1
|
Hernandez Cordero AI, Li X, Yang CX, Ambalavanan A, MacIsaac JL, Kobor MS, Doiron D, Tan W, Bourbeau J, Sin DD, Duan Q, Leung JM. Cannabis smoking is associated with advanced epigenetic age. Eur Respir J 2024; 63:2400458. [PMID: 38609099 PMCID: PMC11063617 DOI: 10.1183/13993003.00458-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
Cannabis use has been controversial, largely having been designated a controlled substance over the past century. While certain studies have linked cannabis smoking with harmful effects such as increased respiratory symptoms and faster lung function decline in older adults [1, 2], these findings have not been fully replicated by others [3]. The link between cannabis and disease pathogenesis may best be explored through DNA methylation. This mechanism consists of the addition or removal of a methyl group at a cytosine–guanine residue (CpG), can be influenced by exposures, and can modify transcription. Methylation changes can accumulate over time in patterns that are highly associated with age, leading to the development of epigenetic clocks that can estimate biological age [4]. Current cannabis smoking is significantly associated with faster peripheral blood epigenetic age acceleration; interestingly, cannabis smoking cessation is shown to normalise this age acceleration signal. https://bit.ly/3x7s2CU
Collapse
Affiliation(s)
- Ana I Hernandez Cordero
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
- Edwin S.H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xuan Li
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Chen Xi Yang
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Amirtha Ambalavanan
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Julie L MacIsaac
- Edwin S.H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Michael S Kobor
- Edwin S.H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Dany Doiron
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Wan Tan
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
- Edwin S.H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Qingling Duan
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
- Q. Duan and J.M. Leung contributed equally as senior authors
| | - Janice M Leung
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada
- Edwin S.H. Leong Healthy Aging Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Q. Duan and J.M. Leung contributed equally as senior authors
| |
Collapse
|
2
|
Vameghestahbanati M, Kingdom L, Hoffman EA, Kirby M, Allen NB, Angelini E, Bertoni A, Hamid Q, Hogg JC, Jacobs DR, Laine A, Maltais F, Michos ED, Sack C, Sin D, Watson KE, Wysoczanksi A, Couper D, Cooper C, Han M, Woodruff P, Tan WC, Bourbeau J, Barr RG, Smith BM. Airway tree caliber heterogeneity and airflow obstruction among older adults. J Appl Physiol (1985) 2024; 136:1144-1156. [PMID: 38420676 DOI: 10.1152/japplphysiol.00694.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
Smaller mean airway tree caliber is associated with airflow obstruction and chronic obstructive pulmonary disease (COPD). We investigated whether airway tree caliber heterogeneity was associated with airflow obstruction and COPD. Two community-based cohorts (MESA Lung, CanCOLD) and a longitudinal case-control study of COPD (SPIROMICS) performed spirometry and computed tomography measurements of airway lumen diameters at standard anatomical locations (trachea-to-subsegments) and total lung volume. Percent-predicted airway lumen diameters were calculated using sex-specific reference equations accounting for age, height, and lung volume. The association of airway tree caliber heterogeneity, quantified as the standard deviation (SD) of percent-predicted airway lumen diameters, with baseline forced expired volume in 1-second (FEV1), FEV1/forced vital capacity (FEV1/FVC) and COPD, as well as longitudinal spirometry, were assessed using regression models adjusted for age, sex, height, race-ethnicity, and mean airway tree caliber. Among 2,505 MESA Lung participants (means ± SD age: 69 ± 9 yr; 53% female, mean airway tree caliber: 99 ± 10% predicted, airway tree caliber heterogeneity: 14 ± 5%; median follow-up: 6.1 yr), participants in the highest quartile of airway tree caliber heterogeneity exhibited lower FEV1 (adjusted mean difference: -125 mL, 95%CI: -171,-79), lower FEV1/FVC (adjusted mean difference: -0.01, 95%CI: -0.02,-0.01), and higher odds of COPD (adjusted odds ratio: 1.42, 95%CI: 1.01-2.02) when compared with the lowest quartile, whereas longitudinal changes in FEV1 and FEV1/FVC did not differ significantly. Observations in CanCOLD and SPIROMICS were consistent. Among older adults, airway tree caliber heterogeneity was associated with airflow obstruction and COPD at baseline but was not associated with longitudinal changes in spirometry.NEW & NOTEWORTHY In this study, by leveraging two community-based samples and a case-control study of heavy smokers, we show that among older adults, airway tree caliber heterogeneity quantified by CT is associated with airflow obstruction and COPD independent of age, sex, height, race-ethnicity, and dysanapsis. These observations suggest that airway tree caliber heterogeneity is a structural trait associated with low baseline lung function and normal decline trajectory that is relevant to COPD.
Collapse
Affiliation(s)
| | - Leina Kingdom
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Norrina B Allen
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, United States
| | - Elsa Angelini
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Medicine, Columbia University, New York, New York, United States
| | - Alain Bertoni
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina, United States
| | - Qutayba Hamid
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Jacobs
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
| | - Andrew Laine
- Department of Medicine, Columbia University, New York, New York, United States
| | - Francois Maltais
- Faculty of Medicine , University of Laval, Laval, Quebec, Canada
| | - Erin D Michos
- Faculty of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington, United States
| | - Don Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karol E Watson
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Artur Wysoczanksi
- Department of Medicine, Columbia University, New York, New York, United States
| | - David Couper
- Department of Biostatistics, University of North Carolina, North Carolina, United States
| | - Christopher Cooper
- Department of Medicine, University of California, Los Angeles, California, United States
| | - Meilan Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott Woodruff
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, California, United States
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - R Graham Barr
- Department of Medicine, Columbia University, New York, New York, United States
| | - Benjamin M Smith
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Medicine, Columbia University, New York, New York, United States
| |
Collapse
|
3
|
Bourbeau J, Bhutani M, Hernandez P, Penz E, Marciniuk DD. Optimizing Pharmacotherapy Management of COPD: Don't Miss the Forest for the Trees. Am J Respir Crit Care Med 2024. [PMID: 38626371 DOI: 10.1164/rccm.202402-0338vp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/16/2024] [Indexed: 04/18/2024] Open
Affiliation(s)
- Jean Bourbeau
- Montreal Chest Institute, CORE, Montreal, Quebec, Canada
- McGill University Health Centre, 54473, Montreal, Quebec, Canada;
| | - Mohit Bhutani
- University of Alberta, 3158, Faculty of Medicine, Edmonton, Alberta, Canada
| | | | - Erika Penz
- University of Saskatchewan, Medicine, Saskatoon, Saskatchewan, Canada
| | - Darcy D Marciniuk
- University of Saskatchewanl, Respiratory, Critical Care and Sleep Medicine, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
4
|
Aaron SD, Montes de Oca M, Celli B, Bhatt SP, Bourbeau J, Criner GJ, DeMeo DL, Halpin DMG, Han MK, Hurst JR, Krishnan JK, Mannino D, van Boven JFM, Vogelmeier CF, Wedzicha JA, Yawn BP, Martinez FJ. Early Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease: The Costs and Benefits of Case Finding. Am J Respir Crit Care Med 2024; 209:928-937. [PMID: 38358788 DOI: 10.1164/rccm.202311-2120pp] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Shawn D Aaron
- The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Montes de Oca
- Universidad Central de Venezuela, Caracas, Venezuela
- Hospital Centro Médico de Caracas, Caracas, Venezuela
| | | | - Surya P Bhatt
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David M G Halpin
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - MeiLan K Han
- Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Jamuna K Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - David Mannino
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Claus F Vogelmeier
- Philipps-Universität Marburg, German Center for Lung Research, Marburg, Germany
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; and
| | | |
Collapse
|
5
|
Richard R, Jensen D, Touron J, Frederic C, Mulliez A, Pereira B, Filaire L, Marciniuk D, Maltais F, Tan W, Bourbeau J, Perrault H. Haemodynamic compensations for exercise tissue oxygenation in early stages of COPD: an integrated cardiorespiratory assessment study. BMJ Open Respir Res 2024; 11:e002241. [PMID: 38548372 PMCID: PMC10982806 DOI: 10.1136/bmjresp-2023-002241] [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: 12/07/2023] [Accepted: 02/23/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Cardiovascular comorbidities are increasingly being recognised in early stages of chronic obstructive pulmonary disease (COPD) yet complete cardiorespiratory functional assessments of individuals with mild COPD or presenting with COPD risk factors are lacking. This paper reports on the effectiveness of the cardiocirculatory-limb muscles oxygen delivery and utilisation axis in smokers exhibiting no, or mild to moderate degrees of airflow obstruction using standardised cardiopulmonary exercise testing (CPET). METHODS Post-bronchodilator spirometry was used to classify participants as 'ever smokers without' (n=88), with 'mild' (n=63) or 'mild-moderate' COPD (n=56). All underwent CPET with continuous concurrent monitoring of oxygen uptake (V'O2) and of bioimpedance cardiac output (Qc) enabling computation of arteriovenous differences (a-vO2). Mean values of Qc and a-vO2 were mapped across set ranges of V'O2 and Qc isolines to allow for meaningful group comparisons, at same metabolic and circulatory requirements. RESULTS Peak exercise capacity was significantly reduced in the 'mild-moderate COPD' as compared with the two other groups who showed similar pulmonary function and exercise capacity. Self-reported cardiovascular and skeletal muscle comorbidities were not different between groups, yet disease impact and exercise intolerance scores were three times higher in the 'mild-moderate COPD' compared with the other groups. Mapping of exercise Qc and a-vO2 also showed a leftward shift of values in this group, indicative of a deficit in peripheral O2 extraction even for submaximal exercise demands. Concurrent with lung hyperinflation, a distinctive blunting of exercise stroke volume expansion was also observed in this group. CONCLUSION Contrary to the traditional view that cardiovascular complications were the hallmark of advanced disease, this study of early COPD spectrum showed a reduced exercise O2 delivery and utilisation in individuals meeting spirometry criteria for stage II COPD. These findings reinforce the preventive clinical management approach to preserve peripheral muscle circulatory and oxidative capacities.
Collapse
Affiliation(s)
- Ruddy Richard
- Université Clermont Auvergne, Clermont-Ferrand, France
- CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
- CHU Clermont Ferrand, Service de médecine du Sport et des Explorations Fonctionnelles, Université Clermont Auvergne, Clermont Ferrand Cedex 1, France
| | - Dennis Jensen
- Kinesiology & Physical Education, McGill University, Montreal, Quebec, Canada
| | | | - Costes Frederic
- Université Clermont Auvergne, Clermont-Ferrand, France
- CHU Clermont Ferrand, Service de médecine du Sport et des Explorations Fonctionnelles, Université Clermont Auvergne, Clermont Ferrand Cedex 1, France
| | | | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Darcy Marciniuk
- Respiratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Wan Tan
- The University of British Columbia, Vancouver, Vancouver, Canada
| | | | - Hélène Perrault
- University of Ottawa Faculty of Health Sciences, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Ekström M, Li PZ, Lewthwaite H, Bourbeau J, Tan WC, Jensen D. Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiological Responses in Chronic Airflow Limitation. Chest 2024:S0012-3692(24)00270-8. [PMID: 38423279 DOI: 10.1016/j.chest.2024.02.034] [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: 10/15/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. RESEARCH QUESTION How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiological responses in people with chronic airflow limitation (CAL)? STUDY DESIGN AND METHODS An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output (W), rate of oxygen uptake (V˙o2), and minute ventilation (V˙e) at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated. RESULTS We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40-89 years); FEV1/FVC, 57.3% ± 8.2%; FEV1, 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak V˙o2 < lower limit of normal) was present in 26%. Relative to peak W, V˙o2, and V˙e, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiological abnormalities during CPET. INTERPRETATION Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness.
Collapse
Affiliation(s)
- Magnus Ekström
- Division of Respiratory Medicine, Allergology and Palliative Medicine, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden; Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada.
| | - Pei Zhi Li
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada
| | - Hayley Lewthwaite
- Centre of Research Excellence Treatable Traits, College of Medicine, Health and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jean Bourbeau
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
| | - Wan C Tan
- Department of Medicine, University of British Columbia Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
| |
Collapse
|
7
|
Molgat-Seon Y, Sawatzky MAT, Dominelli PB, Kirby M, Guenette JA, Bourbeau J, Tan WC, Sheel AW. Dysanapsis is not associated with exertional dyspnoea in healthy male and female never-smokers aged 40 years and older. Appl Physiol Nutr Metab 2024; 49:223-235. [PMID: 37847929 DOI: 10.1139/apnm-2023-0246] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
In healthy adults, airway-to-lung (i.e., dysanapsis) ratio is lower and dyspnoea during exercise at a given minute ventilation (V̇E) is higher in females than in males. We investigated the relationship between dysanapsis and sex on exertional dyspnoea in healthy adults. We hypothesized that females would have a smaller airway-to-lung ratio than males and that exertional dyspnoea would be associated with airway-to-lung ratio in males and females. We analyzed data from n = 100 healthy never-smokers aged ≥40 years enrolled in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study who underwent pulmonary function testing, a chest computed tomography scan, and cardiopulmonary exercise testing. The luminal area of the trachea, right main bronchus, left main bronchus, right upper lobe, bronchus intermedius, left upper lobe, and left lower lobe were 22%-37% smaller (all p < 0.001) and the airway-to-lung ratio (i.e., average large conducting airway diameter relative to total lung capacity) was lower in females than in males (0.609 ± 0.070 vs. 0.674 ± 0.082; p < 0.001). During exercise, there was a significant effect of V̇E, sex, and their interaction on dyspnoea (all p < 0.05), indicating that dyspnoea increased as a function of V̇E to a greater extent in females than in males. However, after adjusting for age and total lung capacity, there were no significant associations between airway-to-lung ratio and measures of exertional dyspnoea, regardless of sex (all r < 0.34; all p > 0.05). Our findings suggest that sex differences in airway size do not contribute to sex differences in exertional dyspnoea.
Collapse
Affiliation(s)
- Yannick Molgat-Seon
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Mathieu A T Sawatzky
- Department of Kinesiology and Applied Health, University of Winnipeg, Winnipeg, MB R3B 2E9, Canada
| | - Paolo B Dominelli
- Department of KinesiologyUniversity of Waterloo, Waterloo, ON N2 L3G1, Canada
| | - Miranda Kirby
- Department of PhysicsToronto Metropolitan University, Toronto, ON M5 B2K3, Canada
| | - Jordan A Guenette
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
- Department of Physical TherapyThe University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Jean Bourbeau
- Department of MedicineMcGill University, Montreal, QC H4A 3J1, Canada
| | - Wan C Tan
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - A William Sheel
- Centre for Heart and Lung Innovation, The University of British Columbia and St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
- School of Kinesiology, The University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| |
Collapse
|
8
|
Marciniuk J, Frohlich M, Bourbeau J, Kaminska M, Drouin I, Ouellet I, Ross B. Long-Term Home Noninvasive Ventilation and Exacerbations of Chronic Obstructive Pulmonary Disease: A Real-World Study. Ann Am Thorac Soc 2024; 21:356-360. [PMID: 37948735 DOI: 10.1513/annalsats.202303-244rl] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Jeffrey Marciniuk
- McGill University Health Centre Montreal, Quebec, Canada
- University of Saskatchewan Saskatoon, Saskatchewan, Canada
| | - Michael Frohlich
- McGill University Health Centre Montreal, Quebec, Canada
- Hull Hospital Gatineau, Quebec, Canada
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre (RI-MUHC) Montreal, Quebec, Canada
| | - Marta Kaminska
- Research Institute of the McGill University Health Centre (RI-MUHC) Montreal, Quebec, Canada
| | | | | | - Bryan Ross
- Research Institute of the McGill University Health Centre (RI-MUHC) Montreal, Quebec, Canada
| |
Collapse
|
9
|
Day de Larrañaga F, Joubert A, Drouin I, Ouellet I, Li PZ, Ross BA, Baglole CJ, Bourbeau J. Biological Anti-IL-5/IL-5R Therapeutics for Chronic Obstructive Pulmonary Disease (COPD) with Specific Treatable Traits: A Real-World Retrospective Analysis. Int J Chron Obstruct Pulmon Dis 2024; 19:217-223. [PMID: 38249820 PMCID: PMC10800109 DOI: 10.2147/copd.s438153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
Introduction We describe the use of anti-IL-5 monoclonal antibodies from a COPD clinic, a source other than traditional clinical trials. The objectives were to characterize the patient subgroup prescribed anti-IL-5 monoclonal antibodies and to report potential benefits. Methods This is a retrospective case series study of 17 patients treated in a COPD subspecialty clinic. All patients had a diagnosis of COPD (post-bronchodilator FEV1/FVC <0.7) and had been prescribed an anti-IL-5 biologic for at least 8 months. Acute exacerbations of COPD (AECOPDs) were collected as reported in electronic medical records. Results All patients (17) enrolled were treated with biologics for ≥8 months, and 13 (76%) for ≥1 year. Patients were characterized by severe disease traits, FEV1 <50% predicted, recurrent exacerbations (3.5 moderate-to-severe AECOPDs in the year before treatment), high peripheral blood eosinophil counts (≥250 cells/μL in the previous year), all on inhaled triple therapy, and only 1 patient with a diagnosis of asthma prior to smoking. There was a statistically significant decrease in the exacerbation rate compared with baseline after 8 and 12 months of anti-IL-5 treatment, respectively, yielding the equivalent of a 2-3x reduction in exacerbation rate. Absolute FEV1 decreased, and the decline in FEV1 % of predicted reached statistical significance (p<0.05); CAT score improved (p<0.05). Discussion This real-world evidence data aligns with existing studies suggesting the potential benefit of anti-IL-5 treatment for specific patients with COPD and therefore advocates for further investigation of RCTs on the use of anti-IL-5 biologics for well-characterized patients with COPD.
Collapse
Affiliation(s)
- Forest Day de Larrañaga
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Alexandre Joubert
- COPD Clinic, McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Drouin
- COPD Clinic, McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Ouellet
- COPD Clinic, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pei Zhi Li
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Bryan A Ross
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- COPD Clinic, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carolyn J Baglole
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Jean Bourbeau
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
- COPD Clinic, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
10
|
Phillips DB, James MD, Vincent SG, Elbehairy AF, Neder JA, Kirby M, Ora J, Day AG, Tan WC, Bourbeau J, O'Donnell DE. Physiological Characterization of Preserved Ratio Impaired Spirometry in the CanCOLD Study: Implications for Exertional Dyspnea and Exercise Intolerance. Am J Respir Crit Care Med 2024. [PMID: 38170674 DOI: 10.1164/rccm.202307-1184oc] [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: 07/11/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
RATIONALE It is increasingly recognized that adults with preserved ratio impaired spirometry (PRISm) are prone to increased morbidity. However, the underlying pathophysiological mechanisms are unknown. OBJECTIVES Evaluate the mechanisms of increased dyspnea and reduced exercise capacity in PRISm. METHODS We completed a cross-sectional analysis of the CanCOLD population-based study. We compared physiological responses in 59 participants meeting PRISm spirometric criteria (post-bronchodilator FEV1<80% predicted and FEV1/FVC≥0.7), 264 controls, and 170 ever-smokers with chronic obstructive pulmonary disease (COPD), at rest and during cardiopulmonary exercise testing (CPET). MEASUREMENTS AND MAIN RESULTS PRISm had lower total lung, vital and inspiratory capacities than controls (all p<0.05), and minimal small airway, pulmonary gas-exchange, and radiographic parenchymal lung abnormalities. Compared with control, PRISm had higher dyspnea/oxygen uptake [V̇O2] ratio at peak exercise (4.0±2.2vs2.9±1.9, Borg units/L/min, p<0.001) and lower V̇O2peak (74±22vs96±25% predicted, p<0.001). At standardized submaximal work rates, PRISm had greater tidal volume/inspiratory capacity (VT%IC, p<0.001), reflecting inspiratory mechanical constraint. In contrast to PRISm, COPD had characteristic small airways dysfunction, dynamic hyperinflation, and pulmonary gas-exchange abnormalities. Despite these physiological differences between the 3 groups, the relationship between increasing dyspnea and VT%IC during CPET was similar. Resting IC significantly correlated with V̇O2peak (r=0.65, p<0.001) in the entire sample, even after adjusting for airflow limitation, gas-trapping and diffusing capacity. CONCLUSION In PRISm, lower exercise capacity and higher exertional dyspnea than healthy controls were mainly explained by lower resting lung volumes and earlier onset of dynamic inspiratory mechanical constraints at relatively low work rates.
Collapse
Affiliation(s)
| | - Matthew D James
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | | | - Amany F Elbehairy
- Manchester University NHS Foundation Trust, 5293, Manchester, United Kingdom of Great Britain and Northern Ireland
- Alexandria University Faculty of Medicine, 68789, Department of Chest Diseases, Alexandria, Egypt
| | - J Alberto Neder
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | - Miranda Kirby
- Ryerson University, Physics, Toronto, Ontario, Canada
- United States
| | - Josuel Ora
- Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Kingston Health Sciences Hospital Research Institute, Kingston, Ontario, Canada
| | - Wan C Tan
- Providence Heart & Lung Institute, University of British Columbia, St Paul's Hospital, UBC James Hogg Research Centre, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Montreal Chest Institute, CORE, Montreal, Quebec, Canada
- McGill University Health Centre, 54473, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Queen's University, Division of Respiratory and Critical Care Medicine, Department of Medicine, Kingston, Ontario, Canada;
| |
Collapse
|
11
|
Robert P, Lévesque B, Bourbeau J, Ahmad Khan F, Boulet LP, Dubé MA, Proulx JF, Ayotte P. Respiratory health and its determinants among Nunavimmiut: results from the Qanuilirpitaa? 2017 Nunavik Health Survey. Can J Public Health 2024; 115:136-151. [PMID: 36624337 PMCID: PMC10830964 DOI: 10.17269/s41997-022-00722-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/09/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Respiratory diseases are the leading cause of hospitalization in Nunavik (northern Québec, Canada) and contribute to disparities in life expectancy with the rest of Canada. As part of Qanuilirpitaa? 2017, a cross-sectional population-based health survey, we sought to describe the prevalence of respiratory health indicators, including the first estimate of airway obstruction based on spirometry in an Inuit population, and explore their associated characteristics. METHODS We analyzed data from 1296 participants aged 16 years and older, using multivariate logistic regression to assess characteristics associated with spirometry-determined airway obstruction and self-reported respiratory symptoms, i.e., wheezing in the last year and chronic cough during at least 3 months. RESULTS In this relatively young population (83% aged 16 to 54), the prevalences of wheezing, chronic cough, and airway obstruction were, respectively, 27% (95% CI 24-30), 21% (18-23), and 17% (14-20). These estimates are prone to biases due to the relatively low participation rate (about 37%). The most consistent associations were with smoking (≥ 15 pack-years; odds ratio [OR] 3.13, 3.39, and 2.86 for the three indicators, respectively) and food security (OR 0.55 with wheezing and OR 0.26 with chronic cough), as defined in the Household Food Security Survey Module. Wheezing was also associated with allergic sensitization to dogs (2.60) and obesity (2.18). Chronic cough was associated with respiratory infections during childhood (2.12), housing in need of major repairs (1.72), and housing crowding (1.50), and was negatively associated with participation to traditional activities (0.62) and going on the land (0.64). Airway obstruction was associated with being underweight (3.84) and post-secondary education (0.40). Among young adults and women, wheezing was also associated with any inhalation of solvents for recreational purposes during their lifetime (2.62 and 1.56, respectively), while airway obstruction was associated with regular marijuana use (2.22 and 1.84, respectively). CONCLUSION Smoking and food insecurity are both highly prevalent and strongly associated with respiratory symptoms in Nunavik. Together with essential smoking prevention and cessation programs, our findings suggest that solving food security and housing crises, improving socioeconomic conditions, and promoting traditional lifestyle may improve respiratory health in Nunavik.
Collapse
Affiliation(s)
- Philippe Robert
- Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada
| | - Benoît Lévesque
- Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal Chest Institute, Montreal, QC, Canada
| | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal Chest Institute, Montreal, QC, Canada
- McGill International TB Centre, Montreal, QC, Canada
| | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
- Département de médecine, Université Laval, Quebec City, QC, Canada
| | - Marc-André Dubé
- Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Jean-François Proulx
- Department of Public Health, Nunavik Regional Board of Health and Social Services, Kuujjuaq, QC, Canada
| | - Pierre Ayotte
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada.
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada.
| |
Collapse
|
12
|
Ekström M, Li PZ, Lewthwaite H, Bourbeau J, Tan WC, Schiöler L, Brotto A, Stickland MK, Jensen D. Normative Reference Equations for Breathlessness Intensity during Incremental Cardiopulmonary Cycle Exercise Testing. Ann Am Thorac Soc 2024; 21:56-67. [PMID: 37708387 PMCID: PMC10867914 DOI: 10.1513/annalsats.202305-394oc] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023] Open
Abstract
Rationale: Cardiopulmonary exercise testing (CPET) is the gold standard to evaluate exertional breathlessness, a common and disabling symptom. However, the interpretation of breathlessness responses to CPET is limited by a scarcity of normative data. Objectives: We aimed to develop normative reference equations for breathlessness intensity (Borg 0-10 category ratio) response in men and women aged ⩾40 years during CPET, in relation to power output (watts), oxygen uptake, and minute ventilation. Methods: Analysis of ostensibly healthy people aged ⩾40 years undergoing symptom-limited incremental cycle CPET (10 W/min) in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study. Participants had smoking histories <5 pack-years and normal lung function and exercise capacity. The probability of each Borg 0-10 category ratio breathlessness intensity rating by power output, oxygen uptake, and minute ventilation (as an absolute or a relative value [percentage of predicted maximum]) was predicted using ordinal multinomial logistic regression. Model performance was evaluated by fit, calibration, and discrimination (C statistic) and externally validated in an independent sample (n = 86) of healthy Canadian adults. Results: We included 156 participants (43% women) from CanCOLD; the mean age was 65 (range, 42-91) years, and the mean body mass index was 26.3 (standard deviation, 3.8) kg/m2. Reference equations were developed for women and men separately, accounting for age and/or body mass. Model performance was high across all equations, including in the validation sample (C statistic for men = 0.81-0.92, C statistic for women = 0.81-0.96). Conclusions: Normative reference equations are provided to compare exertional breathlessness intensity ratings among individuals or groups and to identify and quantify abnormal breathlessness responses (scores greater than the upper limit of normal) during CPET.
Collapse
Affiliation(s)
- Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology, and Palliative Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Hayley Lewthwaite
- Centre of Research Excellence in Treatable Traits, College of Health, Medicine, and Wellbeing, University of Newcastle, New Lambton, New South Wales, Australia
- UniSA: Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Jean Bourbeau
- Montreal Chest Institute and
- Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, McGill University Health Center Research Institute, and
| | - Wan C. Tan
- Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and
| | - Andrew Brotto
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael K. Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dennis Jensen
- Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, McGill University Health Center Research Institute, and
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Québec, Canada
| |
Collapse
|
13
|
Genkin D, Jenkins AR, van Noord N, Makimoto K, Collins S, Stickland MK, Tan WC, Bourbeau J, Jensen D, Kirby M. A fully automated pipeline for the extraction of pectoralis muscle area from chest computed tomography scans. ERJ Open Res 2024; 10:00485-2023. [PMID: 38259805 PMCID: PMC10801752 DOI: 10.1183/23120541.00485-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024] Open
Abstract
Background Computed tomography (CT)-derived pectoralis muscle area (PMA) measurements are prognostic in people with or at-risk of COPD, but fully automated PMA extraction has yet to be developed. Our objective was to develop and validate a PMA extraction pipeline that can automatically: 1) identify the aortic arch slice; and 2) perform pectoralis segmentation at that slice. Methods CT images from the Canadian Cohort of Obstructive Lung Disease (CanCOLD) study were used for pipeline development. Aorta atlases were used to automatically identify the slice containing the aortic arch by group-based registration. A deep learning model was trained to segment the PMA. The pipeline was evaluated in comparison to manual segmentation. An external dataset was used to evaluate generalisability. Model performance was assessed using the Dice-Sorensen coefficient (DSC) and PMA error. Results In total 90 participants were used for training (age 67.0±9.9 years; forced expiratory volume in 1 s (FEV1) 93±21% predicted; FEV1/forced vital capacity (FVC) 0.69±0.10; 47 men), and 32 for external testing (age 68.6±7.4 years; FEV1 65±17% predicted; FEV1/FVC 0.50±0.09; 16 men). Compared with manual segmentation, the deep learning model achieved a DSC of 0.94±0.02, 0.94±0.01 and 0.90±0.04 on the true aortic arch slice in the train, validation and external test sets, respectively. Automated aortic arch slice detection obtained distance errors of 1.2±1.3 mm and 1.6±1.5 mm on the train and test data, respectively. Fully automated PMA measurements were not different from manual segmentation (p>0.05). PMA measurements were different between people with and without COPD (p=0.01) and correlated with FEV1 % predicted (p<0.05). Conclusion A fully automated CT PMA extraction pipeline was developed and validated for use in research and clinical practice.
Collapse
Affiliation(s)
- Daniel Genkin
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, Canada
| | - Alex R. Jenkins
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Nikki van Noord
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
| | - Kalysta Makimoto
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
| | - Sophie Collins
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Wan C. Tan
- Center for Heart, Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
| |
Collapse
|
14
|
Cherian M, Adam V, Ross B, Bourbeau J, Kaminska M. Mortality in individuals with COPD on long-term home non-invasive ventilation. Respir Med 2023; 218:107378. [PMID: 37567515 DOI: 10.1016/j.rmed.2023.107378] [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] [Received: 01/05/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Real-world evidence regarding survival of patients with chronic obstructive pulmonary disease (COPD) using chronic non-invasive ventilation (NIV) is scarce. RESEARCH QUESTION How do obesity and other factors relate to mortality in patients with COPD on chronic NIV? STUDY DESIGN and Methods: We retrospectively analyzed data from COPD patients enrolled in a home ventilation program between 2014 and 2018. Survival was compared between obese and non-obese groups using the Kaplan-Meier method. Factors associated with mortality were identified using multivariable Cox proportional regression analyses with Least Absolute Selection and Shrinkage Operator (LASSO) regularization. Univariable analyses were also done stratified by obesity. RESULTS Median survival was 80.0 (95% CI: 71.0-NA) months among obese (n = 205) and 30.0 (95%CI: 19.0-42.0) months in non-obese (n = 61) patients. NIV adherence was high in both groups. Mortality was associated with male gender [HR 1.44], chronic opioids or benzodiazepines use [HR 1.07], home oxygen use [HR 1.82], fixed pressure mode of ventilation [HR 1.55], NIV inspiratory pressure [HR 1.05], and thoracic cancer [HR 1.27]; obesity [HR: 0.43], age [HR 0.99] and NIV expiratory pressure [HR 0.94] were associated with decreased mortality. In the obese, univariable analyses revealed that chest wall disease, thoracic cancer, home oxygen use, FEV1% predicted, and ventilation parameters were associated with mortality. In the non-obese, male gender and respiratory comorbidities were related to mortality. INTERPRETATION Obesity is associated with improved survival in COPD patients highly adherent to NIV. Other factors associated with mortality reflect disease severity and ventilator parameters, with differences between obese and non-obese patients.
Collapse
Affiliation(s)
- Mathew Cherian
- Division of Pulmonary Medicine, Sir Mortimer B. David Jewish General Hospital, Montreal, QC, Canada
| | - Veronique Adam
- Quebec National Program for Home Ventilatory Assistance-McGill University Health Center (PNAVD-MUHC), Montreal, QC, Canada
| | - Bryan Ross
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Jean Bourbeau
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marta Kaminska
- Quebec National Program for Home Ventilatory Assistance-McGill University Health Center (PNAVD-MUHC), Montreal, QC, Canada; Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
| |
Collapse
|
15
|
Makimoto K, Hogg JC, Bourbeau J, Tan WC, Kirby M. CT Imaging With Machine Learning for Predicting Progression to COPD in Individuals at Risk. Chest 2023; 164:1139-1149. [PMID: 37421974 DOI: 10.1016/j.chest.2023.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Identifying individuals at risk of progressing to COPD may allow for initiation of treatment to potentially slow the progression of the disease or the selection of subgroups for discovery of novel interventions. RESEARCH QUESTION Does the addition of CT imaging features, texture-based radiomic features, and established quantitative CT scan to conventional risk factors improve the performance for predicting progression to COPD in individuals who smoke with machine learning? STUDY DESIGN AND METHODS Participants at risk (individuals who currently or formerly smoked, without COPD) from the Canadian Cohort Obstructive Lung Disease (CanCOLD) population-based study underwent CT imaging at baseline and spirometry at baseline and follow-up. Various combinations of CT scan features, texture-based CT scan radiomics (n = 95), and established quantitative CT scan (n = 8), as well as demographic (n = 5) and spirometry (n = 3) measurements, with machine learning algorithms were evaluated to predict progression to COPD. Performance metrics included the area under the receiver operating characteristic curve (AUC) to evaluate the models. DeLong test was used to compare the performance of the models. RESULTS Among the 294 at-risk participants who were evaluated (mean age, 65.6 ± 9.2 years; 42% female; mean pack-years, 17.9 ± 18.7), 52 participants (23.7%) in the training data set and 17 participants (23.0%) in the testing data set progressed to spirometric COPD at follow-up (2.5 ± 0.9 years from baseline). Compared with machine learning models with demographics alone (AUC, 0.649), the addition of CT imaging features to demographics (AUC, 0.730; P < .05) or CT imaging features and spirometry to demographics (AUC, 0.877; P < .05) significantly improved the performance for predicting progression to COPD. INTERPRETATION Heterogeneous structural changes occur in the lungs of individuals at risk that can be quantified using CT imaging features, and evaluation of these features together with conventional risk factors improves performance for predicting progression to COPD.
Collapse
Affiliation(s)
| | - James C Hogg
- Center for Heart, Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Wan C Tan
- Center for Heart, Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Kirby
- Toronto Metropolitan University, Toronto, ON, Canada.
| |
Collapse
|
16
|
Bourbeau J, Bhutani M, Hernandez P, Aaron SD, Beauchesne MF, Kermelly SB, D'Urzo A, Lal A, Maltais F, Marciniuk JD, Mulpuru S, Penz E, Sin DD, Van Dam A, Wald J, Walker BL, Marciniuk DD. 2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD. Chest 2023; 164:1159-1183. [PMID: 37690008 DOI: 10.1016/j.chest.2023.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
Collapse
Affiliation(s)
- Jean Bourbeau
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada.
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shawn D Aaron
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Sophie B Kermelly
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Anthony D'Urzo
- Primary Care Lung Clinic, University of Toronto, Toronto, ON, Canada
| | - Avtar Lal
- Canadian Thoracic Society, Ottawa, ON, Canada
| | - François Maltais
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Jeffrey D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Erika Penz
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Don D Sin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Joshua Wald
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brandie L Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
17
|
Flahaut M, Leprohon P, Pham NP, Gingras H, Bourbeau J, Papadopoulou B, Maltais F, Ouellette M. Distinctive features of the oropharyngeal microbiome in Inuit of Nunavik and correlations of mild to moderate bronchial obstruction with dysbiosis. Sci Rep 2023; 13:16622. [PMID: 37789055 PMCID: PMC10547696 DOI: 10.1038/s41598-023-43821-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Inuit of Nunavik are coping with living conditions that can influence respiratory health. Our objective was to investigate associations between respiratory health in Inuit communities and their airway microbiome. Oropharyngeal samples were collected during the Qanuilirpitaa? 2017 Inuit Health Survey and subjected to metagenomic analyses. Participants were assigned to a bronchial obstruction group or a control group based on their clinical history and their pulmonary function, as monitored by spirometry. The Inuit microbiota composition was found to be distinct from other studied populations. Within the Inuit microbiota, differences in diversity measures tend to distinguish the two groups. Bacterial taxa found to be more abundant in the control group included candidate probiotic strains, while those enriched in the bronchial obstruction group included opportunistic pathogens. Crossing taxa affiliation method and machine learning consolidated our finding of distinct core microbiomes between the two groups. More microbial metabolic pathways were enriched in the control participants and these were often involved in vitamin and anti-inflammatory metabolism, while a link could be established between the enriched pathways in the disease group and inflammation. Overall, our results suggest a link between microbial abundance, interactions and metabolic activities and respiratory health in the Inuit population.
Collapse
Affiliation(s)
- Mathilde Flahaut
- Centre de Recherche en Infectiologie and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - Philippe Leprohon
- Centre de Recherche en Infectiologie and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - Nguyen Phuong Pham
- Centre de Recherche en Infectiologie and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - Hélène Gingras
- Centre de Recherche en Infectiologie and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - Jean Bourbeau
- Department of Medicine, Division of Respiratory Medicine, McGill University Health Center, Montréal, QC, Canada
| | - Barbara Papadopoulou
- Centre de Recherche en Infectiologie and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - François Maltais
- Groupe de Recherche en Santé Respiratoire, Centre de Recherche de L'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - Marc Ouellette
- Centre de Recherche en Infectiologie and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec City, QC, Canada.
| |
Collapse
|
18
|
Ross BA, Doiron D, Benedetti A, Aaron SD, Chapman K, Hernandez P, Maltais F, Marciniuk D, O'Donnell DE, Sin DD, Walker BL, Tan W, Bourbeau J. Short-term air pollution exposure and exacerbation events in mild to moderate COPD: a case-crossover study within the CanCOLD cohort. Thorax 2023; 78:974-982. [PMID: 37147124 DOI: 10.1136/thorax-2022-219619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/05/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infections are considered as leading causes of acute exacerbations of chronic obstructive pulmonary disease (COPD). Non-infectious risk factors such as short-term air pollution exposure may play a clinically important role. We sought to estimate the relationship between short-term air pollutant exposure and exacerbations in Canadian adults living with mild to moderate COPD. METHODS In this case-crossover study, exacerbations ('symptom based': ≥48 hours of dyspnoea/sputum volume/purulence; 'event based': 'symptom based' plus requiring antibiotics/corticosteroids or healthcare use) were collected prospectively from 449 participants with spirometry-confirmed COPD within the Canadian Cohort Obstructive Lung Disease. Daily nitrogen dioxide (NO2), fine particulate matter (PM2.5), ground-level ozone (O3), composite of NO2 and O3 (Ox), mean temperature and relative humidity estimates were obtained from national databases. Time-stratified sampling of hazard and control periods on day '0' (day-of-event) and Lags ('-1' to '-6') were compared by fitting generalised estimating equation models. All data were dichotomised into 'warm' (May-October) and 'cool' (November-April) seasons. ORs and 95% CIs were estimated per IQR increase in pollutant concentrations. RESULTS Increased warm season ambient concentration of NO2 was associated with symptom-based exacerbations on Lag-3 (1.14 (1.01 to 1.29), per IQR), and increased cool season ambient PM2.5 was associated with symptom-based exacerbations on Lag-1 (1.11 (1.03 to 1.20), per IQR). There was a negative association between warm season ambient O3 and symptom-based events on Lag-3 (0.73 (0.52 to 1.00), per IQR). CONCLUSIONS Short-term ambient NO2 and PM2.5 exposure were associated with increased odds of exacerbations in Canadians with mild to moderate COPD, further heightening the awareness of non-infectious triggers of COPD exacerbations.
Collapse
Affiliation(s)
- Bryan A Ross
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kenneth Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Darcy Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Wan Tan
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
| |
Collapse
|
19
|
Delbressine JM, Jensen D, Vaes AW, Li PZ, Bourbeau J, Tan WC, Hajian B, van 't Hul AJ, Spruit MA. Reference values for six-minute walk distance and six-minute walk work in Caucasian adults. Pulmonology 2023; 29:399-409. [PMID: 37045743 DOI: 10.1016/j.pulmoe.2023.02.014] [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] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
RATIONALE The six-minute walk test (6MWT) is a practical and simple field-based test to assess physical capacity. Several reference equations for six-minute walking distance (6MWD, m) exist, but have a number of limitations that decrease their clinical utility. In addition, no reference equations exist for the 6MWT-derived outcome six-minute walk work (6MWORK, kg.m). OBJECTIVES To establish new reference equations for 6MWD and 6MWORK on a 20 m course using data from the population-based Canadian Cohort Obstructive Lung Disease study. METHODS AND MEASUREMENTS A total of 335 participants without obstructive or restrictive pulmonary function, with normal self-reported health status, normal exercise capacity, and <30 pack years cigarette smoking history were selected to create a representative sample of Canadian adults aged ≥40 years. All participants performed two 6MWTs. Reference equations were derived using multiple regression analyses. MAIN RESULTS On average, 6MWD and 6MWORK were 541±98 m and 41.3 ± 11.2 kg.m, respectively. All outcomes were significantly greater in males than females. Sex-specific reference equations were derived from the results of 6MWD and 6MWORK with an explained variance of 24 to 35%. CONCLUSIONS This study established reference equations for 6MWD and 6MWORK on a 20 m course in Caucasian males and females aged ≥40 years with normal pulmonary function, self-reported health status and exercise capacity. These newly derived reference equations add value to the assessment of functional capacity in clinical practice.
Collapse
Affiliation(s)
- J M Delbressine
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, the Netherlands.
| | - D Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montréal, Québec, Canada
| | - A W Vaes
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands
| | - P Z Li
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - J Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Department of Medicine, McGill University, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - W C Tan
- The University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - B Hajian
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, the Netherlands
| | - A J van 't Hul
- Department of Pulmonary Disease, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - M A Spruit
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, the Netherlands
| |
Collapse
|
20
|
Ekström M, Li PZ, Lewthwaite H, Bourbeau J, Tan WC, Jensen D. The modified Borg/6-min walk distance ratio: a method to assess exertional breathlessness and leg discomfort using the 6-min walk test. ERJ Open Res 2023; 9:00281-2023. [PMID: 37753276 PMCID: PMC10518869 DOI: 10.1183/23120541.00281-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/23/2023] [Indexed: 09/28/2023] Open
Abstract
Background The 6-min walk test (6MWT) is widely used to assess exercise capacity across chronic health conditions, but is currently not useful to assess symptoms, as the scores do not account for the 6-min walk distance (6MWD). We aimed to 1) develop normative reference equations for breathlessness and leg discomfort intensity expressed as modified Borg (mBorg)/6MWD ratios; and 2) validate the equations in people with COPD. Methods Analysis of people aged ≥40 years who performed two 6MWTs (on a 20-m course) in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study: a healthy cohort (n=291; mean±sd age 67.5±9.4 years; 54% male) with normal 6MWD and lung function, and a COPD cohort (n=156; age 66.2±9.0 years; 56% male; forced expiratory volume in 1 s (FEV1)/forced vital capacity 56.6±8.2%; FEV1 74.4±18.6% pred). The mBorg score was calculated as the Borg 0-10 category ratio intensity rating of breathlessness or leg discomfort recorded at the end of the 6MWT +1 (range 1-11), to avoid zeros and yield ratios proportional to the symptom score and 6MWD-1. Results Using data from the healthy cohort, sex-specific normative reference equations for breathlessness and leg discomfort mBorg/6MWD ratios were developed using multivariable linear regression, accounting for age, and body mass or body mass index. In the COPD cohort, abnormal breathlessness and leg discomfort (mBorg/6MWD>upper limit of normal) showed strong concurrent validity with worse airflow limitation, Medical Research Council breathlessness and COPD Assessment Test scores. Conclusion Normative references for the mBorg/6MWD ratio are presented to assess breathlessness and leg discomfort responses to the 6MWT in COPD.
Collapse
Affiliation(s)
- Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | - Pei Zhi Li
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, QC, Canada
| | - Hayley Lewthwaite
- Centre of Research Excellence Treatable Traits, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, Australia
- UniSA: Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, Australia
| | - Jean Bourbeau
- Montreal Chest Institute, McGill University Health Center Research Institute, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
| | - Wan C. Tan
- University of British Columbia Centre for Heart Lung Innovation, Department of Medicine, Vancouver, BC, Canada
| | - Dennis Jensen
- Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
- Clinical Exercise and Respiratory Physiology Laboratory, Department of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada
| |
Collapse
|
21
|
Krishnan S, Tan WC, Farias R, Aaron SD, Benedetti A, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O'Donnell DE, Sin DD, Walker B, Bourbeau J. Impaired Spirometry and COPD Increase the Risk of Cardiovascular Disease: A Canadian Cohort Study. Chest 2023; 164:637-649. [PMID: 36871842 DOI: 10.1016/j.chest.2023.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Individuals with COPD and preserved ratio impaired spirometry (PRISm) findings in clinical settings have an increased risk of cardiovascular disease (CVD). RESEARCH QUESTION Do individuals with mild to moderate or worse COPD and PRISm findings in community settings have a higher prevalence and incidence of CVD compared with individuals with normal spirometry findings? Can CVD risk scores be improved when impaired spirometry is added? STUDY DESIGN AND METHODS The analysis was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD). Prevalence of CVD (ischemic heart disease [IHD] and heart failure [HF]) and their incidence over 6.3 years were compared between groups with impaired and normal spirometry findings using logistic regression and Cox models, respectively, adjusting for covariables. Discrimination of the pooled cohort equations (PCE) and Framingham risk score (FRS) in predicting CVD were assessed with and without impaired spirometry. RESULTS Participants (n = 1,561) included 726 people with normal spirometry findings and 835 people with impaired spirometry findings (COPD Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 disease, n = 408; GOLD stage ≥ 2, n = 331; PRISm findings, n = 96). Rates of undiagnosed COPD were 84% in GOLD stage 1 and 58% in GOLD stage ≥ 2 groups. Prevalence of CVD (IHD or HF) was significantly higher among individuals with impaired spirometry findings and COPD compared with those with normal spirometry findings, with ORs of 1.66 (95% CI, 1.13-2.43; P = .01∗) (∗ indicates statistical significane with P < .05) and 1.55 (95% CI, 1.04-2.31; P = .033∗), respectively. Prevalence of CVD was significantly higher in participants having PRISm findings and COPD GOLD stage ≥ 2, but not GOLD stage 1. CVD incidence was significantly higher, with hazard ratios of 2.07 (95% CI, 1.10-3.91; P = .024∗) for the impaired spirometry group and 2.09 (95% CI, 1.10-3.98; P = .024∗) for the COPD group compared to individuals with normal spirometry findings. The difference was significantly higher among individuals with COPD GOLD stage ≥ 2, but not GOLD stage 1. The discrimination for predicting CVD was low and limited when impaired spirometry findings were added to either risk score. INTERPRETATION Individuals with impaired spirometry findings, especially those with moderate or worse COPD and PRISm findings, have increased comorbid CVD compared with their peers with normal spirometry findings, and having COPD increases the risk of CVD developing.
Collapse
Affiliation(s)
- Suurya Krishnan
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Wan C Tan
- Center for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Raquel Farias
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Darcy D Marciniuk
- Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Queens University, Kingston, ON, Canada
| | - Don D Sin
- Center for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada.
| |
Collapse
|
22
|
Rochester CL, Alison JA, Carlin B, Jenkins AR, Cox NS, Bauldoff G, Bhatt SP, Bourbeau J, Burtin C, Camp PG, Cascino TM, Dorney Koppel GA, Garvey C, Goldstein R, Harris D, Houchen-Wolloff L, Limberg T, Lindenauer PK, Moy ML, Ryerson CJ, Singh SJ, Steiner M, Tappan RS, Yohannes AM, Holland AE. Pulmonary Rehabilitation for Adults with Chronic Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2023; 208:e7-e26. [PMID: 37581410 PMCID: PMC10449064 DOI: 10.1164/rccm.202306-1066st] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Abstract
Background: Despite the known benefits of pulmonary rehabilitation (PR) for patients with chronic respiratory disease, this treatment is underused. Evidence-based guidelines should lead to greater knowledge of the proven benefits of PR, highlight the role of PR in evidence-based health care, and in turn foster referrals to and more effective delivery of PR for people with chronic respiratory disease. Methods: The multidisciplinary panel formulated six research questions addressing PR for specific patient groups (chronic obstructive pulmonary disease [COPD], interstitial lung disease, and pulmonary hypertension) and models for PR delivery (telerehabilitation, maintenance PR). Treatment effects were quantified using systematic reviews. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to formulate clinical recommendations. Recommendations: The panel made the following judgments: strong recommendations for PR for adults with stable COPD (moderate-quality evidence) and after hospitalization for COPD exacerbation (moderate-quality evidence), strong recommendation for PR for adults with interstitial lung disease (moderate-quality evidence), conditional recommendation for PR for adults with pulmonary hypertension (low-quality evidence), strong recommendation for offering the choice of center-based PR or telerehabilitation for patients with chronic respiratory disease (moderate-quality evidence), and conditional recommendation for offering either supervised maintenance PR or usual care after initial PR for adults with COPD (low-quality evidence). Conclusions: These guidelines provide the basis for evidence-based delivery of PR for people with chronic respiratory disease.
Collapse
|
23
|
Sin DD, Doiron D, Agusti A, Anzueto A, Barnes PJ, Celli BR, Criner GJ, Halpin D, Han MK, Martinez FJ, Montes de Oca M, Papi A, Pavord I, Roche N, Singh D, Stockley R, Lopez Varlera MV, Wedzicha J, Vogelmeier C, Bourbeau J. Air pollution and COPD: GOLD 2023 committee report. Eur Respir J 2023; 61:2202469. [PMID: 36958741 DOI: 10.1183/13993003.02469-2022] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/04/2023] [Indexed: 03/25/2023]
Abstract
Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world.
Collapse
Affiliation(s)
- Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital and University of British Columbia Division of Respiratory Medicine, Vancouver, BC, Canada
| | - Dany Doiron
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and CIBERES, Barcelona, Spain
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, San Antonio, TX, USA
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico de Caracas, Caracas, Venezuela
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicolas Roche
- Service de Pneumologie, Hôpital Cochin, AP-HP, Université Paris Cité, UMR 1016, Institut Cochin, Paris, France
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | - Jadwiga Wedzicha
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Claus Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Hospital Giessen and Marburg, German Center for Lung Research (DZL), University of Marburg, Marburg, Germany
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| |
Collapse
|
24
|
Abozid H, Kirby M, Nasir N, Hartl S, Breyer-Kohansal R, Breyer MK, Burghuber OC, Bourbeau J, Wouters EFM, Tan W. CT airway remodelling and chronic cough. BMJ Open Respir Res 2023; 10:10/1/e001462. [PMID: 37173074 DOI: 10.1136/bmjresp-2022-001462] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
RATIONALE Structural airway changes related to chronic cough (CC) are described in the literature, but so far reported data are rare and non-conclusive. Furthermore, they derive mainly from cohorts with small sample sizes. Advanced CT imaging not only allows airway abnormalities to be quantified, but also to count the number of visible airways. The current study evaluates these airway abnormalities in CC and assesses the contribution of CC in addition to CT findings on the progression of airflow limitation, defined as a decline in forced expiratory volume in 1 s (FEV1) over time. METHODS A total of 1183 males and females aged ≥40 years with thoracic CT scans and valid spirometry from Canadian Obstructive Lung Disease, a Canadian multicentre, population-based study has been included in this analysis. Participants were stratified into 286 never-smokers, 297 ever-smokers with normal lung function and 600 with chronic obstructive pulmonary disease (COPD) of different severity grades. Imaging parameters analyses included total airway count (TAC), airway wall thickness, emphysema as well as parameters for functional small airway disease quantification. RESULTS Irrespective of COPD presence, CC was not related to specific airway and lung structure features. Independent of TAC and emphysema score, CC was highly associated with FEV1 decline over time in the entire study population, particularly in ever-smokers (p<0.0001). CONCLUSION The absence of specific structural CT features independently from COPD presence indicate that other underlying mechanisms are contributing to the symptomatology of CC. On top of derived CT parameters, CC seems to be independently associated with FEV1 decline. TRIAL REGISTRATION NUMBER NCT00920348.
Collapse
Affiliation(s)
- Hazim Abozid
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Neha Nasir
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty for Medicine, Sigmund Freud University, Vienna, Austria
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University, Montreal, Québec, Canada
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wan Tan
- Centre for Heart Lung Innovation, University of British Columbia, St Pauls's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
25
|
Katsuno N, Li PZ, Bourbeau J, Aaron S, Maltais F, Hernandez P, Chapman KR, Walker B, Marciniuk DD, ODonnell DD, Sin DD, Hogg JC, Cheng M, Road J, Tan WC. Factors Associated with Attrition in a Longitudinal Cohort of Older Adults in the Community. Chronic Obstr Pulm Dis 2023; 10:178-189. [PMID: 37099700 PMCID: PMC10392873 DOI: 10.15326/jcopdf.2022.0380] [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] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Introduction Retaining participants in longitudinal studies increases their power. We undertook this study in a population-based longitudinal cohort of adults with COPD to determine the factors associated with increased cohort attrition. Methods In the longitudinal population-based Canadian Cohort of Obstructive Lung Disease (CanCOLD) study, 1561 adults > 40 years old were randomly recruited from 9 urban sites. Participants completed in-person visits at 18-month intervals and also were followed up every 3 months over the phone or by email. The cohort retention for the study and the reasons for attrition were analyzed. Hazard ratios and robust standard errors were calculated using Cox regression methods to explore the associations between participants who remained in the study and those who did not. Results The median follow-up (years) of the study is 9.0 years. The overall mean retention was 77%. Reasons for attrition (23%) were: dropout by participant (39%), loss of contact (27%), investigator-initiated withdrawal (15%), deaths (9%), serious disease (9%), and relocation (2%). Factors independently associated with attrition were lower educational attainment, higher pack-year tobacco consumption, diagnosed cardiovascular disease, and a higher Hospital Anxiety and Depression Scale score: adjusted hazard ratios (95% confidence interval) were 1.43(1.11, 1.85); 1.01(1.00, 1.01); 1.44(1.13, 1.83); 1.06(1.02, 1.10) respectively. Conclusions Identification and awareness of risk factors for attrition could direct targeted retention strategies in longitudinal studies. Moreover, the identification of patient characteristics associated with study dropout could address any potential bias introduced by differential dropouts.
Collapse
Affiliation(s)
- Noah Katsuno
- University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pei Z Li
- Research Institute, McGill University Health Centre, McGill University, Montreal, Quebec Canada
| | - Jean Bourbeau
- Research Institute, McGill University Health Centre, McGill University, Montreal, Quebec Canada
| | - Shawn Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Francois Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brandie Walker
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Don D Sin
- University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - James C Hogg
- University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Michael Cheng
- University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jeremy Road
- Department of Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Wan C Tan
- University of British Columbia, Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
26
|
Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Am J Respir Crit Care Med 2023; 207:819-837. [PMID: 36856433 PMCID: PMC10111975 DOI: 10.1164/rccm.202301-0106pp] [Citation(s) in RCA: 104] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/28/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R. Celli
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J. Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas Health, San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J. Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital, New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D. Sin
- St. Paul’s Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
| |
Collapse
|
27
|
Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, de Oca MM, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Eur Respir J 2023; 61:13993003.00239-2023. [PMID: 36858443 PMCID: PMC10066569 DOI: 10.1183/13993003.00239-2023] [Citation(s) in RCA: 165] [Impact Index Per Article: 165.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Affiliation(s)
- Alvar Agustí
- Univ. Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain .,co-first authors
| | - Bartolome R Celli
- Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts, USA.,co-first authors
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health University of Exeter, Exeter Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre McGill University Montreal, Canada
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK.,National Heart and Lung Institute, Imperial College, London, UK.,School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
| |
Collapse
|
28
|
Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, Montes de Oca M, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, López Varela MV, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Arch Bronconeumol 2023; 59:232-248. [PMID: 36933949 DOI: 10.1016/j.arbres.2023.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain.
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System, University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, Canada
| | | | - Fernando J Martinez
- Weill Cornell Medical Center/New York-Presbyterian Hospital, New York, NY, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas, Universidad Central de Venezuela, Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK; School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | - Jadwiga A Wedzicha
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
| |
Collapse
|
29
|
Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, Bourbeau J, Han MK, Martinez FJ, de Oca MM, Mortimer K, Papi A, Pavord I, Roche N, Salvi S, Sin DD, Singh D, Stockley R, Varela MVL, Wedzicha JA, Vogelmeier CF. Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary. Respirology 2023; 28:316-338. [PMID: 36856440 DOI: 10.1111/resp.14486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Alvar Agustí
- University of Barcelona, Hospital Clinic, IDIBAPS and CIBERES, Spain
| | - Bartolome R Celli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David Halpin
- University of Exeter Medical School College of Medicine and Health University of Exeter, Exeter, Devon, UK
| | - Antonio Anzueto
- South Texas Veterans Health Care System University of Texas, Health San Antonio, Texas, USA
| | - Peter Barnes
- National Heart & Lung Institute Imperial College London, UK
| | - Jean Bourbeau
- McGill University Health Centre McGill University Montreal, Canada
| | - MeiLan K Han
- University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando J Martinez
- Weill Cornell Medical Center/ New York-Presbyterian Hospital New York, New York, USA
| | - Maria Montes de Oca
- Hospital Universitario de Caracas Universidad Central de Venezuela Centro Médico de Caracas, Caracas, Venezuela
| | - Kevin Mortimer
- Liverpool University Hospitals NHS Foundation Trust, UK / National Heart and Lung Institute, Imperial College, London, UK / School of Clinical Medicine, College of Health Sciences, University of Kwazulu-Natal, South Africa
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine University of Oxford, UK
| | - Nicolas Roche
- Pneumologie, Hôpital Cochin AP-HP.Centre, Université Paris, France
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Don D Sin
- St. Paul's Hospital University of British Columbia, Vancouver, Canada
| | - Dave Singh
- University of Manchester, Manchester, UK
| | | | | | | | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University, German Center for Lung Research (DZL), Marburg, Germany
| |
Collapse
|
30
|
Lee JH, Kanwar B, Khattak A, Altschuler E, Sergi C, Lee SJ, Choi SH, Park J, Coleman M, Bourbeau J. Bronchitis, COPD, and pneumonia after viral endemic of patients with leprosy on Sorok Island in South Korea. Naunyn Schmiedebergs Arch Pharmacol 2023:10.1007/s00210-023-02407-7. [PMID: 36773052 PMCID: PMC9918834 DOI: 10.1007/s00210-023-02407-7] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
Viral respiratory diseases (VRDs) cause lung inflammation and inflammatory cytokine production. We study whether dapsone is responsible for its observed preventive treatment effects of the sustained viral RNA interferon response. Around 2008 and 2012, Korea's Dementia Management Act stipulated drastic changes in the administration of dementia medication by medical staff. Participants were randomized and we compared leprosy patients with VRDs after prescribing dapsone as a standard treatment from 2005 to 2019. Significance was evaluated based on the dapsone-prescribed (+) subgroup and the dapsone-unprescribed (-) subgroup of the VRD diagnosed (+) and VRD undiagnosed (-) subgroup. We analyzed VRD ( +)/(- with dapsone (+)/(-) group and used a T-test, and designed the equation of acetylation with dapsone and acetylcholine (AA) equation. The 6394 VRD participants who received the dapsone intervention compared to the 3255 VRD participants in the control group demonstrated at T2 VRD (+) dapsone (-) (mean (M) = 224.80, SD = 97.50): T3 VRD (-) dapsone (+) (M = 110.87, SD = 103.80), proving that VRD is low when dapsone is taken and high when it is not taken. The t value is 3.10, and the p value is 0.004395 (significant at p < 0.05). After an increase in VRDs peaked in 2009, bronchitis, COPD, and pneumonia surged in 2013. The AA equation was strongly negatively correlated with the prevalence of bronchitis and chronic obstructive pulmonary disease (COPD): with bronchitis, r(15) = -0.823189, p = 0.005519, and with COPD, r(15) = -0.8161, p = 0.000207 (significant at p < 0.05). Dapsone treated both bronchitis and COPD. This study provides theoretical clinical data to limit acetylcholine excess during the VRD pandemic for bronchitis, COPD, and pneumonia.
Collapse
Affiliation(s)
- Jong Hoon Lee
- Science and Research Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea.
- Department of Respiratory Medicine, Seoul Metropolitan Seobuk Hospital, 49 Galhyeon-ro 7-gil, Yeokchon-dong Eunpyeong-gu, Seoul, 03433, South Korea.
| | - Badar Kanwar
- Department of Intensive Care Unit and Neonatal Intensive Care, Hunt Regional Hospital Greenville, Greenville, TX, 75401, USA
| | - Asif Khattak
- Department of Intensive Care Unit and Neonatal Intensive Care, Hunt Regional Hospital Greenville, Greenville, TX, 75401, USA
| | - Eric Altschuler
- Physical Medicine/Rehab, Metropolitan Hospital, New York, NY, 10029, USA
| | - Consolato Sergi
- Division of Anatomical Pathology, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - So Jeong Lee
- Department of BioSciences, Wiess School of Natural Sciences, Rice University, Houston, TX, USA
| | - Su-Hee Choi
- Department of Obstetrics and Gynaecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jungwuk Park
- Research Center of Integrative Functional Medicine, Department of Neurosurgery, Chungdam Hospital, Seoul, Republic of Korea
| | - Michael Coleman
- College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, QC, Canada
| |
Collapse
|
31
|
Agusti A, Ambrosino N, Blackstock F, Bourbeau J, Casaburi R, Celli B, Crouch R, Negro RD, Dreher M, Garvey C, Gerardi D, Goldstein R, Hanania N, Holland AE, Kaur A, Lareau S, Lindenauer PK, Mannino D, Make B, Maltais F, Marciniuk JD, Meek P, Morgan M, Pepin JL, Reardon JZ, Rochester C, Singh S, Spruit MA, Steiner MC, Troosters T, Vitacca M, Clini E, Jardim J, Nici L, Raskin J, ZuWallack R. COPD: Providing the right treatment for the right patient at the right time. Respir Med 2023; 207:107041. [PMID: 36610384 DOI: 10.1016/j.rmed.2022.107041] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with significant morbidity and mortality that is both preventable and treatable. However, a major challenge in recognizing, preventing, and treating COPD is understanding its complexity. While COPD has historically been characterized as a disease defined by airflow limitation, we now understand it as a multi-component disease with many clinical phenotypes, systemic manifestations, and associated co-morbidities. Evidence is rapidly emerging in our understanding of the many factors that contribute to the pathogenesis of COPD and the identification of "early" or "pre-COPD" which should provide exciting opportunities for early treatment and disease modification. In addition to breakthroughs in our understanding of the origins of COPD, we are optimizing treatment strategies and delivery of care that are showing impressive benefits in patient-centered outcomes and healthcare utilization. This special issue of Respiratory Medicine, "COPD: Providing the Right Treatment for the Right Patient at the Right Time" is a summary of the proceedings of a conference held in Stresa, Italy in April 2022 that brought together international experts to discuss emerging evidence in COPD and Pulmonary Rehabilitation in honor of a distinguished friend and colleague, Claudio Ferdinando Donor (1948-2021). Claudio was a true pioneer in the field of pulmonary rehabilitation and the comprehensive care of individuals with COPD. He held numerous leadership roles in in the field, provide editorial stewardship of several respiratory journals, authored numerous papers, statement and guidelines in COPD and Pulmonary Rehabilitation, and provided mentorship to many in our field. Claudio's most impressive talent was his ability to organize spectacular conferences and symposia that highlighted cutting edge science and clinical medicine. It is in this spirit that this conference was conceived and planned. These proceedings are divided into 4 sections which highlight crucial areas in the field of COPD: (1) New concepts in COPD pathogenesis; (2) Enhancing outcomes in COPD; (3) Non-pharmacologic management of COPD; and (4) Optimizing delivery of care for COPD. These presentations summarize the newest evidence in the field and capture lively discussion on the exciting future of treating this prevalent and impactful disease. We thank each of the authors for their participation and applaud their efforts toward pushing the envelope in our understanding of COPD and optimizing care for these patients. We believe that this edition is a most fitting tribute to a dear colleague and friend and will prove useful to students, clinicians, and researchers as they continually strive to provide the right treatment for the right patient at the right time. It has been our pleasure and a distinct honor to serve as editors and oversee such wonderful scholarly work.
Collapse
Affiliation(s)
- Alvar Agusti
- Clinic Barcelona Hospital University, Barcelona, Spain.
| | | | | | - Jean Bourbeau
- Department of Medicine, Division of Experimental Medicine, McGill University Health Centre, Montreal, QC, CA, USA.
| | | | | | | | - Roberto Dal Negro
- National Centre for Pharmacoeconomics and Pharmacoepidemiology (CESFAR), Verona, Italy.
| | - Michael Dreher
- Clinic of Cardiology, Angiology, Pneumology and Intensive Medicine, University Hospital Aachen, Aachen, 52074, DE, USA.
| | | | | | - Roger Goldstein
- Respiratory Rehabilitation Service, West Park Health Care Centre, Toronto, Ontario, CA, USA.
| | | | - Anne E Holland
- Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Antarpreet Kaur
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA; University of Colorado School of Nursing, Aurora, CO, USA.
| | - Suzanne Lareau
- University of Colorado School of Nursing, Aurora, CO, USA.
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, MA, USA.
| | | | - Barry Make
- National Jewish Health, Denver, CO, USA.
| | - François Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, CA, USA.
| | - Jeffrey D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, CA, USA.
| | - Paula Meek
- University of Utah College of Nursing, Salt Lake City, UT, USA.
| | - Mike Morgan
- Dept of Respiratory Medicine, University Hospitals of Leicester, UK.
| | - Jean-Louis Pepin
- CHU de Grenoble - Clin Univ. de physiologie, sommeil et exercice, Grenoble, France.
| | - Jane Z Reardon
- Section of Pulmonary, Critical Care, and Sleep Medicine, Trinity Health of New England, Hartford, CT, USA.
| | | | - Sally Singh
- Department of Respiratory Diseases, University of Leicester, UK.
| | | | - Michael C Steiner
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre, Professor, University of Leicester, UK.
| | - Thierry Troosters
- Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven: Leuven, Vlaanderen, Belgium.
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, ICS S. Maugeri Care and Research Institutes, IRCCS Pavia, Italy.
| | - Enico Clini
- University of Modena and Reggio Emilia, Italy.
| | - Jose Jardim
- Federal University of Sao Paulo Paulista, Brazil.
| | - Linda Nici
- nBrown University School of Medicine, USA.
| | | | - Richard ZuWallack
- Section of Pulmonary, Critical Care, and Sleep Medicine, Saint Francis Hospital and Medical Center, 114 Woodland Street, Hartford, CT, 06105, USA.
| |
Collapse
|
32
|
Oostrik L, Bourbeau J, Doiron D, Ross B, Zhi-Li P, Aaron SD, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O'Donnell D, Tan WC, Sin DD, Walker B, Janaudis-Ferreira T. Physical Activity and Symptom Burden in COPD: The Canadian Obstructive Lung Disease Study. Chronic Obstr Pulm Dis 2023; 10:89-101. [PMID: 36563057 PMCID: PMC9995232 DOI: 10.15326/jcopdf.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The relationship between symptom burden and physical activity (PA) in chronic obstructive pulmonary disease (COPD) remains poorly understood with limited data on undiagnosed individuals and those with mild to moderate disease. Objective The primary objective was to evaluate the relationship between symptom burden and moderate-to-vigorous intensity PA (MVPA) in individuals from a random population-based sampling mirroring the population at large. Methods Baseline participants of the Canadian Cohort Obstructive Lung Disease (n=1558) were selected for this cross-sectional sub-study. Participants with mild COPD (n=406) and moderate COPD (n=331), healthy individuals (n=347), and those at risk of developing COPD (n=474) were included. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire was used to estimate MVPA in terms of energy expenditure. High symptom burden was classified using the COPD Assessment Test ([CAT] ≥10). Results Significant associations were demonstrated between high symptom burden and lower MVPA levels in the overall COPD sample (β=-717.09; 95% confidence interval [CI]=-1079.78, -354.40; p<0.001) and in the moderate COPD subgroup (β=-694.1; 95% CI=-1206.54, -181.66; p=0.006). A total of 72% of the participants with COPD were previously undiagnosed. The undiagnosed participants had significantly higher MVPA than those with physician diagnosed COPD (β=-592.41 95% CI=-953.11, -231.71; p=0.001). Conclusion MVPA was found to be inversely related to symptom burden in a large general population sample that included newly diagnosed individuals, most with mild to moderate COPD. Assessment of symptom burden may help identify patients with lower MVPA, especially for moderate COPD and for relatively inactive individuals with mild COPD.
Collapse
Affiliation(s)
- Loes Oostrik
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Netherlands
| | - Jean Bourbeau
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada.,Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dany Doiron
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada
| | - Bryan Ross
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pei Zhi-Li
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa University, Ottawa, Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Francois Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Canada
| | - Denis O'Donnell
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Tania Janaudis-Ferreira
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
33
|
Bourbeau J, Bhatt SP. Constructing Modern Pulmonary Rehabilitation: Another Brick From the Wall. Am J Respir Crit Care Med 2023; 207:804-805. [PMID: 36656552 PMCID: PMC10111974 DOI: 10.1164/rccm.202301-0007ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Jean Bourbeau
- Montreal Chest Institute, CORE, Montreal, Quebec, Canada.,McGill University Health Centre, 54473, Montreal, Quebec, Canada
| | - Surya P Bhatt
- University of Alabama at Birmingham, Pulmonary, Allergy and Critical Care Medicine, Birmingham, Alabama, United States;
| |
Collapse
|
34
|
van der Braak K, Wald J, Tansey CM, Paes T, Sedeno M, Selzler AM, Stickland MK, Bourbeau J, Janaudis-Ferreira T. Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study. Chron Respir Dis 2023; 20:14799731231179105. [PMID: 37471305 PMCID: PMC10363903 DOI: 10.1177/14799731231179105] [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: 07/22/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. METHODS Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS Reach: 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program. CONCLUSIONS The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.
Collapse
Affiliation(s)
- Kim van der Braak
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Joshua Wald
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - Catherine M Tansey
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Thais Paes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Maria Sedeno
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- RESPIPLUS, Mont-Royal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anne-Marie Selzler
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
35
|
Lee JH, Kanwar B, Khattak A, Balentine J, Nguyen NH, Kast RE, Lee CJ, Bourbeau J, Altschuler EL, Sergi CM, Nguyen TNM, Oh S, Sohn MG, Coleman M. COVID-19 Molecular Pathophysiology: Acetylation of Repurposing Drugs. Int J Mol Sci 2022; 23:13260. [PMID: 36362045 PMCID: PMC9656873 DOI: 10.3390/ijms232113260] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 01/14/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces immune-mediated type 1 interferon (IFN-1) production, the pathophysiology of which involves sterile alpha motif and histidine-aspartate domain-containing protein 1 (SAMHD1) tetramerization and the cytosolic DNA sensor cyclic-GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling pathway. As a result, type I interferonopathies are exacerbated. Aspirin inhibits cGAS-mediated signaling through cGAS acetylation. Acetylation contributes to cGAS activity control and activates IFN-1 production and nuclear factor-κB (NF-κB) signaling via STING. Aspirin and dapsone inhibit the activation of both IFN-1 and NF-κB by targeting cGAS. We define these as anticatalytic mechanisms. It is necessary to alleviate the pathologic course and take the lag time of the odds of achieving viral clearance by day 7 to coordinate innate or adaptive immune cell reactions.
Collapse
Affiliation(s)
- Jong Hoon Lee
- Science and Research Center, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Badar Kanwar
- Department of Intensive Care Unit and Neonatal Intensive Care, Hunt Regional Hospital, Greenville, 75401 TX, USA
| | - Asif Khattak
- Department of Intensive Care Unit and Neonatal Intensive Care, Hunt Regional Hospital, Greenville, 75401 TX, USA
| | - Jenny Balentine
- Department of Intensive Care Unit and Neonatal Intensive Care, Hunt Regional Hospital, Greenville, 75401 TX, USA
| | - Ngoc Huy Nguyen
- Department of Health, Phutho Province, Tran Phu Str., Viet Tri City 227, Vietnam
| | | | - Chul Joong Lee
- Department of Anesthesiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, QC H4A 3S5, Canada
| | - Eric L. Altschuler
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY 10029, USA
| | - Consolato M. Sergi
- Division of Anatomical Pathology, Children’s Hospital of Eastern Ontario (CHEO), University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | | | - Sangsuk Oh
- Department of Food Engineering, Food Safety Laboratory, Memory Unit, Ewha Womans University, Seoul 03600, Korea
| | - Mun-Gi Sohn
- Department of Food Science, KyungHee University College of Life Science, Seoul 17104, Korea
| | - Michael Coleman
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| |
Collapse
|
36
|
Makimoto K, Au R, Moslemi A, Hogg JC, Bourbeau J, Tan WC, Kirby M. Comparison of Feature Selection Methods and Machine Learning Classifiers for Predicting Chronic Obstructive Pulmonary Disease Using Texture-Based CT Lung Radiomic Features. Acad Radiol 2022; 30:900-910. [PMID: 35965158 DOI: 10.1016/j.acra.2022.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023]
Abstract
RATIONALE Texture-based radiomics analysis of lung computed tomography (CT) images has been shown to predict chronic obstructive pulmonary disease (COPD) status using machine learning models. However, various approaches are used and it is unclear which provides the best performance. OBJECTIVES To compare the most commonly used feature selection and classification methods and determine the optimal models for classifying COPD status in a mild, population-based COPD cohort. MATERIALS AND METHODS CT images from the multi-center Canadian Cohort Obstructive Lung Disease (CanCOLD) study were pre-processed by resampling the image to a 1mm isotropic voxel volume, segmenting the lung and removing the airways (VIDA Diagnostics Inc.), and applying a threshold of -1000HU-to-0HU. A total of 95 texture features were then extracted from each CT image. Combinations of 17 feature selection methods and 9 classifiers were tested and evaluated. In addition, the role of data cleaning (outlier removal and highly correlated feature removal) was evaluated. The area under the curve (AUC) from the receiver operating characteristic curve was used to evaluate model performance. RESULTS A total of 1204 participants were evaluated (n = 602 no COPD, n = 602 COPD). There were no significant differences between the groups for female sex (no COPD = 46.3%; COPD = 38.5%; p = 0.77), or body mass index (no COPD = 27.7 kg/m2; COPD = 27.4 kg/m2; p = 0.21). The highest AUC value for predicting COPD status (AUC = 0.78 [0.73, 0.84]) was obtained following data cleaning and feature selection using Elastic Net with the Linear-SVM classifier. CONCLUSION In a population-based cohort, the optimal combination for radiomics-based prediction of COPD status was Elastic Net as the feature selection method and Linear-SVM as the classifier.
Collapse
Affiliation(s)
- Kalysta Makimoto
- Toronto Metropolitan University, Kerr Hall South Bldg. Room - KHS-344, 350 Victoria St., Toronto, M5B 2K3, Ontario, Canada
| | - Ryan Au
- Western University, London, Ontario, Canada
| | - Amir Moslemi
- Toronto Metropolitan University, Kerr Hall South Bldg. Room - KHS-344, 350 Victoria St., Toronto, M5B 2K3, Ontario, Canada
| | - James C Hogg
- Center for Heart, Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, Québec, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, Québec, Canada
| | - Wan C Tan
- Center for Heart, Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miranda Kirby
- Toronto Metropolitan University, Kerr Hall South Bldg. Room - KHS-344, 350 Victoria St., Toronto, M5B 2K3, Ontario, Canada.
| |
Collapse
|
37
|
Bourbeau J, Marciniuk J. Non-Pharmacological Treatments of Asthma Chronic Obstructive Pulmonary Disease Overlap and Rehabilitation Programs. Immunol Allergy Clin North Am 2022; 42:e1-e12. [PMID: 37543394 DOI: 10.1016/j.iac.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Non-pharmacologic treatment is a vital, yet often under-utilized aspect of care for patients with ACO. As patients with ACO are often excluded from clinical trials, management decisions should be based on patient characteristic "phenotypes," such as dyspnea or exacerbation, and considering whether COPD or asthma is more pronounced in the individual patient. Self-management interventions in asthma and COPD have an overwhelming amount of supporting evidence and should be an integral part of ACO management. Additionally, pulmonary rehabilitation has widespread benefits in patients with COPD as well as asthma and should be offered in symptomatic patients with ACO. While the COVID-19 pandemic has highlighted some shortcomings, and introduced several challenges, to the delivery of PR world-wide, it has also presented the opportunity for the development and refinement of new models to deliver PR, such as telerehabilitation. While further research and development are necessary, telerehabilitation offers a promising alternative to reach patients, such as those with ACO, who would benefit from the programming. While future research is needed, we can make a more explicit and judicious use of current best evidence in making therapeutic decisions that includes non-pharmacological interventions in patients with ACO.
Collapse
Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montreal, Quebec, H4A 3S5, Canada.
| | - Jeff Marciniuk
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montreal, Quebec, H4A 3S5, Canada
| |
Collapse
|
38
|
Bourbeau J, Doiron D, Biswas S, Smith BM, Benedetti A, Brook JR, Aaron SD, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O’Donnell D, Sin DD, Walker B, Dsilva L, Nadeau G, Coats V, Compton C, Miller BE, Tan WC. Ambient Air Pollution and Dysanapsis: Associations with Lung Function and Chronic Obstructive Pulmonary Disease in the Canadian Cohort Obstructive Lung Disease Study. Am J Respir Crit Care Med 2022; 206:44-55. [PMID: 35380941 PMCID: PMC9954329 DOI: 10.1164/rccm.202106-1439oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Indexed: 11/16/2022] Open
Abstract
Rationale: Outdoor air pollution is a potential risk factor for lower lung function and chronic obstructive pulmonary disease (COPD). Little is known about how airway abnormalities and lung growth might modify this relationship. Objectives: To evaluate the associations of ambient air pollution exposure with lung function and COPD and examine possible interactions with dysanapsis. Methods: We made use of cross-sectional postbronchodilator spirometry data from 1,452 individuals enrolled in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study with linked ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) air pollution estimates. Dysanapsis, or the ratio of the airway-to-lung volume calculated from thoracic computed tomography images, was used to examine possible interactions. Measurements and Main Results: In adjusted models, 101.7 ml (95% confidence interval [CI], -166.2 to -37.2) and 115.0 ml (95% CI, -196.5 to -33.4) lower FEV1 were demonstrated per increase of 2.4 ug/m3 PM2.5 and 9.2 ppb NO2, respectively. Interaction between air pollution and dysanapsis was not statistically significant when modeling the airway-to-lung ratio as a continuous variable. However, a 109.8 ml (95% CI, -209.0 to -10.5] lower FEV1 and an 87% (95% CI, 12% to 213%) higher odds of COPD were observed among individuals in the lowest, relative to highest, airway-to-lung ratio, per 2.4 μg/m3 increment of PM2.5. Conclusions: Ambient air pollution exposure was associated with lower lung function, even at relatively low concentrations. Individuals with dysanaptic lung growth might be particularly susceptible to inhaled ambient air pollutants, especially those at the extremes of dysanapsis.
Collapse
Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada;,Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Sharmistha Biswas
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Benjamin M. Smith
- Department of Medicine, McGill University, Montreal, Québec, Canada;,Department of Medicine, Columbia University Medical Center, New York, New York
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada;,Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Jeffrey R. Brook
- Southern Ontario Centre for Atmospheric Aerosol Research, Department of Chemical Engineering and Applied Chemistry,,Dalla Lana School of Public Health, and
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, Ottawa University, Ottawa, Ontario, Canada
| | - Kenneth R. Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Darcy D. Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Denis O’Donnell
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | - Wan C. Tan
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
39
|
Moslemi A, Makimoto K, Tan WC, Bourbeau J, Hogg JC, Coxson HO, Kirby M. Quantitative CT Lung Imaging and Machine Learning Improves Prediction of Emergency Room Visits and Hospitalizations in COPD. Acad Radiol 2022; 30:707-716. [PMID: 35690537 DOI: 10.1016/j.acra.2022.05.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/03/2022] [Accepted: 05/15/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE Predicting increased risk of future healthcare utilization in chronic obstructive pulmonary disease (COPD) patients is an important goal for improving patient management. OBJECTIVE Our objective was to determine the importance of computed tomography (CT) lung imaging measurements relative to other demographic and clinical measurements for predicting future health services use with machine learning in COPD. MATERIALS AND METHODS In this retrospective study, lung function measurements and chest CT images were acquired from Canadian Cohort of Obstructive Lung Disease study participants from 2010 to 2017 (https://clinicaltrials.gov, NCT00920348). Up to two follow-up visits (1.5- and 3-year follow-up) were performed and participants were asked for details related to healthcare utilization. Healthcare utilization was defined as any COPD hospitalization or emergency room visit due to respiratory problems in the 12 months prior to the follow-up visits. CT analysis was performed (VIDA Diagnostics Inc.); a total of 108 CT quantitative emphysema, airway and vascular measurements were investigated. A hybrid feature selection method with support vector machine classifier was used to predict healthcare utilization. Performance was determined using accuracy, F1-measure and area under the receiver operating characteristic curve (AUC) and Matthews's correlation coefficient (MC). RESULTS Of the 527 COPD participants evaluated, 179 (35%) used healthcare services at follow-up. There were no significant differences between the participants with or without healthcare utilization at follow-up for age (p = 0.50), sex (p = 0.44), BMI (p = 0.05) or pack-years (p = 0.76). The accuracy for predicting subsequent healthcare utilization was 80% ± 3% (F1-measure = 74%, AUC = 0.80, MC = 0.6) when all measurements were considered, 76% ± 6% (F1-measure = 72%, AUC = 0.77, MC = 0.55) for CT measurements alone and 65% ± 5% (F1-measure = 60%, AUC = 0.67, MC = 0.34) for demographic and lung function measurements alone. CONCLUSION The combination of CT lung imaging and conventional measurements leads to greater prediction accuracy of subsequent health services use than conventional measurements alone, and may provide needed prognostic information for patients suffering from COPD.
Collapse
Affiliation(s)
- Amir Moslemi
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Kalysta Makimoto
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Harvey O Coxson
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada; Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
| | | |
Collapse
|
40
|
Kermelly SB, Bourbeau J. eHealth in Self-Managing at a Distance Patients with COPD. Life (Basel) 2022; 12:life12060773. [PMID: 35743804 PMCID: PMC9225278 DOI: 10.3390/life12060773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/17/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022] Open
Abstract
Worldwide, healthcare delivery for chronic diseases has been challenging due to the current SARS-COV-2 pandemic. The growing use of information and communication technologies via telehealth has gained popularity in all fields of medicine. In chronic respiratory diseases, self-management, defined as a structured but personalized multi-component intervention with the main goal of achieving healthy behavioral change, is an essential element of long-term care. Iterative interventions delivered by a well-trained health coach in order to empower and provide the patient with the tools and skills needed to adopt sustained healthy behaviors have proven to be effective in chronic obstructive pulmonary disease (COPD). Benefits have been shown to both improve patient quality of life and reduce acute exacerbation events and acute healthcare utilization. In COPD, the evidence so far has shown us that remote technologies such as telemonitoring or remote management may improve patient-reported outcomes and healthcare utilization. However, clear limitations are still present and questions remain unanswered. More and better designed studies are therefore necessary to define the place of eHealth in self-managing at a distance in patients with COPD.
Collapse
Affiliation(s)
- Sophie B. Kermelly
- Respiratory Division, Department of Medicine, Montreal Chest Institute of the McGill University Health Center, Montreal, QC H4A 3J1, Canada;
| | - Jean Bourbeau
- Respiratory Division, Department of Medicine, Montreal Chest Institute of the McGill University Health Center, Montreal, QC H4A 3J1, Canada;
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Center of Outcome and Research Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 De Maisonneuve, Room 3D.62, Montreal, QC H4A 3S5, Canada
- Correspondence: ; Tel.: +1-514-934-1934 (ext. 32185)
| |
Collapse
|
41
|
Madore AM, Bossé Y, Margaritte-Jeannin P, Vucic E, Lam WL, Bouzigon E, Bourbeau J, Laprise C. Analysis of GWAS-nominated loci for lung cancer and COPD revealed a new asthma locus. BMC Pulm Med 2022; 22:155. [PMID: 35461280 PMCID: PMC9034599 DOI: 10.1186/s12890-022-01890-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/06/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma, lung cancer (LC) and chronic obstructive pulmonary disease (COPD) are three respiratory diseases characterized by complex mechanisms underlying and genetic predispositions, with asthma having the highest calculated heritability. Despite efforts deployed in the last decades, only a small part of its heritability has been elucidated. It was hypothesized that shared genetic factors by these three diseases could help identify new asthma loci. METHODS GWAS-nominated LC and COPD loci were selected among studies performed in Caucasian cohorts using the GWAS Catalog. Genetic analyses were carried out for these loci in the Saguenay-Lac-Saint-Jean (SLSJ) asthma familial cohort and then replicated in two independent cohorts (the Canadian Cohort Obstructive Lung Disease [CanCOLD] and the Epidemiological Study of the Genetics and Environment of Asthma [EGEA]). RESULTS Analyses in the SLSJ cohort identified 2851 and 4702 genetic variants to be replicated in the CanCOLD and EGEA cohorts for LC and COPD loci respectively. Replication and meta-analyses allowed the association of one new locus with asthma, 2p24.3, from COPD studies. None was associated from LC studies reported. CONCLUSIONS The approach used in this study contributed to better understand the heritability of asthma with shared genetic backgrounds of respiratory diseases.
Collapse
Affiliation(s)
- Anne-Marie Madore
- Département des Sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada
| | - Yohan Bossé
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, QC, G1V 4G5, Canada.,Department of Molecular Medicine, Université Laval, Quebec, QC, G1V 0A6, Canada
| | | | - Emily Vucic
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, 10016, USA.,Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, V5Z 1L3, Canada.,Canadian Environmental Exposures in Cancer (CE2C) Network (CE2C.Ca), Halifax, Canada
| | - Wan L Lam
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, V5Z 1L3, Canada.,Canadian Environmental Exposures in Cancer (CE2C) Network (CE2C.Ca), Halifax, Canada
| | | | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, H3H 2R9, Canada
| | - Catherine Laprise
- Département des Sciences fondamentales, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada. .,Centre intersectoriel en santé durable, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada. .,Canada Research Chair on Environment and Genetics of Respiratory Diseases and Allergy, Université du Québec à Chicoutimi, Saguenay, QC, G7H 2B1, Canada.
| |
Collapse
|
42
|
Phillips DB, Elbehairy AF, James MD, Vincent SG, Milne KM, de-Torres JP, Neder JA, Kirby M, Jensen D, Stickland MK, Guenette JA, Smith BM, Aaron SD, Tan WC, Bourbeau J, O'Donnell DE. Impaired Ventilatory Efficiency, Dyspnea and Exercise Intolerance in Chronic Obstructive Pulmonary Disease: Results from the CanCOLD Study. Am J Respir Crit Care Med 2022; 205:1391-1402. [PMID: 35333135 DOI: 10.1164/rccm.202109-2171oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Impaired exercise ventilatory efficiency (high ventilatory requirements for CO2 [V̇E/V̇CO2]) provides an indication of pulmonary gas exchange abnormalities in chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine: 1) the association between high V̇E/V̇CO2 and clinical outcomes (dyspnea and exercise capacity) and its relationship to lung function and structural radiographic abnormalities; and 2) its prevalence in a large population-based cohort. METHODS Participants were recruited randomly from the population and underwent clinical evaluation, pulmonary function, cardiopulmonary exercise testing and chest computed tomography (CT). Impaired exercise ventilatory efficiency was defined by a nadir V̇E/V̇CO2 above the upper limit of normal (V̇E/V̇CO2>ULN), using population-based normative values. MEASUREMENTS AND MAIN RESULTS Participants included 445 never-smokers, 381 ever-smokers without airflow obstruction, 224 with GOLD 1 COPD, and 200 with GOLD 2-4 COPD. Participants with V̇E/V̇CO2>ULN were more likely to have activity-related dyspnea (Medical Research Council dyspnea scale≥2, odds ratio=1.77[1.31-2.39]) and abnormally low peak oxygen uptake (V̇O2peak<LLN, odds ratio=4.58[3.06-6.86]). The carbon monoxide transfer coefficient (KCO) had a stronger correlation with nadir V̇E/V̇CO2 (r=-0.38, p<0.001) than other relevant lung function and CT metrics. The prevalence of V̇E/V̇CO2>ULN was 24% in COPD (similar in GOLD 1 and 2-4), which was greater than in never-smokers (13%) and ever-smokers (12%). CONCLUSIONS V̇E/V̇CO2>ULN was associated with greater dyspnea and low VO2peak and was present in 24% of all participants with COPD, regardless of GOLD stage. The results show the importance of recognizing impaired exercise ventilatory efficiency as a potential contributor to dyspnea and exercise limitation, even in mild COPD.
Collapse
Affiliation(s)
| | - Amany F Elbehairy
- Queen's University and Kingston General Hospital, Medicine, Kingston, Ontario, Canada.,Alexandria University, Department of Chest Diseases, Faculty of Medicine, Alexandria, Egypt
| | - Matthew D James
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | | | - Kathryn M Milne
- The University of British Columbia, 8166, Medicine, Vancouver, British Columbia, Canada
| | | | - J Alberto Neder
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | - Miranda Kirby
- Ryerson University, Physics, Toronto, Ontario, Canada
| | - Dennis Jensen
- McGill University, Kinesiology & Physical Education, Montreal, Quebec, Canada
| | | | | | - Benjamin M Smith
- McGill University, Respiratory Medicine, Montreal, Quebec, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Wan C Tan
- Providence Heart & Lung Institute, University of British Columbia, St Paul's Hospital, UBC James Hogg Research Centre, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Montreal Chest Institute, CORE, Montreal, Quebec, Canada.,McGill University Health Centre, 54473, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Queen's University, Division of Respiratory and Critical Care Medicine, Department of Medicine, Kingston, Ontario, Canada;
| | | |
Collapse
|
43
|
Soril LJJ, Damant RW, Lam GY, Smith MP, Weatherald J, Bourbeau J, Hernandez P, Stickland MK. The effectiveness of pulmonary rehabilitation for Post-COVID symptoms: A rapid review of the literature. Respir Med 2022; 195:106782. [PMID: 35272262 PMCID: PMC8887973 DOI: 10.1016/j.rmed.2022.106782] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multi-disciplinary rehabilitation is recommended for individuals with post-acute sequelae of COVID-19 infection (i.e., symptoms 3-4 weeks after acute infection). There are emerging reports of use of pulmonary rehabilitation (PR) in the post-acute stages of COVID-19, however the appropriateness of PR for managing post-COVID symptoms remains unclear. To offer practical guidance with regards to post-COVID PR, a greater understanding of the clinical effectiveness literature is required. METHODS A rapid review of the published literature was completed. An electronic database search of the literature published between July 1, 2020 and June 1, 2021 was performed in MEDLINE, Pubmed, and EMBASE. Primary studies evaluating the clinical effectiveness of PR for individuals with post-COVID symptoms were included. RESULTS Nine studies evaluating the effectiveness of PR were identified; most were small, experimental or quasi-experimental studies, including 1 RCT, and were primarily of low quality. After attending PR, all studies reported improvements in exercise capacity, pulmonary function, and/or quality of life for individuals with post-COVID symptoms who had been hospitalized for their acute COVID-19 infection. Few studies evaluated changes in post-COVID symptom severity or frequency and, of these, improvements in dyspnea, fatigue, anxiety and depression were observed following PR. Further, no studies evaluated non-hospitalized patients or long-term outcomes beyond 3 months after initiating PR. CONCLUSIONS With limited high-quality evidence, any recommendations or practical guidance for PR programmes for those with post-COVID symptoms should consider factors such as feasibility, current PR capacity, and resource constraints.
Collapse
Affiliation(s)
- Lesley J J Soril
- Medicine Strategic Clinical Network - Respiratory Health Section, Alberta Health Services, Edmonton, AB, Canada; Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ronald W Damant
- Medicine Strategic Clinical Network - Respiratory Health Section, Alberta Health Services, Edmonton, AB, Canada; Division of Pulmonary Medicine, Department of Medicine, and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Grace Y Lam
- Division of Pulmonary Medicine, Department of Medicine, and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Maeve P Smith
- Division of Pulmonary Medicine, Department of Medicine, and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Jason Weatherald
- Department of Medicine, Division of Respirology and Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Michael K Stickland
- Medicine Strategic Clinical Network - Respiratory Health Section, Alberta Health Services, Edmonton, AB, Canada; Division of Pulmonary Medicine, Department of Medicine, and Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
44
|
Vachon B, Giasson G, Gaboury I, Gaid D, Noël De Tilly V, Houle L, Bourbeau J, Pomey MP. Challenges and Strategies for Improving COPD Primary Care Services in Quebec: Results of the Experience of the COMPAS+ Quality Improvement Collaborative. Int J Chron Obstruct Pulmon Dis 2022; 17:259-272. [PMID: 35140460 PMCID: PMC8819163 DOI: 10.2147/copd.s341905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/17/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Management of chronic obstructive pulmonary disease (COPD) remains a challenge in primary care and multiple barriers can limit implementation of COPD guidelines. Since 2016, a quality improvement (QI) collaborative, called COMPAS+, has been implemented across the province of Quebec (Canada) to support improvement of chronic disease management in primary care. The aim of this study was to describe the main COPD quality problems reported by participating teams and the strategies they proposed and implemented to improve COPD primary care services in Quebec. Methods Sixteen sites in four different regions of Quebec were engaged in the COMPAS+ intervention to improve primary care services delivered to people living with COPD. A total of 14 workshop reports, 31 QI action plans and 4 regional final reports underwent content analysis. Key COPD quality problems were first identified and, for each of them, root causes were classified according to the domains and constructs of the Consolidated Framework for Implementation Research. Proposed strategies were organized according to the intervention function types described in the Behavior Change Wheel. Results Four key COPD quality problems were identified: 1) lack of organization/coordination of COPD services, 2) lack of screening services coordination, 3) lack of interprofessional communication and collaboration and 4) lack of treatment adherence. Main root causes explaining these quality gaps were 1) lack of awareness of COPD, 2) lack of professional knowledge, 3) lack of definition of professional roles, 4) lack of resources and tools for COPD prevention, diagnosis, and follow-up, 5) lack of communication tools, 6) lack of integration of the patient-as-partner approach, and 7) lack of adaptation of patient education to their specific needs. Multiple strategies were proposed to improve healthcare professionals’ education and interprofessional collaboration and communication. Conclusion QI collaborative activities can support achieving understanding of QI challenges healthcare organizations face to improve COPD services.
Collapse
Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS de l’Est de Montréal, Montreal, Quebec, Canada
- Correspondence: Brigitte Vachon, School of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, Quebec, H3C 3J7, Canada, Tel +1 514 343-2094, Email
| | | | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Dina Gaid
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Lise Houle
- Institut national d’excellence en santé et en services sociaux (INESSS), Montreal, Quebec, Canada
| | - Jean Bourbeau
- Center of Innovative Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Pascale Pomey
- Public Health School, Department of Management, Evaluation and Health Policy, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de Centre hospitalier universitaire de l’Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|
45
|
Thome T, Miguez K, Willms AJ, Burke SK, Chandran V, de Souza AR, Fitzgerald LF, Baglole C, Anagnostou ME, Bourbeau J, Jagoe RT, Morais JA, Goddard Y, Taivassalo T, Ryan TE, Hepple RT. Chronic aryl hydrocarbon receptor activity phenocopies smoking-induced skeletal muscle impairment. J Cachexia Sarcopenia Muscle 2022; 13:589-604. [PMID: 34725955 PMCID: PMC8818603 DOI: 10.1002/jcsm.12826] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/30/2021] [Accepted: 09/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients exhibit skeletal muscle atrophy, denervation, and reduced mitochondrial oxidative capacity. Whilst chronic tobacco smoke exposure is implicated in COPD muscle impairment, the mechanisms involved are ambiguous. The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor that activates detoxifying pathways with numerous exogenous ligands, including tobacco smoke. Whereas transient AHR activation is adaptive, chronic activation can be toxic. On this basis, we tested the hypothesis that chronic smoke-induced AHR activation causes adverse muscle impact. METHODS We used clinical patient muscle samples, and in vitro (C2C12 myotubes) and in vivo models (mouse), to perform gene expression, mitochondrial function, muscle and neuromuscular junction morphology, and genetic manipulations (adeno-associated virus-mediated gene transfer). RESULTS Sixteen weeks of tobacco smoke exposure in mice caused muscle atrophy, neuromuscular junction degeneration, and reduced oxidative capacity. Similarly, smoke exposure reprogrammed the muscle transcriptome, with down-regulation of mitochondrial and neuromuscular junction genes. In mouse and human patient specimens, smoke exposure increased muscle AHR signalling. Mechanistically, experiments in cultured myotubes demonstrated that smoke condensate activated the AHR, caused mitochondrial impairments, and induced an AHR-dependent myotube atrophy. Finally, to isolate the role of AHR activity, expression of a constitutively active AHR mutant without smoke exposure caused atrophy and mitochondrial impairments in cultured myotubes, and muscle atrophy and neuromuscular junction degeneration in mice. CONCLUSIONS These results establish that chronic AHR activity, as occurs in smokers, phenocopies the atrophy, mitochondrial impairment, and neuromuscular junction degeneration caused by chronic tobacco smoke exposure.
Collapse
Affiliation(s)
- Trace Thome
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Kayla Miguez
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Alexander J Willms
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Sarah K Burke
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | - Angela R de Souza
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Liam F Fitzgerald
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Carolyn Baglole
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | | | - Jean Bourbeau
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - R Thomas Jagoe
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Jose A Morais
- Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Yana Goddard
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Tanja Taivassalo
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| | - Terence E Ryan
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Russell T Hepple
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.,Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA
| |
Collapse
|
46
|
Beauchamp MK, Janaudis-Ferreira T, Wald J, Aceron R, Bhutani M, Bourbeau J, Brooks D, Dechman G, Goldstein R, Goodridge D, Hernandez P, Marciniuk D, Penz E, J. Ryerson C, Saey D, Stickland MK, Weatherald J. Canadian Thoracic Society position statement on rehabilitation for COVID-19 and implications for pulmonary rehabilitation. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine 2022. [DOI: 10.1080/24745332.2021.1992939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Marla K. Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Joshua Wald
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Raymond Aceron
- Faculty of Nursing, University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jean Bourbeau
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Gail Dechman
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Roger Goldstein
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
| | - Donna Goodridge
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Hernandez
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Darcy Marciniuk
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Critical Care and Sleep Medicine, and the Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Erika Penz
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Critical Care and Sleep Medicine, and the Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Christopher J. Ryerson
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Heart Lung Innovation, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Didier Saey
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Michael K. Stickland
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- G.F. MacDonald Centre for Lung Health & Alberta Health Services Medicine Strategic Clinical Network, Edmonton, Canada
| | - Jason Weatherald
- West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Respirology, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
47
|
Joyal-Desmarais K, Stojanovic J, Kennedy EB, Enticott JC, Boucher VG, Vo H, Košir U, Lavoie KL, Bacon SL, Granana N, Losada AV, Boyle J, Shawon SR, Dawadi S, Teede H, Kautzky-Willer A, Dash A, Cornelio ME, Karsten M, Matte DL, Reichert F, Abou-Setta A, Aaron S, Alberga A, Barnett T, Barone S, Bélanger-Gravel A, Bernard S, Birch LM, Bondy S, Booij L, Da Silva RB, Bourbeau J, Burns R, Campbell T, Carlson L, Charbonneau É, Corace K, Drouin O, Ducharme F, Farhadloo M, Falk C, Fleet R, Fournier M, Garber G, Gauvin L, Gordon J, Grad R, Gupta S, Hellemans K, Herba C, Hwang H, Jedwab J, Kakinami L, Kim S, Liu J, Norris C, Pelaez S, Pilote L, Poirier P, Presseau J, Puterman E, Rash J, Ribeiro PAB, Sadatsafavi M, Chaudhuri PS, Suarthana E, Tse S, Vallis M, Caceres NB, Ortiz M, Repetto PB, Lemos-Hoyos M, Kassianos A, Rod NH, Beraneck M, Ninot G, Ditzen B, Kubiak T, Codjoe S, Kpobi L, Laar A, Skoura T, Francis DL, Devi NK, Meitei S, Nethan ST, Pinto L, Saraswathy KN, Tumu D, Lestari S, Wangge G, Byrne M, Durand H, McSharry J, Meade O, Molloy G, Noone C, Levine H, Zaidman-Zait A, Boccia S, Hoxhaj I, Paduano S, Raparelli V, Zaçe D, Aburub A, Akunga D, Ayah R, Barasa C, Godia PM, Kimani-Murage EW, Mutuku N, Mwoma T, Naanyu V, Nyamari J, Oburu H, Olenja J, Ongore D, Ziraba A, Bandawe C, Yim L, Ajuwon A, Shar NA, Usmani BA, Martínez RMB, Creed-Kanashiro H, Simão P, Rutayisire PC, Bari AZ, Vojvodic K, Nagyova I, Bantjes J, Barnes B, Coetzee B, Khagee A, Mothiba T, Roomaney R, Swartz L, Cho J, Lee MG, Berman A, Stattin NS, Fischer S, Hu D, Kara Y, Şimşek C, Üzmezoğlu B, Isunju JB, Mugisha J, Byrne-Davis L, Griffiths P, Hart J, Johnson W, Michie S, Paine N, Petherick E, Sherar L, Bilder RM, Burg M, Czajkowski S, Freedland K, Gorin SS, Holman A, Lee J, Lopez G, Naar S, Okun M, Powell L, Pressman S, Revenson T, Ruiz J, Sivaram S, Thrul J, Trudel-Fitzgerald C, Yohannes A, Navani R, Ranakombu K, Neto DH, Ben-Porat T, Dragomir A, Gagnon-Hébert A, Gemme C, Jamil M, Käfer LM, Vieira AM, Tasbih T, Woods R, Yousefi R, Roslyakova T, Priesterroth L, Edelstein S, Snir R, Uri Y, Alyami M, Sanuade C, Crescenzi O, Warkentin K, Grinko K, Angne L, Jain J, Mathur N, Mithe A, Nethan S. How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses. Eur J Epidemiol 2022; 37:1233-1250. [PMID: 36335560 PMCID: PMC9638233 DOI: 10.1007/s10654-022-00932-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/30/2021] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
COVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study ( www.icarestudy.com ). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended.
Collapse
Affiliation(s)
- Keven Joyal-Desmarais
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
| | - Jovana Stojanovic
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada ,Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - Eric B. Kennedy
- Disaster and Emergency Management, York University, Toronto, Canada
| | - Joanne C. Enticott
- Department of General Practice, Monash University, Melbourne, Australia ,Monash Partners, Advanced Health Research and Translation Centre, Melbourne, Australia
| | | | - Hung Vo
- Austin Health, Victoria, Australia
| | - Urška Košir
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
| | - Kim L. Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada ,Département de Psychologie, Université du Québec à Montréal, Montreal, Canada
| | - Simon L. Bacon
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, Montreal, QC H4B 1R6 Canada ,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Au RC, Tan WC, Bourbeau J, Hogg JC, Kirby M. Impact of image pre-processing methods on computed tomography radiomics features in chronic obstructive pulmonary disease. Phys Med Biol 2021; 66. [PMID: 34847536 DOI: 10.1088/1361-6560/ac3eac] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/30/2021] [Indexed: 01/06/2023]
Abstract
Computed tomography (CT) imaging texture-based radiomics analysis can be used to assess chronic obstructive pulmonary disease (COPD). However, different image pre-processing methods are commonly used, and how these different methods impact radiomics features and lung disease assessment, is unknown. The purpose of this study was to develop an image pre-processing pipeline to investigate how various pre-processing combinations impact radiomics features and their use for COPD assessment. Spirometry and CT images were obtained from the multi-centered Canadian Cohort of Obstructive Lung Disease study. Participants were divided based on assessment site and were further dichotomized as No COPD or COPD within their participant groups. An image pre-processing pipeline was developed, calculating 32 grey level co-occurrence matrix radiomics features. The pipeline included lung segmentation, airway segmentation or no segmentation, image resampling or no resampling, and either no pre-processing, binning, edgmentation, or thresholding pre-processing techniques. A three-way analysis of variance was used for method comparison. A nested 10-fold cross validation using logistic regression and multiple linear regression models were constructed to classify COPD and assess correlation with lung function, respectively. Logistic regression performance was evaluated using the area under the receiver operating characteristic curve (AUC). A total of 1210 participants (Sites 1-8: No COPD:n = 447, COPD:n = 413; and Site 9: No COPD:n = 155, COPD:n = 195) were evaluated. Between the two participant groups, at least 16/32 features were different between airway segmentation/no segmentation (P ≤ 0.04), at least 29/32 features were different between no resampling/resampling (P ≤ 0.04), and 32/32 features were different between the pre-processing techniques (P < 0.0001). Features generated using the resampling/edgmentation and resampling/thresholding pre-processing combinations, regardless of airway segmentation, performed the best in COPD classification (AUC ≥ 0.718), and explained the most variance with lung function (R2 ≥ 0.353). Therefore, the image pre-processing methods completed prior to CT radiomics feature extraction significantly impacted extracted features and their ability to assess COPD.
Collapse
Affiliation(s)
- Ryan C Au
- Department of Physics, Ryerson University, Toronto, ON, M5B 2K3, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, H3A 0G4, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, ON, M5B 2K3, Canada.,Institute for Biomedical Engineering, Science and Technology, St. Michael's Hospital, Toronto, ON, M5B 1T8, Canada
| |
Collapse
|
49
|
Kirby M, Smith BM, Tanabe N, Hogg JC, Coxson HO, Sin DD, Bourbeau J, Tan WC. Computed tomography total airway count predicts progression to COPD in at-risk smokers. ERJ Open Res 2021; 7:00307-2021. [PMID: 34708120 PMCID: PMC8542990 DOI: 10.1183/23120541.00307-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/03/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
There is limited understanding of how to identify people at high risk of developing COPD. Our objective was to investigate the association between computed tomography (CT) total airway count (TAC) and incident COPD over 3 years among ever-smokers from the population-based Canadian Cohort Obstructive Lung Disease (CanCOLD) study. CT and spirometry were acquired in ever-smokers at baseline; spirometry was repeated at 3-year follow-up. CT TAC was generated by summing all airway segments in the segmented airway tree (VIDA Diagnostics, Inc.). CT airway wall area, wall thickness for a theoretical airway with 10 mm perimeter (Pi10), and low attenuation areas below −856 HU (LAA856) were also measured. Logistic and mixed effects regression models were constructed to determine the association for CT measurements with development of COPD and forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) decline, respectively. Among 316 at-risk participants evaluated at baseline (65±9 years, 40% female, 18±19 pack-years), incident COPD was detected in 56 participants (18%) over a median 3.1±0.6 years of follow-up. Among CT measurements, only TAC was associated with incident COPD (p=0.03), where a 1-sd decrement in TAC increased the odds ratio for incident COPD by a factor of two. In a multivariable linear regression model, reduced TAC was significantly associated with greater longitudinal FEV1/FVC decline (p=0.03), but no other measurements were significant. CT TAC predicts incident COPD in at-risk smokers, indicating that smokers exhibit early structural changes associated with COPD prior to abnormal spirometry. Computed tomography (CT) total airway count (TAC) predicts incident COPD in at-risk smokers, indicating that smokers exhibit early airway remodelling prior to abnormal spirometry and that CT TAC is a potential tool to help identify smokers at increased risk of COPDhttps://bit.ly/2UTw3I4
Collapse
Affiliation(s)
- Miranda Kirby
- Dept of Physics, Ryerson University, Toronto, ON, Canada.,UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Benjamin M Smith
- Dept of Medicine, McGill University, Montreal, QC, Canada.,Dept of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Dept of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Naoya Tanabe
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - James C Hogg
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Harvey O Coxson
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Don D Sin
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | - Jean Bourbeau
- Montreal Chest Institute of the Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Wan C Tan
- UBC Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| |
Collapse
|
50
|
Virdee S, Tan WC, Hogg JC, Bourbeau J, Hague CJ, Leipsic JA, Kirby M. Spatial Dependence of CT Emphysema in Chronic Obstructive Pulmonary Disease Quantified by Using Join-Count Statistics. Radiology 2021; 301:702-709. [PMID: 34519575 DOI: 10.1148/radiol.2021210198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Existing CT emphysema measurements quantify the extent or clustering of emphysema voxels in chronic obstructive pulmonary disease (COPD); however, these measurements do not quantify how those voxels are clustered. Purpose To develop a CT measurement to quantify the "compactness" of emphysema voxels, called the normalized join count (NJC), and to determine whether the NJC measurement differentiates COPD disease severity and correlates with lung function and visual emphysema scores. Materials and Methods In this secondary analysis of a prospective study, lung function and CT images were obtained from the Canadian Cohort Obstructive Lung Disease study visit 1 from 2009 to 2013. Participants were categorized as never-smokers, at risk, mild COPD, or moderate-severe COPD. Diffusion capacity for carbon monoxide/alveolar volume was measured. CT emphysema was scored visually by radiologists. CT measurements included the percentage low-attenuation area with attenuation less than -950 HU (%LAA-950insp), low-attenuation cluster (LAC), and lowest 15th percentile point of the CT lung density histogram. NJC was developed to measure compactness of CT emphysema voxels. An analysis of variance determined differences between groups. Multivariable ridge regression determined association between CT measurements with lung function and radiologist scores. Results A total of 1294 participants (750 men; mean age, 67 years ± 10) were analyzed (277 never-smokers, 306 at risk, 427 mild COPD, and 284 moderate-severe COPD). NJC, %LAA-950insp, and LAC measurements were higher in moderate-severe COPD than in never-smokers and at-risk participants (P < .05 for all comparisons), but only NJC was different between mild and ;moderate-severe COPD (mean, 1.98% ± 3.61 vs 1.44% ± 2.14; P < .05). In multivariable regression analysis, among all CT measurements NJC had the greatest relative contribution to diffusion capacity for carbon monoxide/alveolar volume (P = .002) and visual emphysema score (P < .001). Conclusion The relationship of normalized join count with severity of chronic obstructive pulmonary disease may indicate that the assessment of this disease is dependent on the number of low attenuating voxels or the size of clusters and the spatial arrangement of such voxels. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
Collapse
Affiliation(s)
- Sukhraj Virdee
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Wan C Tan
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - James C Hogg
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Jean Bourbeau
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Cameron J Hague
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Jonathon A Leipsic
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| | - Miranda Kirby
- From the Department of Physics, Ryerson University, 350 Victoria St, Kerr Hall South Bldg, Room KHS-344, Toronto, ON, Canada M5B 2K3 (S.V., M.K.); Heart Lung Innovation Centre, St Paul's Hospital, University of British Columbia, Vancouver, Canada (W.C.T., J.C.H., C.J.H., J.A.L., M.K.); and Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Canada (J.B.)
| |
Collapse
|