improved significantly from hospitalization to follow-up 2–3 months after discharge in COVID-19 survivors. However, persistent B-lines were frequent at follow-up, especially among those who initially had ARDS. LUS seems to be a promising method to monitor COVID-19 lung changes over time. Clinicaltrials.gov ID NCT04377035.
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48
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Granholm A, Kjær MBN, Munch MW, Myatra SN, Vijayaraghavan BKT, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Vesterlund GK, Meyhoff TS, Helleberg M, Møller MH, Benfield T, Venkatesh B, Hammond NE, Micallef S, Bassi A, John O, Jha V, Kristiansen KT, Ulrik CS, Jørgensen VL, Smitt M, Bestle MH, Andreasen AS, Poulsen LM, Rasmussen BS, Brøchner AC, Strøm T, Møller A, Khan MS, Padmanaban A, Divatia JV, Saseedharan S, Borawake K, Kapadia F, Dixit S, Chawla R, Shukla U, Amin P, Chew MS, Wamberg CA, Bose N, Shah MS, Darfelt IS, Gluud C, Lange T, Perner A. Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia. Intensive Care Med 2022; 48:580-589. [PMID: 35359168 PMCID: PMC8970069 DOI: 10.1007/s00134-022-06677-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. METHODS We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the international, stratified, blinded COVID STEROID 2 trial, which randomised 1000 adults with confirmed COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 26 hospitals in Europe and India. In the HRQoL analyses, higher values indicated better outcomes, and deceased patients were given a score of zero. RESULTS We obtained vital status at 180 days for 963 of 982 patients (98.1%) in the intention-to-treat population, EQ-5D-5L index value data for 922 (93.9%) and EQ VAS data for 924 (94.1%). At 180 days, 164 of 486 patients (33.7%) had died in the 12 mg group versus 184 of 477 (38.6%) in the 6 mg group [adjusted risk difference - 4.3%; 99% confidence interval (CI) - 11.7-3.0; relative risk 0.89; 0.72-1.09; P = 0.13]. The adjusted mean differences between the 12 mg and the 6 mg groups in EQ-5D-5L index values were 0.06 (99% CI - 0.01 to 0.12; P = 0.10) and in EQ VAS scores 4 (- 3 to 10; P = 0.22). CONCLUSION Among patients with COVID-19 and severe hypoxaemia, dexamethasone 12 mg compared with 6 mg did not result in statistically significant improvements in mortality or HRQoL at 180 days, but the results were most compatible with benefit from the higher dose.
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Affiliation(s)
- Anders Granholm
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Maj-Brit Nørregaard Kjær
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Warrer Munch
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Sheila Nainan Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Department of Critical Care, Apollo Hospitals, Chennai, India.,Chennai Critical Care Consultants, Chennai, India.,The George Institute for Global Health, New Delhi, India
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Rubenson Wahlin
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gitte Kingo Vesterlund
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Tine Sylvest Meyhoff
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark
| | - Thomas Benfield
- Center of Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.,Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sharon Micallef
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Oommen John
- Chennai Critical Care Consultants, Chennai, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Vivekanand Jha
- Chennai Critical Care Consultants, Chennai, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.,School of Public Health, Imperial College London, London, UK
| | - Klaus Tjelle Kristiansen
- Department of Anaesthesia and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Lind Jørgensen
- Department of Thoracic Anaesthesiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten H Bestle
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-North Zealand, Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sofie Andreasen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | | | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Craveiro Brøchner
- Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark.,Department of Anaesthesia and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Thomas Strøm
- Department of Anaesthesia and Critical Care Medicine, Odense University Hospital, Odense, Denmark.,Department of Anaesthesia and Critical Care Medicine, Hospital Sønderjylland, University Hospital of Southern, Aabenraa, Denmark
| | - Anders Møller
- Department of Anaesthesia and Intensive Care, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mohd Saif Khan
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, India
| | - Ajay Padmanaban
- Department of Critical Care, Apollo Hospitals, Chennai, India
| | - Jigeeshu Vasishtha Divatia
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sanjith Saseedharan
- Department of Intensive Care, SL Raheja Hospital, Mumbai, Maharashtra, India
| | - Kapil Borawake
- Department of Intensive Care, Vishwaraj Hospital, Pune, India
| | - Farhad Kapadia
- Section of Critical Care, Department of Medicine, Hinduja Hospital, Mahim, Mumbai, India
| | - Subhal Dixit
- Department of Critical Care Medicine, Sanjeevan Hospital, Pune, Maharashtra, India
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine, Indraprastha Apollo Hospital, New Delhi, India
| | - Urvi Shukla
- Intensive Care Unit and Emergency Services, Symbiosis University Hospital and Research Centre, Lavale, Pune, India
| | - Pravin Amin
- Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Neeta Bose
- Gotri General Hospital, Vadodara, Gujarat, India
| | - Mehul S Shah
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Iben S Darfelt
- Department of Anaesthesia and Intensive Care, Herning Hospital, Herning, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, the Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, the Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark. .,The George Institute for Global Health, University of New South Wales, Sydney, Australia.
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Saeed MI, Sivapalan P, Eklöf J, Ulrik CS, Browatzki A, Weinreich UM, Jensen TT, Biering-Sørensen T, Jensen JUS. Social Distancing in Relation to Severe Exacerbations of Chronic Obstructive Pulmonary Disease: A Nationwide Semi-Experimental Study During the COVID-19 Pandemic. Am J Epidemiol 2022; 191:874-885. [PMID: 34999742 PMCID: PMC9383148 DOI: 10.1093/aje/kwab292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/17/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
Social distancing measures introduced on March 12, 2020, in Denmark during the COVID-19 pandemic may affect non–COVID-19 admissions for severe acute exacerbation of chronic obstructive pulmonary disease (s-AECOPD). We compared rates of s-AECOPD in a nationwide, observational, semi-experimental cohort study using data from all Danish inhabitants between calendar week 1 through 25 in 2019 and 2020. In a sub-cohort of patients with chronic obstructive pulmonary disease, we examined incidence of s-AECOPD, admissions to an intensive care unit, and all-cause mortality. A total of 3.0 million inhabitants aged ≥40 years, corresponding to 3.0 million person-years, were followed for s-AECOPD. In the social distancing period in 2020, there were 6,212 incidents of s-AECOPD, compared with 11,260 incidents in 2019, resulting in a 45% relative risk reduction. In the cohort with chronic obstructive pulmonary disease (n = 16,675), we observed a lower risk of s-AECOPD in the social distancing period (subdistribution hazard ratio (HR) = 0.34, 95% confidence interval (CI): 0.33, 0.36; absolute risk: 25.4% in 2020 and 42.8% in 2019). The risk of admissions to an intensive care unit was reduced (subdistribution HR = 0.64, 95% CI: 0.47, 0.87), as was all-cause mortality (HR = 0.83, 95% CI: 0.76, 0.90). Overall, the social distancing period was associated with a significant risk reduction for hospital admittance with s-AECOPD.
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Affiliation(s)
- Mohamad Isam Saeed
- Correspondence to Mohamad Isam Saeed, Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalssvej 7, Ground Floor, DK-2900 Hellerup, Denmark (e-mail: )
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50
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Vejen M, Hansen EF, Al-Jarah BNI, Jensen C, Thaning P, Jeschke KN, Ulrik CS. Hospital admission for COVID-19 pneumonitis - long-term impairment in quality of life and lung function. Eur Clin Respir J 2022; 9:2024735. [PMID: 35024101 PMCID: PMC8745367 DOI: 10.1080/20018525.2021.2024735] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and Aim Knowledge of long-term consequences of severe COVID-19 pneumonitis is of outmost importance. Our aim was, therefore, to assess the long-term impact on quality of life and lung function in adults hospitalized with severe COVID-19. Methods All patients hospitalized with COVID-19 pneumonitis at Copenhagen University Hospital-Hvidovre, Denmark, were invited to participate in the study 4–5 months after discharge. Of the 160 invited 128 responded positively (80%). Medical history and symptoms were assessed, and patients rated impact on quality of life and functional status with EuroQol-5D-5L and Post Covid Functional Scale. Lung function was assessed by dynamic spirometry and measurement of diffusing capacity. Results Fatigue, dyspnea, cough and cognitive dysfunction were the most common symptoms. Of 128 patients, 85% had at least one symptom, and 51% reported two or more symptoms. Self-rated Quality of life was impaired assessed by EuroQol 5D-5L, with dimensions ‘Pain or discomfort’ (61%) and ‘Usual activities’ (54%) mostly affected. Functional status was significantly worse than before COVID-19 assessed by Post-COVID Functional Scale. Among lung function parameters, diffusing capacity was most affected, with 45% having diffusing capacity < 80% of predicted. Conclusion Fatigue, respiratory symptoms and cognitive symptoms are highly common months after hospitalization for severe COVID-19. Compared to pre-COVID-19, functional status and usual activities continued to be impaired. In line with this, almost half of the patients were found to have impaired diffusing capacity.
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Affiliation(s)
- Marie Vejen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Ejvind Frausing Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | | | - Casper Jensen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Pia Thaning
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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