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Mills DR, Masters IB, Yerkovich ST, McEniery J, Kapur N, Chang AB, Marchant JM, Goyal V. Radiographic Outcomes in Paediatric Bronchiectasis and Factors Associated with Reversibility. Am J Respir Crit Care Med 2024. [PMID: 38631023 DOI: 10.1164/rccm.202402-0411oc] [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: 02/22/2024] [Accepted: 04/17/2024] [Indexed: 04/19/2024] Open
Abstract
RATIONALE Conventionally considered irreversible, bronchiectasis reversibility in children has been demonstrated in small studies. However, the factors associated with radiographic reversibility in bronchiectasis have yet to be defined. OBJECTIVES In a large cohort of children with bronchiectasis, we aimed to determine (a) if and to what extent bronchiectasis is reversible and (b) factors associated with radiographic chest high resolution computed tomography (cHRCT) resolution. METHODS We identified children with bronchiectasis who had a repeat multidetector HRCT between 2010-2021. We excluded those with cystic fibrosis, surgical pulmonary resection, traction bronchiectasis only, or lobar opacification. MAIN RESULTS cHRCT scans were scored using the modified Reiff-score (MRS) with a paediatric correction. Resolution was defined as absence of abnormal broncho-arterial ratio (>0.8) on the second cHRCT. We included 142 children (median age=5years: IQR 2.6-7.4), Inter- and intra-rater agreement in MRSs was excellent (weighted kappa=0.83-0.86 and 0.95 respectively). Radiographically resolution was documented in 57/142 (40.1%), improved in 56/142 (39.4%), unchanged/worse in 29/142 (20.4%). Pseudomonas aeruginosa (PsA) was absolutely associated with non-resolution. On multivariable regression, in those without PsA cultured, younger age-at-diagnosis (risk ratio (RR)=0.94, 95%CI 0.88-0.99) lower MRS (RR=0.89, 95% CI 0.82-0.97) and lower annual exacerbation rate requiring intravenous antibiotics (RR=0.60, 95%CI 0.37-0.98) increased the likelihood of radiographic resolution. CONCLUSIONS This first large cohort confirms bronchiectasis in children is often reversible with appropriate management. Younger aged children and those with lesser radiographic severity at diagnosis were most likely to achieve radiographic reversibility whilst those with PsA infection were least likely.
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Affiliation(s)
- Dustin R Mills
- Queensland Children's Hospital, 67568, Department of Respiratory and Sleep Medicine , South Brisbane, Queensland, Australia
- The University of Queensland, 1974, Brisbane, Queensland, Australia
- Townsville Hospital and Health Service, 157842, Townsville, Queensland, Australia;
| | - Ian B Masters
- Queensland Children's Hospital, 67568, Department of Respiratory and Sleep Medicine, South Brisbane, Queensland, Australia
- NHMRC, 95574, Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Canberra, Australian Capital Territory, Australia
- QUT, 1969, Australian Centre for Health Services Innovation, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Queensland University of Technology, 1969, Australian Centre for Health Services Innovation, Brisbane, Queensland, Australia
- Menzies School of Health Research, 10095, Child Health Division, Darwin, Northern Territory, Australia
- NHMRC, 95574, Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), , Canberra, Australian Capital Territory, Australia
| | - Jane McEniery
- Queensland Children's Hospital, 67568, Radiology, South Brisbane, Queensland, Australia
| | - Nitin Kapur
- Queensland Children's Hospital, 67568, Department of Respiratory and Sleep Medicine , South Brisbane, Queensland, Australia
- The University of Queensland, 1974, Brisbane, Queensland, Australia
| | - Anne B Chang
- Queensland Children's Hospital, 67568, Department of Respiratory and Sleep Medicine, South Brisbane, Queensland, Australia
- Queensland University of Technology, 1969, Australian Centre for Health Service Innovation, Brisbane, Queensland, Australia
- Menzies School of Health Research, 10095, Child and Maternal Health Division , Darwin, Northern Territory, Australia
- NHMRC, 95574, Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Canberra, Australian Capital Territory, Australia
| | - Julie M Marchant
- Queensland Children's Hospital, 67568, Department of Respiratory and Sleep Medicine, South Brisbane, Queensland, Australia
- QUT, 1969, Australian Centre for Health Services Innovation, Brisbane, Queensland, Australia
- NHMRC, 95574, Australian Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Canberra, Australian Capital Territory, Australia
| | - Vikas Goyal
- Queensland Children's Hospital, 67568, Department of Respiratory and Sleep Medicine , South Brisbane, Queensland, Australia
- Gold Coast University Hospital, 60093, Department of Paediatrics , Southport, Queensland, Australia
- NHMRC, 95574, Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Canberra, Australian Capital Territory, Australia
- QUT, 1969, Australian Centre for Health Services Innovation, Brisbane, Queensland, Australia
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Conrad TJ, Lau HX, Yerkovich ST, Alghamry A, Lee JC. Ventilation-perfusion scan for diagnosing pulmonary embolism: do chest x-rays matter? Nucl Med Commun 2024; 45:181-187. [PMID: 38247659 DOI: 10.1097/mnm.0000000000001802] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND Ventilation-perfusion (V/Q) scan coupled with single photon emission computed tomography (SPECT) is commonly used for the diagnosis of pulmonary embolism (PE). An abnormal chest x-ray (CXR) is deemed to hinder the interpretation of V/Q scan and therefore a normal CXR is recommended prior to V/Q scan. AIMS To determine if an abnormal CXR impacted on V/Q scan interpretation and subsequent management. METHODS A retrospective cohort analysis of all patients who underwent a V/Q scan for diagnosis of suspected acute PE between March 2016 and 2022 was performed. CXR reports were reviewed and classified as normal or abnormal. Low-dose computerised tomography was routinely performed in patients above the age of 70. Data regarding V/Q scan results and subsequent management including initiation of anticoagulation for PE or further diagnostic investigations were collected. RESULTS A total of 340 cases were evaluated. Of the positive V/Q scans (92/340), 98.3% of the normal CXR were anticoagulated compared to 100% of the abnormal CXR group. Of the negative V/Q scans (239/340), no cases were started on anticoagulation and no further investigations were performed across both normal and abnormal CXR groups. Indeterminate results occurred in only 9 cases with no significant difference in management between normal and abnormal CXR groups. CONCLUSION An abnormal CXR does not affect the reliability of V/Q scan interpretation in the diagnosis of PE when coupled with SPECT. Unless clinically indicated, the mandate by clinical society guidelines for a normal CXR prior to V/Q should be revisited.
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Affiliation(s)
- Thomas J Conrad
- Internal Medicine Services, The Prince Charles Hospital, Metro North Health, Brisbane
- Internal Medicine Services, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Han X Lau
- Internal Medicine Services, The Prince Charles Hospital, Metro North Health, Brisbane
| | - Stephanie T Yerkovich
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology
| | - Alaa Alghamry
- Internal Medicine Services, The Prince Charles Hospital, Metro North Health, Brisbane
- Faculty of Medicine, The University of Queensland
| | - Joseph C Lee
- Faculty of Medicine, The University of Queensland
- Department of Medical Imaging, The Prince Charles Hospital, Metro North Health, Brisbane, Queensland, Australia
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Thomas RJ, Yerkovich ST, Goyal V, Chang AB, Rutter C, Masters IB, Marchant JM. The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review. Pediatr Pulmonol 2024. [PMID: 38411339 DOI: 10.1002/ppul.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review (SRs) aimed to determine the utility of FB on its impact in clinical decision making and quality of life (QoL). METHODS We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organization Clinical Trials Registry Platform and Cochrane database of SRs from inception to April 20, 2023. We included SRs and randomized controlled trials (RCTs) that used parallel group design (comparing use of elective FB vs. no FB, or a wait-list approach [early FB vs. usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. RESULTS Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our patient, intervention, comparator, outcome measures framework. CONCLUSIONS There is a paucity of high-quality RCT evidence to support the routine use of elective FB in children with respiratory conditions. However, available retrospective and a single prospective study demonstrate the high utility of FB in the elective pediatric setting. REGISTRATION PROSPERO CRD42021291305.
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Affiliation(s)
- Rahul J Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Departments of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cameron Rutter
- Academic Division, Library, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Thomas R, Marchant JM, Goyal V, Masters IB, Yerkovich ST, Chang AB. Clinical utility of elective paediatric flexible bronchoscopy and impact on the quality of life: protocol for a single-centre, single-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e001704. [PMID: 38413121 PMCID: PMC10900573 DOI: 10.1136/bmjresp-2023-001704] [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: 03/07/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there are no randomised controlled trials (RCTs) that have examined its benefits (or otherwise).Our primary aim is to determine the impact of FB on the parent-proxy quality-of-life (QoL) scores. Our secondary aims are to determine if undertaking FB leads to (a) change in management and (b) improvement of other relevant patient-reported outcome measures (PROMs). We also quantified the benefits of elective FB (using 10-point Likert scale). We hypothesised that undertaking elective FB will contribute to accurate diagnosis and therefore appropriate treatment, which will in turn improve QoL and will be deemed to be beneficial from patient and doctor perspectives. METHODS AND ANALYSIS Our parallel single-centre, single-blind RCT (commenced in May 2020) has a planned sample size of 114 children (aged <18 years) recruited from respiratory clinics at Queensland Children's Hospital, Brisbane, Australia. Children are randomised (1:1 concealed allocation) within two strata: age (≤2 vs >2 years) and indication for FB (chronic cough vs other indications) to either (a) early arm (intervention where FB undertaken within 2 weeks) or (b) delayed (control, FB undertaken at usual wait time). Our primary outcome is the difference between groups in their change in QoL at the T2 timepoint when the intervention group has had the FB and the control group has not. Our secondary outcomes are change in management, change in PROMs, adverse events and the Likert scales. ETHICS AND DISSEMINATION The human research ethics committee of the Queensland Children's Hospital granted ethical clearance (HREC/20/QCHQ/62394). Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation. Results will be disseminated through conference presentations, teaching avenues, workshops, websites and publications. REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12620000610932.
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Affiliation(s)
- Rahul Thomas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Anne B Chang
- Respiratory Medicine, Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
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Lew YL, Tan AF, Yerkovich ST, Yeo TW, Chang AB, Lowbridge CP. Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis. Arch Dis Child 2024; 109:188-194. [PMID: 37979964 DOI: 10.1136/archdischild-2023-326151] [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: 07/31/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Despite tuberculosis (TB) being a curable disease, current guidelines fail to account for the long-term outcomes of post-tuberculosis lung disease-a cause of global morbidity despite successful completion of effective treatment. Our systematic review aimed to synthesise the available evidence on the lung function outcomes of childhood pulmonary tuberculosis (PTB). METHODS PubMed, ISI Web of Science, Cochrane Library and ProQuest databases were searched for English-only studies without time restriction (latest search date 22 March 2023). Inclusion criteria were (1) patients who had TB with pulmonary involvement at age ≤18 years; (2) pulmonary function tests (PFTs) performed on patients after treatment completion; and (3) observational studies, including cohort and cross-sectional studies. We adhered to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS From 8040 records, 5 studies were included (involving n=567 children), with spirometry measures from 4 studies included in the meta-analyses. The effect sizes of childhood TB on forced expiratory volume in the first second and forced vital capacity z-scores were estimated to be -1.53 (95% CI -2.65, -0.41; p=0.007) and -1.93 (95% CI -3.35, -0.50; p=0.008), respectively. DISCUSSION The small number of included studies reflects this under-researched area, relative to the global burden of TB. Nevertheless, as childhood PTB impacts future lung function, PFTs (such as spirometry) should be considered a routine test when evaluating the long-term lung health of children beyond their completion of TB treatment. PROSPERO registration number CRD42021250172.
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Affiliation(s)
- Yao Long Lew
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angelica Fiona Tan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tsin Wen Yeo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Anne B Chang
- Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher P Lowbridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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O’Farrell HE, Kok HC, Goel S, Chang AB, Yerkovich ST. Endotypes of Paediatric Cough-Do They Exist and Finding New Techniques to Improve Clinical Outcomes. J Clin Med 2024; 13:756. [PMID: 38337450 PMCID: PMC10856076 DOI: 10.3390/jcm13030756] [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: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic cough is a common symptom of many childhood lung conditions. Given the phenotypic heterogeneity of chronic cough, better characterization through endotyping is required to provide diagnostic certainty, precision therapies and to identify pathobiological mechanisms. This review summarizes recent endotype discoveries in airway diseases, particularly in relation to children, and describes the multi-omic approaches that are required to define endotypes. Potential biospecimens that may contribute to endotype and biomarker discoveries are also discussed. Identifying endotypes of chronic cough can likely provide personalized medicine and contribute to improved clinical outcomes for children.
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Affiliation(s)
- Hannah E. O’Farrell
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Hing Cheong Kok
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Department of Paediatrics, Sabah Women and Children’s Hospital, Kota Kinabalu 88996, Sabah, Malaysia
| | - Suhani Goel
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Anne B. Chang
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Newcombe PA, Chang AB. Clinical determinants for State-Trait Anxiety Inventory of the parents of children with respiratory problems. Pediatr Pulmonol 2024; 59:31-40. [PMID: 37750592 PMCID: PMC10952396 DOI: 10.1002/ppul.26702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUNDS Understanding factors associated with anxiety of parents/carers of children with respiratory problems is clinically important yet there is relative paucity of data. In 106 children seen in the respiratory clinic of a pediatric hospital, we evaluated (a) the determinants for parental anxiety and (b) whether the anxiety scores correlate with quality-of-life (QoL) scores in the subset with chronic cough. METHODS We opportunistically re-analyzed data of our main study that examined the benefits of using spirometry for pediatric respiratory consultation where parents completed an anxiety questionnaire (State-Trait Anxiety Inventory, STAI) pre- and postconsultation. A subset (children with chronic cough) also completed the parent-proxy quality-of-life (PC-QoL) tool. We computed the association between clinical characteristics and anxiety scores using multivariable regression and between the two patient-reported outcome measures using Spearman's correlation. RESULTS The majority of parents/carers were women (n = 89, 84%). Most children (mean age = 10.9 years, SD = 3.7 years) were previously seen at the clinic (n = 67, 63.2%). In multivariate regression, parental anxiety score was significantly associated with reported presence of cough [coefficient β = 17.31 (95% confidence interval 9.62, 25.1)] and lower forced expiratory volume in first second (FEV1 )/forced vital capacity (FVC) [-3.88 (-7.05, -0.71)] at preconsultation, but associated with cough only [coefficient β = 12.04 (5.24, 18.84)] at postconsultation, all p < .05. STAI strongly correlated with PC-QoL scores at pre- but only modestly at postconsultation (rs = -.63 and -.39, respectively, p < .05). CONCLUSION Parental anxiety levels of children attending respiratory clinics are influenced by the presence of cough and low FEV1 /FVC of their child and are associated with poorer QoL. These highlight the need for on-going research to reduce parental anxiety focusing on cough and lung function indices.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Pediatrics, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Julie M. Marchant
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Margaret S. McElrea
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
| | - Stephanie T. Yerkovich
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Peter A. Newcombe
- School of PsychologyUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health Research, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE)Charles Darwin UniversityDarwinNorthern TerritoryAustralia
- Australian Centre for Health Services Innovation, Centre for Healthcare TransformationQueensland University of TechnologyBrisbaneQueenslandAustralia
- Department of Respiratory & Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Collaro AJ, Chalmers JD, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. A core outcome set for bronchiectasis in children and adolescents for use in clinical research: an international consensus study. Lancet Respir Med 2024; 12:78-88. [PMID: 38070531 DOI: 10.1016/s2213-2600(23)00233-3] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 01/06/2024]
Abstract
Improving the treatment of non-cystic fibrosis bronchiectasis in children and adolescents requires high-quality research with outcomes that meet study objectives and are meaningful for patients and their parents and caregivers. In the absence of systematic reviews or agreement on the health outcomes that should be measured in paediatric bronchiectasis, we established an international, multidisciplinary panel of experts to develop a core outcome set (COS) that incorporates patient and parent perspectives. We undertook a systematic review from which a list of 21 outcomes was constructed; these outcomes were used to inform the development of separate surveys for ranking by parents and patients and by health-care professionals. 562 participants (201 parents and patients from 17 countries, 361 health-care professionals from 58 countries) completed the surveys. Following two consensus meetings, agreement was reached on a ten-item COS with five outcomes that were deemed to be essential: quality of life, symptoms, exacerbation frequency, non-scheduled health-care visits, and hospitalisations. Use of this international consensus-based COS will ensure that studies have consistent, patient-focused outcomes, facilitating research worldwide and, in turn, the development of evidence-based guidelines for improved clinical care and outcomes. Further research is needed to develop validated, accessible measurement instruments for several of the outcomes in this COS.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary and University of Edinburgh, Edinburgh, UK
| | | | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinik Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - James D Chalmers
- College of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Carolina Constant
- Department of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University of Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Department of Pulmonology, Children's Hospital, Winterthur, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- Pulmonology Department, National Pirogov Medical University, Vinnytsya Children's Regional Hospital, Vinnytsya, Ukraine
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
| | - Marijke Proesmans
- Pediatric Pulmonology, Department of Pediatrics, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Ponte San Pietro-Bergamo, Bergamo, Italy
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, QLD, Australia; School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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9
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Goyal V, Yerkovich ST, Grimwood K, Marchant JM, Byrnes CA, Masters IB, Chang AB. Phenotypic Features of Pediatric Bronchiectasis Exacerbations Associated With Symptom Resolution After 14 Days of Oral Antibiotic Treatment. Chest 2023; 164:1378-1386. [PMID: 37437879 DOI: 10.1016/j.chest.2023.07.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Respiratory exacerbations in children and adolescents with bronchiectasis are treated with antibiotics. However, antibiotics can have variable interindividual effects when treating exacerbations. RESEARCH QUESTION Can phenotypic features associated with symptom resolution after a 14-day course of oral antibiotics for a nonsevere exacerbation of bronchiectasis be identified? STUDY DESIGN AND METHODS Combining data from two multicenter randomized controlled trials, we identified 217 children with bronchiectasis assigned to at least 14 days of oral antibiotics to treat nonsevere (nonhospitalized) exacerbations. Univariable and then multivariable logistic regression were used to identify factors associated with symptom resolution within 14 days of commencing antibiotics. Identified associations were re-evaluated by mediation analysis. RESULTS Of the 217 study participants (52% male patients), 41% were Indigenous (Australian First Nations, New Zealand Māori, or Pacific Islander). The median age was 6.6 years (interquartile range, 4.0-10.1 years). By day 14, symptoms had resolved in 130 children (responders), but persisted in the remaining 87 children (nonresponders). Multivariable analysis found those who were Indigenous (adjusted OR [AOR], 3.59; 95% CI, 1.35-9.54) or showed new abnormal auscultatory findings (AOR, 3.85; 95% CI, 1.56-9.52) were more likely to be responders, whereas those with multiple bronchiectatic lobes at diagnosis (AOR, 0.66; 95% CI, 0.46-0.95) or higher cough scores when starting exacerbation treatment (AOR, 0.55; 95% CI, 0.34-0.90) were more likely to be nonresponders. Detecting a respiratory virus at the beginning of an exacerbation was not associated with antibiotic failure at 14 days. INTERPRETATION Children with Indigenous ethnicity, milder bronchiectasis, mild exacerbations (low reported cough scores), or new abnormal auscultatory signs are more likely to respond to appropriate oral antibiotics than those without these features. These patient and exacerbation phenotypes may assist clinical management and development of biomarkers to identify those whose symptoms are more likely to resolve after 14 days of oral antibiotics. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry; Nos.: ACTRN12612000011886 and ACTRN12612000010897; URL: https://www.anzctr.org.au.
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Affiliation(s)
- Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; Department of Paediatrics, Gold Coast Health, Griffith University, Gold Coast, QLD, Australia.
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Keith Grimwood
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Griffith University Gold Coast, QLD, Australia; School of Medicine and Dentistry and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Catherine A Byrnes
- Department of Paediatrics, University of Auckland, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand; Paediatric Respiratory Medicine, Starship Children's Health & Kidz First Hospital, Auckland, New Zealand
| | - Ian Brent Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis, Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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10
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Apte SH, Groves PL, Tan ME, Lutzky VP, de Silva T, Monteith JN, Yerkovich ST, O’Sullivan BJ, Davis RA, Chambers DC. A Methodological Approach to Identify Natural Compounds with Antifibrotic Activity and the Potential to Treat Pulmonary Fibrosis Using Single-Cell Sequencing and Primary Human Lung Macrophages. Int J Mol Sci 2023; 24:15104. [PMID: 37894784 PMCID: PMC10606775 DOI: 10.3390/ijms242015104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common and lethal form of the interstitial pneumonias. The cause of the disease is unknown, and new therapies that stop or reverse disease progression are desperately needed. Recent advances in next-generation sequencing have led to an abundance of freely available, clinically relevant, organ-and-disease-specific, single-cell transcriptomic data, including studies from patients with IPF. We mined data from published IPF data sets and identified gene signatures delineating pro-fibrotic or antifibrotic macrophages and then used the Enrichr platform to identify compounds with the potential to drive the macrophages toward the antifibrotic transcriptotype. We then began testing these compounds in a novel in vitro phenotypic drug screening assay utilising human lung macrophages recovered from whole-lung lavage of patients with silicosis. As predicted by the Enrichr tool, glitazones potently modulated macrophage gene expression towards the antifibrotic phenotype. Next, we assayed a subset of the NatureBank pure compound library and identified the cyclobutane lignan, endiandrin A, which was isolated from the roots of the endemic Australian rainforest plant, Endiandra anthropophagorum, with a similar antifibrotic potential to the glitazones. These methods open new avenues of exploration to find treatments for lung fibrosis.
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Affiliation(s)
- Simon H. Apte
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Penny L. Groves
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
| | - Maxine E. Tan
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Viviana P. Lutzky
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Tharushi de Silva
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Joshua N. Monteith
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Stephanie T. Yerkovich
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Brendan J. O’Sullivan
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
| | - Rohan A. Davis
- School of Environment and Science, Griffith University, Brisbane, QLD 4111, Australia;
- NatureBank, Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD 4111, Australia
| | - Daniel C. Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD 4032, Australia; (P.L.G.); (M.E.T.); (V.P.L.); (T.d.S.); (B.J.O.)
- Faculty of Medicine, The University of Queensland, Brisbane, QLD 4072, Australia; (J.N.M.); (S.T.Y.)
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11
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Masters IB, Chang AB. Does routine spirometry impact on clinical decisions and patient-related outcome measures of children seen in respiratory clinics: an open-label randomised controlled trial. BMJ Open Respir Res 2023; 10:10/1/e001402. [PMID: 37169400 DOI: 10.1136/bmjresp-2022-001402] [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: 08/13/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION There is limited evidence on the efficacy of using spirometry routinely in paediatric practice for improving outcomes. OBJECTIVE To determine whether the routine use of spirometry alters clinical decisions and patient-related outcome measures for children managed by respiratory paediatricians. METHODS We undertook a parallel open-label randomised controlled trial involving children (aged 4-18 years) able to perform spirometry in a specialist children's hospital in Australia. Children were randomised to either routine use of spirometry (intervention) or clinical review without use of spirometry (control) for one clinic visit. The primary outcomes were the (a) proportion of children with 'any change in clinical decisions' and (b) 'change score' in clinical decisions. Secondary outcomes were change in patient-related outcome measures assessed by State-Trait Anxiety Inventory (STAI) and Parent-Proxy QoL questionnaire for paediatric chronic cough (PC-QoL). RESULTS Of 136 eligible children, 106 were randomised. Compared with controls, the intervention group had significantly higher proportion of children with 'any change in clinical decisions' (n=54/54 (100%) vs n=34/52 (65.4%), p<0.001) and higher clinical decision 'change score' (median=2 (IQR 1-4) vs 1 (0-2), p<0.001). Also, improvement was significantly greater in the intervention group for overall STAI score (median=-5 (IQR -10 to -2) vs -2.5 (-8.5, 0), p=0.021) and PC-QoL social domain (median=3 (IQR 0 to 5) vs 0 (-1, 1), p=0.017). CONCLUSION The routine use of spirometry in children evaluated for respiratory issues at clinical outpatient review is beneficial for optimising clinical management and improving parent psychosocial well-being. REGISTRATION Australia and New Zealand Clinical Trials Registry ACTRN12619001686190.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia
- Department of Pediatrics, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian B Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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12
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Thomas RJ, Masters IB, Chang AB. The ‘knee’ pattern in spirometry flow-volume curves in children: Does it relate to tracheomalacia? Respir Med 2022; 204:107029. [DOI: 10.1016/j.rmed.2022.107029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
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13
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Boonjindasup W, Chang AB, McElrea MS, Yerkovich ST, Marchant JM. Does the routine use of spirometry improve clinical outcomes in children?-A systematic review. Pediatr Pulmonol 2022; 57:2390-2397. [PMID: 35754141 PMCID: PMC9796376 DOI: 10.1002/ppul.26045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/18/2022] [Accepted: 06/04/2022] [Indexed: 01/01/2023]
Abstract
Spirometry provides a quantitative measure of lung function and its use is recommended as an adjunct to enhance pediatric respiratory healthcare in many clinical practice guidelines. However, there is limited evidence confirming the benefits (or otherwise) of using spirometry from either clinician or patient perspectives. This systematic review aimed to determine the impact of spirometry on change in clinical decision making and patient-reported outcome measures. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov, and World Health Organization International Clinical Trials Registry Platform, from inception to July 2021. We included randomized controlled trials (RCTs) comparing the use versus non-use of spirometry during standard clinical review in children aged <18 years with respiratory problems in clinics. We used Cochrane methodology. The search identified 3475 articles; 8 full-text articles were reviewed but only 1 study fulfilled the inclusion criteria. The single study involved two cluster RCTs of spirometry for children with asthma in general practice. The included study did not find any significant intergroup difference at the 12-month follow-up for asthma-related quality-of-life and clinical endpoints. However, the findings were limited by methodological weaknesses and high risks of bias. With a paucity of data, the clinical benefits of spirometry remain unclear. Thus, there is a clear need for RCTs that provide high-quality evidence to support the routine use of spirometry in children with suspected or known lung disease. Pending the availability of better evidence, we recommend that clinicians adhere to the current clinical practice recommendations.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Cough & Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Paediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Cough & Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Cough & Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Cough & Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Cough & Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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14
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Thomas RJ, Masters IB, Chang AB. Pulmonary function of children with tracheomalacia and associated clinical factors. Pediatr Pulmonol 2022; 57:2437-2444. [PMID: 35785487 PMCID: PMC9796637 DOI: 10.1002/ppul.26054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/01/2022] [Accepted: 06/25/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Spirometry is easily accessible yet there is limited data in children with tracheomalacia. Availability of such data may inform clinical practice. We aimed to describe spirometry indices of children with tracheomalacia, including Empey index and flow-volume curve pattern, and determine whether these indices relate with bronchoscopic features. METHODS From the database of children with tracheomalacia diagnosed during 2016-2019, we reviewed their flexible bronchoscopy and spirometry data in a blinded manner. We specially evaluated several spirometry indices and tracheomalacia features (cross-sectional lumen reduction, malacic length, and presence of bronchomalacia) and determined their association using multivariable regression. RESULTS Of 53 children with tracheomalacia, the mean (SD) peak expiratory flow (PEF) was below the normal range [68.9 percent of predicted value (23.08)]. However, all other spirometry parameters were within normal range [Z-score forced expired volume in 1 s (FEV1 ) = -1.18 (1.39), forced vital capacity (FVC) = -0.61 (1.46), forced expiratory flow between 25% and 75% of vital capacity (FEF25%-75% ) = -1.43 (1.10), FEV1 /FVC = -1.04 (1.08)], Empey Index = 8.21 (1.59). The most common flow-volume curve pattern was the "knee" pattern (n = 39, 73.6%). Multivariable linear regression identified the presence of bronchomalacia was significantly associated with lower flows: FEV1 [coefficient (95% CI) -0.78 (-1.54, -0.02)], FEF25%-75% [-0.61 (-1.22, 0)], and PEF [-12.69 (-21.13, -4.25)], all p ≤ 0.05. Other bronchoscopic-defined tracheomalacia features examined (cross-sectional lumen reduction, malacic length) were not significantly associated with spirometry indices. CONCLUSION The "knee" pattern in spirometry flow-volume curve is common in children with tracheomalacia but other indices, including Empey index, cannot be used to characterize tracheomalacia. Spirometry indices were not significantly associated with bronchoscopic tracheomalacia features but children with tracheobronchomalacia have significantly lower flow than those with tracheomalacia alone.
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Affiliation(s)
- Wicharn Boonjindasup
- Menzies School of Health Research, Child Health Division, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Casuarina, Northern Territory, Australia.,Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Menzies School of Health Research, Child Health Division, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Casuarina, Northern Territory, Australia.,Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rahul J Thomas
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ian B Masters
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Menzies School of Health Research, Child Health Division, NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Charles Darwin University, Casuarina, Northern Territory, Australia.,Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory & Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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15
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Chalmers JD, Collaro AJ, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. Quality standards for managing children and adolescents with bronchiectasis: an international consensus. Breathe (Sheff) 2022; 18:220144. [PMID: 36865655 PMCID: PMC9973502 DOI: 10.1183/20734735.0144-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline. The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients' survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis. The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent- and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.
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Affiliation(s)
- Anne B. Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia,Corresponding author: Anne B. Chang ()
| | | | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T. Hill
- Dept of Respiratory Medicine, Royal Infirmary, Edinburgh, UK,University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation Bronchiectasis Paediatric Patient Advisory Group
| | - Angela Zacharasiewicz
- Department of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinik Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Department, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - James D. Chalmers
- College of Medicine, University of Dundee, Dundee, UK,Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J. Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Carolina Constant
- Department of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland, Childhood Research Center, Zurich, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya, Ukraine,Vinnytsya Children's Regional Hospital, Pulmonology Dept, Vinnytsya, Ukraine
| | - Fabio Midulla
- Department of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland, Childhood Research Center, Zurich, Switzerland
| | - Marijke Proesmans
- Department of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Department of Physiotherapy, Queensland Children's Hospital, Brisbane, Australia
| | - Stephanie T. Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy,Both authors contributed equally to this article as senior authors
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, Australia,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia,Both authors contributed equally to this article as senior authors
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16
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Chang AB, Boyd J, Bush A, Hill AT, Powell Z, Zacharasiewicz A, Alexopoulou E, Chalmers JD, Collaro AJ, Constant C, Douros K, Fortescue R, Griese M, Grigg J, Hector A, Karadag B, Mazulov O, Midulla F, Moeller A, Proesmans M, Wilson C, Yerkovich ST, Kantar A, Grimwood K. International consensus statement on quality standards for managing children/adolescents with bronchiectasis from the ERS CRC Child-BEAR-Net. Eur Respir J 2022; 59:59/6/2200264. [PMID: 35680151 DOI: 10.1183/13993003.00264-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia .,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial School of Medicine, London, UK
| | - Adam T Hill
- Dept of Respiratory Medicine, Royal Infirmary, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Zena Powell
- European Lung Foundation bronchiectasis paediatric patient advisory group
| | - Angela Zacharasiewicz
- Dept of Pediatrics, and Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Efthymia Alexopoulou
- 2nd Radiology Dept, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - James D Chalmers
- College of Medicine, University of Dundee, Dundee, UK.,Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Carolina Constant
- Dept of Pediatrics, Hospital de Santa Maria and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Paediatric Dept, National and Kapodistrian University of Athens, Athens, Greece
| | - Rebecca Fortescue
- Population Health Research Institute, St George's University of London, London, UK
| | - Matthias Griese
- Dept of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Andreas Hector
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Childhood Research Center, Zurich, Switzerland
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya, Ukraine.,Pulmonology Dept, Vinnytsya Children's Regional Hospital, Vinnytsya, Ukraine
| | - Fabio Midulla
- Dept of Maternal Science, Sapienza University of Rome, Rome, Italy
| | - Alexander Moeller
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland.,Childhood Research Center, Zurich, Switzerland
| | - Marijke Proesmans
- Dept of Pediatrics, Pediatric Pulmonology, University Hospital of Leuven, Leuven, Belgium
| | - Christine Wilson
- Dept of Physiotherapy, Queensland Children's Hospital, Brisbane, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.,Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia.,NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, Bergamo, Italy.,Co-senior author
| | - Keith Grimwood
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Depts of Infectious Diseases and Paediatrics, Gold Coast Health, Southport, Australia.,Co-senior author
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17
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Chang AB, Morgan LC, Duncan EL, Chatfield MD, Schultz A, Leo PJ, McCallum GB, McInerney-Leo AM, McPhail SM, Zhao Y, Kruljac C, Smith-Vaughan HC, Morris PS, Marchant JM, Yerkovich ST, Cook AL, Wurzel D, Versteegh L, O'Farrell H, McElrea MS, Fletcher S, D'Antoine H, Stroil-Salama E, Robinson PJ, Grimwood K. Reducing exacerbations in children and adults with primary ciliary dyskinesia using erdosteine and/or azithromycin therapy (REPEAT trial): study protocol for a multicentre, double-blind, double-dummy, 2×2 partial factorial, randomised controlled trial. BMJ Open Respir Res 2022; 9:9/1/e001236. [PMID: 35534039 PMCID: PMC9086630 DOI: 10.1136/bmjresp-2022-001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction Primary ciliary dyskinesia (PCD) is a rare, progressive, inherited ciliopathic disorder, which is incurable and frequently complicated by the development of bronchiectasis. There are few randomised controlled trials (RCTs) involving children and adults with PCD and thus evidence of efficacy for interventions are usually extrapolated from people with cystic fibrosis. Our planned RCT seeks to address some of these unmet needs by employing a currently prescribed (but unapproved for long-term use in PCD) macrolide antibiotic (azithromycin) and a novel mucolytic agent (erdosteine). The primary aim of our RCT is to determine whether regular oral azithromycin and erdosteine over a 12-month period reduces acute respiratory exacerbations among children and adults with PCD. Our primary hypothesis is that: people with PCD who regularly use oral azithromycin and/or erdosteine will have fewer exacerbations than those receiving the corresponding placebo medications. Our secondary aims are to determine the effect of the trial medications on PCD-specific quality-of-life (QoL) and other clinical outcomes (lung function, time-to-next exacerbation, hospitalisations) and nasopharyngeal bacterial carriage and antimicrobial resistance. Methods and analysis We are currently undertaking a multicentre, double-blind, double-dummy RCT to evaluate whether 12 months of azithromycin and/or erdosteine is beneficial for children and adults with PCD. We plan to recruit 104 children and adults with PCD to a parallel, 2×2 partial factorial superiority RCT at five sites across Australia. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, lung function and nasopharyngeal carriage by respiratory bacterial pathogens and their associated azithromycin resistance. Ethics and dissemination Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation and National Health and Medical Research Council guidelines for ethical conduct of Research, including that for First Nations Australians. Trial registration number ACTRN12619000564156.
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Affiliation(s)
- Anne B Chang
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia .,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Lucy C Morgan
- Department of Health and Ageing, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Emma L Duncan
- School of Life Course & Population Sciences, King's College London, London, UK.,Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Australian Translational Genomics Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Paul J Leo
- Australian Translational Genomics Centre, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Aideen M McInerney-Leo
- University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yuejen Zhao
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | | | - Heidi C Smith-Vaughan
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anne L Cook
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Danielle Wurzel
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lesley Versteegh
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Hannah O'Farrell
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sabine Fletcher
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Heather D'Antoine
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Enna Stroil-Salama
- Lung Foundation of Australia, Metro South Health, Brisbane, Queensland, Australia.,Brisbane South Palliative Care Collaborative, Metro South, Queensland Health, Brisbane, Queensland, Australia
| | - Phil J Robinson
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Keith Grimwood
- Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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18
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Marchant JM, Chang AB, Schutz KL, Versteegh L, Cook A, Roberts J, Morris PS, Yerkovich ST, McCallum GB. Utility of a personalised Bronchiectasis Action Management Plan (BAMP) for children with bronchiectasis: protocol for a multicentre, double-blind parallel, superiority randomised controlled trial. BMJ Open 2021; 11:e049007. [PMID: 34937712 PMCID: PMC8704965 DOI: 10.1136/bmjopen-2021-049007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Bronchiectasis is no longer considered rare or irreversible in children, yet it remains relatively under-researched and neglected in respiratory health globally. Bronchiectasis (including chronic suppurative lung disease) causes substantial morbidity for patients and significant impact on caregivers, especially during acute respiratory exacerbations. In other chronic respiratory diseases (eg, asthma), empowering consumers with an individualised plan for management of acute exacerbations improves clinical outcomes. However, in the absence of any such data specific to bronchiectasis, action management plans are rarely currently used in children or adults with bronchiectasis. We hypothesise that providing an individualised bronchiectasis action management plan (BAMP) to children with bronchiectasis reduces non-scheduled doctor consultations, compared with not having a BAMP. METHODS AND ANALYSIS This multicentre, parallel, double-blind, randomised trial involving three urban Australian hospitals commenced in June 2018 and will include 198 children, aged <19 years with bronchiectasis who had 2 or more exacerbations in the previous 18 months. Children will be randomised to having an individualised BAMP or standard care (a decoy clinic letter). Primary caregivers will then be followed up monthly for 12 months. The primary outcome is the rate of acute non-scheduled doctor visits for respiratory exacerbations by 12 months. The main secondary outcomes are cough-specific quality of life scores at 6 and 12 months, overall exacerbation rate over 12 months, and proportion of children who received timely influenza vaccination by 30 May annually. ETHICS AND DISSEMINATION The Human Research Ethics Committees of the Northern Territory Department of Health and Menzies School of Heath Research and Queensland Children's Hospital approved the study. The results of the trial will be submitted for publication and the BAMP made available free online. TRIAL REGISTRATION NUMBER Australia and New Zealand Clinical Trials Register ACTRN12618000604202.
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Affiliation(s)
- Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Kobi L Schutz
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lesley Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Cook
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jack Roberts
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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19
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Marchant JM, Cook AL, Roberts J, Yerkovich ST, Goyal V, Arnold D, O’Farrell HE, Chang AB. Burden of Care for Children with Bronchiectasis from Parents/Carers Perspective. J Clin Med 2021; 10:jcm10245856. [PMID: 34945152 PMCID: PMC8707334 DOI: 10.3390/jcm10245856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchiectasis is a neglected chronic respiratory condition. In children optimal appropriate management can halt the disease process, and in some cases reverse the radiological abnormality. This requires many facets, including parental/carer bronchiectasis-specific knowledge, for which there is currently no such published data. Further, the importance of patient voices in guiding clinical research is becoming increasingly appreciated. To address these issues, we aimed to describe the voices of parents of children with bronchiectasis relating to (a) burden of illness and quality of life (QoL), (b) their major worries/concerns and (c) understanding/management of exacerbations. The parents of 152 children with bronchiectasis (median age = 5.8 years, range 3.5-8.4) recruited from the Queensland Children's Hospital (Australia) completed questionnaires, including a parent-proxy cough-specific QoL. We found that parents of children with bronchiectasis had impaired QoL (median 4.38, range 3.13-5.63) and a high disease burden with median 7.0 (range 4.0-10.0) doctor visits in 12-months. Parental knowledge varied with only 41% understanding appropriate management of an exacerbation. The highest worry/concern expressed were long-term effects (n = 42, 29.8%) and perceived declining health (n = 36, 25.5%). Our study has highlighted the need for improved education, high parental burden and areas of concern/worry which may inform development of a bronchiectasis-specific paediatric QoL tool.
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Affiliation(s)
- Julie M. Marchant
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Correspondence:
| | - Anne L. Cook
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Jack Roberts
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Daniel Arnold
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Hannah E. O’Farrell
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
| | - Anne B. Chang
- Australian Centre for Health Services Innovation @ Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia; (A.L.C.); (J.R.); (S.T.Y.); (V.G.); (D.A.); (H.E.O.); (A.B.C.)
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
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20
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Mackintosh JA, Pietsch M, Lutzky V, Enever D, Bancroft S, Apte SH, Tan M, Yerkovich ST, Dickinson JL, Pickett HA, Selvadurai H, Grainge C, Goh NS, Hopkins P, Glaspole I, Reynolds PN, Wrobel J, Jaffe A, Corte TJ, Chambers DC. TELO-SCOPE study: a randomised, double-blind, placebo-controlled, phase 2 trial of danazol for short telomere related pulmonary fibrosis. BMJ Open Respir Res 2021; 8:8/1/e001127. [PMID: 34857525 PMCID: PMC8640666 DOI: 10.1136/bmjresp-2021-001127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Recent discoveries have identified shortened telomeres and related mutations in people with pulmonary fibrosis (PF). There is evidence to suggest that androgens, including danazol, may be effective in lengthening telomeres in peripheral blood cells. This study aims to assess the safety and efficacy of danazol in adults and children with PF associated with telomere shortening. Methods and analysis A multi-centre, double-blind, placebo-controlled, randomised trial of danazol will be conducted in subjects aged >5 years with PF associated with age-adjusted telomere length ≤10th centile measured by flow fluorescence in situ hybridisation; or in children, a diagnosis of dyskeratosis congenita. Adult participants will receive danazol 800 mg daily in two divided doses or identical placebo capsules orally for 12 months, in addition to standard of care (including pirfenidone or nintedanib). Paediatric participants will receive danazol 2 mg/kg/day orally in two divided doses or identical placebo for 6 months. If no side effects are encountered, the dose will be escalated to 4 mg/kg/day (maximum 800 mg daily) orally in two divided doses for a further 6 months. The primary outcome is change in absolute telomere length in base pairs, measured using the telomere shortest length assay (TeSLA), at 12 months in the intention to treat population. Ethics and dissemination Ethics approval has been granted in Australia by the Metro South Human Research Ethics Committee (HREC/2020/QMS/66385). The study will be conducted and reported according to Standard Protocol Items: Recommendations for Interventional Trials guidelines. Results will be published in peer-reviewed journals and presented at international and national conferences. Trial registration numbers NCT04638517; Australian New Zealand Clinical Trials Registry (ACTRN12620001363976p).
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Affiliation(s)
- John A Mackintosh
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Maria Pietsch
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Viviana Lutzky
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Debra Enever
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Sandra Bancroft
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Simon H Apte
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Maxine Tan
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Stephanie T Yerkovich
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Joanne L Dickinson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hilda A Pickett
- Children's Medical Research Institute, University of Sydney, Westmead, New South Wales, Australia
| | - Hiran Selvadurai
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Grainge
- Department of Respiratory Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Nicole S Goh
- Respiratory and Sleep Medicine Department, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Hopkins
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ian Glaspole
- Department of Allergy and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul N Reynolds
- Department of Respiratory Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jeremy Wrobel
- Advanced Lung Disease Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Department of Medicine, University of Notre Dame, Perth, Western Australia, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Tamera J Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Daniel C Chambers
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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21
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Boonjindasup W, Marchant JM, McElrea MS, Yerkovich ST, Masters IB, Chang AB. Impact of using spirometry on clinical decision making and quality of life in children: protocol for a single centre randomised controlled trial. BMJ Open 2021; 11:e050974. [PMID: 34548360 PMCID: PMC8458340 DOI: 10.1136/bmjopen-2021-050974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/05/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Although spirometry has been available for decades, it is underused in paediatric practice, other than in specialist clinics. This is unsurprising as there is limited evidence on the benefit of routine spirometry in improving clinical decision making and/or outcomes for children. We hypothesised that using spirometry for children being evaluated for respiratory diseases impacts on clinical decision making and/or improves patient-related outcome measures (PROMs) and/or quality of life (QoL), compared with not using spirometry. METHODS AND ANALYSIS We are undertaking a randomised controlled trial (commenced in March 2020) that will include 106 children (aged 4-18 years) recruited from respiratory clinics at Queensland Children's Hospital, Australia. Inclusion criteria are able to perform reliable spirometry and a parent/guardian who can complete questionnaire(s). Children (1:1 allocation) are randomised to clinical medical review with spirometry (intervention group) or without spirometry (control group) within strata of consultation status (new/review), and cough condition (present/absent). The primary outcome is change in clinical decision making. The secondary outcomes are change in PROM scores, opinions regarding spirometry and degree of diagnosis certainty. Intergroup differences of these outcomes will be determined by χ2 test or unpaired t-test (or Mann-Whitney if not normally distributed). Change in outcomes within the control group after review of spirometry will also be assessed by McNemar's test or paired t-test/Wilcoxon signed-rank test. ETHICS AND DISSEMINATION The Human Research Ethics Committee of the Queensland Children's Hospital approved the study. The trial results will be disseminated through conference presentations, teaching avenues and publications. TRIAL REGISTRATION NUMBER ACTRN12619001686190; Pre-results.
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Affiliation(s)
- Wicharn Boonjindasup
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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22
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Mackintosh JA, Yerkovich ST, Tan ME, Samson L, Hopkins PMA, Chambers DC. Airway Telomere Length in Lung Transplant Recipients. Front Immunol 2021; 12:658062. [PMID: 33936089 PMCID: PMC8085488 DOI: 10.3389/fimmu.2021.658062] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Chronic lung allograft dysfunction (CLAD) represents the major impediment to long term survival following lung transplantation. Donor and recipient telomere length have been shown to associate with lung transplant outcomes, including CLAD. In this study we aimed to measure the telomere lengths of bronchial and bronchiolar airway cells in lung allografts early after transplantation and to investigate associations with CLAD and all-cause mortality. Methods This prospective, longitudinal study was performed at The Prince Charles Hospital, Australia. Airway cells were collected via bronchial and bronchiolar airway brushings at post-transplant bronchoscopies. The relative telomere length in airway cells was determined by quantitative PCR based on the T/S ratio. All patients were censored for CLAD and all-cause mortality in August 2020. Results In total 231 bronchoscopies incorporating transbronchial brush and bronchial brush were performed in 120 patients. At the time of censoring, 43% and 35% of patients, respectively, had developed CLAD and had died. Airway bronchiolar and bronchial telomere lengths were strongly correlated (r=0.78, p<0.001), confirming conservation of telomere length with airway branch generation. Both the bronchiolar (r = -0.34, p<0.001) and bronchial (r = -0.31, p<0.001) telomere length decreased with age. Shorter airway telomere length was associated with older donor age and higher donor pack-year smoking history. Neither the bronchiolar nor the bronchial airway telomere length were associated with the development of CLAD (HR 0.39 (0.06-2.3), p=0.30; HR 0.66 (0.2-1.7), p=0.39, respectively) or all-cause mortality (HR 0.92 (0.2-4.5), p=0.92; HR 0.47 (0.1-1.9), p=0.28, respectively). Conclusions In this cohort, airway telomere length was associated with donor age and smoking history but was not associated with the future development of CLAD or all-cause mortality.
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Affiliation(s)
- John A. Mackintosh
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Stephanie T. Yerkovich
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Maxine E. Tan
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Luke Samson
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Peter MA Hopkins
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Daniel C. Chambers
- Queensland Lung Transplant Service, Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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23
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Chang AB, Toombs M, Chatfield MD, Mitchell R, Fong SM, Binks MJ, Smith-Vaughan H, Pizzutto SJ, Lust K, Morris PS, Marchant JM, Yerkovich ST, O'Farrell H, Torzillo PJ, Maclennan C, Simon D, Unger HW, Ellepola H, Odendahl J, Marshall HS, Swamy GK, Grimwood K. Study Protocol for Preventing Early-Onset Pneumonia in Young Children Through Maternal Immunisation: A Multi-Centre Randomised Controlled Trial (PneuMatters). Front Pediatr 2021; 9:781168. [PMID: 35111703 PMCID: PMC8802227 DOI: 10.3389/fped.2021.781168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Preventing and/or reducing acute lower respiratory infections (ALRIs) in young children will lead to substantial short and long-term clinical benefits. While immunisation with pneumococcal conjugate vaccines (PCV) reduces paediatric ALRIs, its efficacy for reducing infant ALRIs following maternal immunisation has not been studied. Compared to other PCVs, the 10-valent pneumococcal-Haemophilus influenzae Protein D conjugate vaccine (PHiD-CV) is unique as it includes target antigens from two common lower airway pathogens, pneumococcal capsular polysaccharides and protein D, which is a conserved H. influenzae outer membrane lipoprotein. Aims: The primary aim of this randomised controlled trial (RCT) is to determine whether vaccinating pregnant women with PHiD-CV (compared to controls) reduces ALRIs in their infants' first year of life. Our secondary aims are to evaluate the impact of maternal PHiD-CV vaccination on different ALRI definitions and, in a subgroup, the infants' nasopharyngeal carriage of pneumococci and H. influenzae, and their immune responses to pneumococcal vaccine type serotypes and protein D. Methods: We are undertaking a parallel, multicentre, superiority RCT (1:1 allocation) at four sites across two countries (Australia, Malaysia). Healthy pregnant Australian First Nation or Malaysian women aged 17-40 years with singleton pregnancies between 27+6 and 34+6 weeks gestation are randomly assigned to receive either a single dose of PHiD-CV or usual care. Treatment allocation is concealed. Study outcome assessors are blinded to treatment arms. Our primary outcome is the rate of medically attended ALRIs by 12-months of age. Blood and nasopharyngeal swabs are collected from infants at birth, and at ages 6- and 12-months (in a subset). Our planned sample size (n = 292) provides 88% power (includes 10% anticipated loss to follow-up). Discussion: Results from this RCT potentially leads to prevention of early and recurrent ALRIs and thus preservation of lung health during the infant's vulnerable period when lung growth is maximum. The multicentre nature of our study increases the generalisability of its future findings and is complemented by assessing the microbiological and immunological outcomes in a subset of infants. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374381, identifier: ACTRN12618000150246.
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Affiliation(s)
- Anne B Chang
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Maree Toombs
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
| | - Mark D Chatfield
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Siew M Fong
- Division of Paediatric Infectious Diseases, Hospital Likas, Kota Kinabalu, Malaysia
| | - Michael J Binks
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Heidi Smith-Vaughan
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Susan J Pizzutto
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Karin Lust
- Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Peter S Morris
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hannah O'Farrell
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Paul J Torzillo
- Central Clinical School, University of Sydney, Sydney, NSW, Australia.,Prince Alfred Hospital, Sydney, NSW, Australia
| | - Carolyn Maclennan
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Simon
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Holger W Unger
- Child Health Division and NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Hasthika Ellepola
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Jens Odendahl
- Department of Obstetrics and Gynaecology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Helen S Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide Medical School, Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Geeta K Swamy
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Health System, Durham, NC, United States
| | - Keith Grimwood
- Department of Infectious Disease and Paediatrics, Gold Coast Health, Southport, QLD, Australia.,School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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24
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Flynn DE, Mao D, Yerkovich ST, Franz R, Iswariah H, Hughes A, Shaw IM, Tam DPL, Chandrasegaram MD. The impact of comorbidities on post-operative complications following colorectal cancer surgery. PLoS One 2020; 15:e0243995. [PMID: 33362234 PMCID: PMC7757883 DOI: 10.1371/journal.pone.0243995] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 09/10/2020] [Accepted: 12/01/2020] [Indexed: 02/05/2023] Open
Abstract
Background Colorectal cancer surgery is complex and can result in severe post-operative complications. Optimisation of surgical outcomes requires a thorough understanding of the background complexity and comorbid status of patients. Aim The aim of this study is to determine whether certain pre-existing comorbidities are associated with high grade post-operative complications following colorectal cancer surgery. The study also aims to define the prevalence of demographic, comorbid and surgical features in a population undergoing colorectal cancer resection. Method A colorectal cancer database at The Prince Charles Hospital was established to capture detailed information on patient background, comorbidities and clinicopathological features. A single-centre retrospective study was undertaken to assess the effect of comorbidities on post-operative outcomes following colorectal cancer resection. Five hundred and thirty-three patients were reviewed between 2010–2018 to assess if specific comorbidities were associated with higher grade post-operative complications. A Clavien-Dindo grade of three or higher was defined as a high grade complication. Results Fifty-eight percent of all patients had an ASA grade of ASA III or above. The average BMI of patients undergoing resection was 28 ± 6.0. Sixteen percent of all patients experienced a high grade complications. Patients with high grade complications had a higher mean average age compared to patients with low grade or no post-operative complications (74 years vs 70 years, p = 0.01). Univariate analysis revealed patients with atrial fibrillation, COPD, ischaemic heart disease and heart failure had an increased risk of high grade complications. Multivariate analysis revealed pre-existing atrial fibrillation (OR 2.70, 95% CI 1.53–4.89, p <0.01) and COPD (OR 2.02 1.07–3.80, p = 0.029) were independently associated with an increased risk of high grade complications. Conclusion Pre-existing atrial fibrillation and COPD are independent risk factors for high grade complications. Targeted perioperative management is necessary to optimise outcomes.
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Affiliation(s)
- David E. Flynn
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
- * E-mail:
| | - Derek Mao
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Stephanie T. Yerkovich
- The Common Good Foundation, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Robert Franz
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Harish Iswariah
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrew Hughes
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Ian M. Shaw
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Diana P. L. Tam
- Department of General Surgery, The Prince Charles Hospital, Brisbane, Queensland, Australia
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25
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Ruffles TJC, Marchant JM, Masters IB, Yerkovich ST, Wurzel DF, Gibson PG, Busch G, Baines KJ, Simpson JL, Smith-Vaughan HC, Pizzutto SJ, Buntain HM, Hodge G, Hodge S, Upham JW, Chang AB. Outcomes of protracted bacterial bronchitis in children: A 5-year prospective cohort study. Respirology 2020; 26:241-248. [PMID: 33045125 DOI: 10.1111/resp.13950] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Long-term data on children with PBB has been identified as a research priority. We describe the 5-year outcomes for children with PBB to ascertain the presence of chronic respiratory disease (bronchiectasis, recurrent PBB and asthma) and identify the risk factors for these. METHODS Prospective cohort study was undertaken at the Queensland Children's Hospital, Brisbane, Australia, of 166 children with PBB and 28 controls (undergoing bronchoscopy for symptoms other than chronic wet cough). Monitoring was by monthly contact via research staff. Clinical review, spirometry and CT chest were performed as clinically indicated. RESULTS A total of 194 children were included in the analysis. Median duration of follow-up was 59 months (IQR: 50-71 months) post-index PBB episode, 67.5% had ongoing symptoms and 9.6% had bronchiectasis. Significant predictors of bronchiectasis were recurrent PBB in year 1 of follow-up (ORadj = 9.6, 95% CI: 1.8-50.1) and the presence of Haemophilus influenzae in the BAL (ORadj = 5.1, 95% CI: 1.4-19.1). Clinician-diagnosed asthma at final follow-up was present in 27.1% of children with PBB. A significant BDR (FEV1 improvement >12%) was obtained in 63.5% of the children who underwent reversibility testing. Positive allergen-specific IgE (ORadj = 14.8, 95% CI: 2.2-100.8) at baseline and bronchomalacia (ORadj = 5.9, 95% CI: 1.2-29.7) were significant predictors of asthma diagnosis. Spirometry parameters were in the normal range. CONCLUSION As a significant proportion of children with PBB have ongoing symptoms at 5 years, and outcomes include bronchiectasis and asthma, they should be carefully followed up clinically. Defining biomarkers, endotypes and mechanistic studies elucidating the different outcomes are now required.
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Affiliation(s)
- Tom J C Ruffles
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Academic Department of Paediatrics, The Royal Alexandra Children's Hospital, Brighton and Sussex Medical School, Brighton, UK
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ian B Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Danielle F Wurzel
- Infection and Immunity, Murdoch Children's Research Institute; Respiratory and Sleep Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Greta Busch
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Katherine J Baines
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen M Buntain
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gregory Hodge
- The Chronic Inflammatory Lung Disease Research Laboratory, Department of Thoracic Medicine, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Sandra Hodge
- The Chronic Inflammatory Lung Disease Research Laboratory, Department of Thoracic Medicine, Royal Adelaide Hospital and School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - John W Upham
- The University of Queensland Diamantina Institute and Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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26
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Murray LM, Yerkovich ST, Ferreira MA, Upham JW. Risks for cold frequency vary by sex: role of asthma, age, TLR7 and leukocyte subsets. Eur Respir J 2020; 56:13993003.02453-2019. [PMID: 32513781 DOI: 10.1183/13993003.02453-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/17/2020] [Indexed: 11/05/2022]
Abstract
Viral respiratory infections are usually benign but can trigger asthma exacerbations. The factors associated with upper respiratory tract infection (cold) frequency are not fully understood, nor is it clear whether such factors differ between women and men.To determine which immunological and clinical variables associate with the frequency of self-reported respiratory infections (colds), 150 asthma cases and 151 controls were recruited. Associations between antiviral immune response variables: toll-like receptor (TLR)7/8 gene expression, plasmacytoid dendritic cell (pDC) numbers and interferon-α, tumour necrosis factor and interleukin-12 production, and asthma were then examined that might explain cold frequency.People with asthma cases reported more colds per year (median 3 versus 2; p<0.001) and had lower baseline TLR7 gene expression (odds ratio 0.12; p=0.02) than controls. Associations between many variables and cold frequency differed between women and men. In women, high blood neutrophil counts (β=0.096, p=0.002), and younger age (β=-0.017, p<0.001), but not exposure to children, were independently associated with more frequent colds. In men, low TLR7 expression (β=-0.96, p=0.041) and high CLEC4C gene expression (a marker of pDC; β=0.88, p=0.008) were independently associated with more frequent colds. Poor asthma symptom control was independently associated with reduced TLR8 gene expression (β=-1.4, p=0.036) and high body mass index (β=0.041, p=0.004).Asthma, age and markers of inflammation and antiviral immunity in peripheral blood are associated with frequent colds. Interestingly, the variables associated with cold frequency differed between women and men.
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Affiliation(s)
- Liisa M Murray
- Diamantina Institute, The University of Queensland, Brisbane, Australia
| | | | | | - John W Upham
- Diamantina Institute, The University of Queensland, Brisbane, Australia.,Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, Australia
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27
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Walsh JR, Pegg J, Yerkovich ST, Morris N, McKeough ZJ, Comans T, Paratz JD, Chambers DC. Longevity of pulmonary rehabilitation benefit for chronic obstructive pulmonary disease-health care utilisation in the subsequent 2 years. BMJ Open Respir Res 2019; 6:e000500. [PMID: 31803476 PMCID: PMC6890390 DOI: 10.1136/bmjresp-2019-000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 11/14/2022] Open
Abstract
Background The primary aim was to determine the healthcare utilisation benefits including respiratory-related hospital admissions, hospital admission days and emergency department presentations in the 0–12 and 12–24 months postpulmonary rehabilitation compared with the 12 months preprogramme. Methods An observational, data-linkage design of 11 standardised pulmonary rehabilitation programmes were used. All programmes were 8 weeks in duration with two supervised exercise sessions per week and were required to use the national pulmonary rehabilitation recommendations with regard to programme organisation, exercise training guidelines and multidisciplinary education. For each participant with chronic obstructive pulmonary disease (COPD), healthcare utilisation data were collected for the 12 months preprogramme and 24 months postprogramme. Results 426 participants (231 males, FEV149.3 (19.6) % predicted) were studied. The number of respiratory admissions/participant/year decreased from 0.7 (1.1) in the 12 months preprogramme to 0.5 (1.9) in the 12 months postprogramme, p=0.083; but increased in the 12–24 months postprogramme to 1.0 (2.3), p<0.001. The hospital days/participant/year improved from 4.0 (7.8) days in the 12 months preprogramme to 2.5 (8.5) days in the 12 months postprogramme, p<0.001; but increased in the 12–24 months postprogramme to 6.1 (16.6) days, p=0.004. The emergency department presentations/participant/year improved from 1.15 (1.75) in the 12 months preprogramme to 0.9 (1.8) in the 12 months postprogramme, p=0.003; but increased in the 12–24 months postprogramme to 2.0 (3.3), p<0.001. Conclusion Pulmonary rehabilitation significantly improves hospital days and emergency department presentations in the first 12 months postprogramme. Healthcare utilisation benefits in the second 12 months are less clear.
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Affiliation(s)
- James R Walsh
- Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Jane Pegg
- Physiotherapy, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Norman Morris
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Zoe J McKeough
- Discipline of Physiotherapy, The University of Sydney, Sydney, New South Wales, Australia
| | - Tracy Comans
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Jenny D Paratz
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Daniel C Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Faculty of Health Sciences, Brisbane, Queensland, Australia
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28
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Wong OY, Marchant JM, Yerkovich ST, Chang AB. Predictors of time to cough resolution in children with chronic wet cough treated with antibiotics after bronchoscopy. Pediatr Pulmonol 2019; 54:1997-2002. [PMID: 31496125 DOI: 10.1002/ppul.24506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/21/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic wet cough is common in pediatric pulmonology practice and is clinically important. Guidelines recommend treatment with antibiotics as their effectiveness has been proven. However, factors associated with duration of cough in response to antibiotics in children with chronic wet cough have not been prospectively examined. OBJECTIVE To determine if demographic, clinical and/or bronchoalveolar lavage (BAL) factors are associated with "time to cough resolution" in children with chronic wet cough treated with antibiotics after bronchoscopy. METHODS Data from children with chronic wet cough treated with antibiotics after bronchoscopy were extracted from a prospective cohort study database. Cough dairies were used to determine when the cough resolved. Associations between various factors with "time to cough resolution" were examined using regression. RESULTS The median age of the 133 children was 2.4 years (interquartile range, 1.4-4.9). Duration of prior cough at bronchoscopy was significantly positively related with "time to cough resolution" (β = .010; 95% confidence interval, 0.004-0.017; P = .002). This translated to; for each month of prior cough, it took an extra 1.02 days to achieve cough resolution while on antibiotic treatment. Gender, age, diagnosis, tobacco smoke exposure, pneumonia history, blood cellularity, and BAL cellular and microbiology profiles were not significantly associated with time to cough resolution. CONCLUSION In children with chronic wet cough, duration of cough before antibiotic treatment is a small but significant determinant of "time to cough resolution." Research using standardized antibiotic regimes is required to provide clinical and/or biomarkers that can further identify factors associated with the response of chronic cough to antibiotic treatment.
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Affiliation(s)
- Oi Yin Wong
- Department of Paediatric and Adolescent Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong.,Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Anne B Chang
- Children's Centre of Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
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29
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Marsh RL, Smith-Vaughan HC, Chen AC, Marchant JM, Yerkovich ST, Gibson PG, Pizzutto SJ, Hodge S, Upham JW, Chang AB. Multiple Respiratory Microbiota Profiles Are Associated With Lower Airway Inflammation in Children With Protracted Bacterial Bronchitis. Chest 2019; 155:778-786. [DOI: 10.1016/j.chest.2019.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 12/01/2022] Open
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30
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Chen ACH, Pena OM, Nel HJ, Yerkovich ST, Chang AB, Baines KJ, Gibson PG, Petsky HL, Pizzutto SJ, Hodge S, Masters IB, Buntain HL, Upham JW. Airway cells from protracted bacterial bronchitis and bronchiectasis share similar gene expression profiles. Pediatr Pulmonol 2018; 53:575-582. [PMID: 29575797 DOI: 10.1002/ppul.23984] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 02/14/2018] [Indexed: 11/06/2022]
Abstract
AIM Protracted bacterial bronchitis (PBB) is a common cause of prolonged cough in young children, and may be a precursor of bronchiectasis. Bacteria are often present in the lower airways in both PBB and bronchiectasis and may cause persistent infections. However, there is a paucity of information available on the pathogenesis of PBB and the factors associated with persistent bacterial infection and progression to bronchiectasis. This study hypothesised that lung immune cells in recurrent PBB and bronchiectasis differentially express genes related to immune cell dysfunction compared to lung immune cells from control subjects. METHOD Cells isolated from bronchoalveolar lavage (adult-control and PBB BAL cells) were stimulated with nontypeable Haemophilus influenzae (NTHi), and expression of genes involved in various inflammatory pathways was assessed. RESULT NTHi induced production of large amounts of IL-1β, IL-6, and IL-8 in adult-control BAL cells, however BAL cells from PBB airways appeared refractory to NTHi stimulation. BAL cells from PBB and bronchiectasis showed differential expression of several genes relative to control cells, including CCL20, MARCO, CCL24, IL-10, PPAR-γ, CD200R, TREM2, RelB. Expression of genes involved in resolution of inflammation and anti-inflammation response, such as CD200R and IL-10, was associated with the number of pathogenic bacteria found in the airways. CONCLUSION In summary, we have shown that the expression of genes related to macrophage function and resolution of inflammation are similar in PBB and bronchiectasis. Lung immune cell dysfunction in PBB and bronchiectasis may contribute to poor bacterial clearance and prolonged resolution of inflammation.
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Affiliation(s)
- Alice C-H Chen
- Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia.,Diamantina Institute, The University of Queensland, Brisbane, Australia
| | - Olga M Pena
- Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia
| | - Hendrik J Nel
- Diamantina Institute, The University of Queensland, Brisbane, Australia
| | | | - Anne B Chang
- Queensland University of Technology, CCHR, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia
| | | | | | - Helen L Petsky
- Queensland University of Technology, CCHR, Brisbane, Australia
| | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia
| | | | - Ian B Masters
- Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Australia
| | | | - John W Upham
- Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia.,Diamantina Institute, The University of Queensland, Brisbane, Australia
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Chen ACH, Tran HB, Xi Y, Yerkovich ST, Baines KJ, Pizzutto SJ, Carroll M, Robertson AAB, Cooper MA, Schroder K, Simpson JL, Gibson PG, Hodge G, Masters IB, Buntain HM, Petsky HL, Prime SJ, Chang AB, Hodge S, Upham JW. Multiple inflammasomes may regulate the interleukin-1-driven inflammation in protracted bacterial bronchitis. ERJ Open Res 2018; 4:00130-2017. [PMID: 29594175 PMCID: PMC5868518 DOI: 10.1183/23120541.00130-2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/26/2017] [Accepted: 02/08/2018] [Indexed: 11/21/2022] Open
Abstract
Protracted bacterial bronchitis (PBB) in young children is characterised by prolonged wet cough, prominent airway interleukin (IL)-1β expression and infection, often with nontypeable Haemophilus influenzae (NTHi). The mechanisms responsible for IL-1-driven inflammation in PBB are poorly understood. We hypothesised that the inflammation in PBB involves the NLRP3 and/or AIM2 inflammasome/IL-1β axis. Lung macrophages obtained from bronchoalveolar lavage (BAL), peripheral blood mononuclear cells (PBMCs), blood monocytes and monocyte-derived macrophages from patients with PBB and age-matched healthy controls were cultured in control medium or exposed to live NTHi. In healthy adult PBMCs, CD14+ monocytes contributed to 95% of total IL-1β-producing cells upon NTHi stimulation. Stimulation of PBB PBMCs with NTHi significantly increased IL-1β expression (p<0.001), but decreased NLRC4 expression (p<0.01). NTHi induced IL-1β secretion in PBMCs from both healthy controls and patients with recurrent PBB. This was inhibited by Z-YVAD-FMK (a caspase-1 selective inhibitor) and by MCC950 (a NLRP3 selective inhibitor). In PBB BAL macrophages inflammasome complexes were visualised as fluorescence specks of NLRP3 or AIM2 colocalised with cleaved caspase-1 and cleaved IL-1β. NTHi stimulation induced formation of specks of cleaved IL-1β, NLRP3 and AIM2 in PBMCs, blood monocytes and monocyte-derived macrophages. We conclude that both the NLRP3 and AIM2 inflammasomes probably drive the IL-1β-dominated inflammation in PBB. Airway IL-1β activation in protracted bacterial bronchitishttp://ow.ly/ut9r30iqim2
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Affiliation(s)
- Alice C-H Chen
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Joint first authors
| | - Hai B Tran
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Joint first authors
| | - Yang Xi
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia
| | - Melanie Carroll
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Kate Schroder
- Institute for Molecular Bioscience, Brisbane, Australia
| | | | | | - Greg Hodge
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Dept of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ian B Masters
- Respiratory and Sleep Medicine, Lady Cilento Children's Hospital and Children's Centre for Health Research, Queensland University of Technology, Brisbane, Australia
| | | | - Helen L Petsky
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia.,Queensland University of Technology, Brisbane, Australia
| | - Sandra Hodge
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Dept of Medicine, The University of Adelaide, Adelaide, Australia.,Joint senior authors
| | - John W Upham
- Diamantina Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Joint senior authors
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Chen ACH, Xi Y, Carroll M, Petsky HL, Gardiner SJ, Pizzutto SJ, Yerkovich ST, Baines KJ, Gibson PG, Hodge S, Masters IB, Buntain HM, Chang AB, Upham JW. Cytokine responses to two common respiratory pathogens in children are dependent on interleukin-1β. ERJ Open Res 2017; 3:00025-2017. [PMID: 29204435 PMCID: PMC5703357 DOI: 10.1183/23120541.00025-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 02/26/2017] [Accepted: 07/07/2017] [Indexed: 11/05/2022] Open
Abstract
Protracted bacterial bronchitis (PBB) in young children is a common cause of prolonged wet cough and may be a precursor to bronchiectasis in some children. Although PBB and bronchiectasis are both characterised by neutrophilic airway inflammation and a prominent interleukin (IL)-1β signature, the contribution of the IL-1β pathway to host defence is not clear. This study aimed to compare systemic immune responses against common pathogens in children with PBB, bronchiectasis and control children and to determine the importance of the IL-1β pathway. Non-typeable Haemophilus influenzae (NTHi) stimulation of peripheral blood mononuclear cells (PBMCs) from control subjects (n=20), those with recurrent PBB (n=20) and bronchiectasis (n=20) induced high concentrations of IL-1β, IL-6, interferon (IFN)-γ and IL-10. Blocking with an IL-1 receptor antagonist (IL-1Ra) modified the cellular response to pathogens, inhibiting cytokine synthesis by NTHi-stimulated PBMCs and rhinovirus-stimulated PBMCs (in a separate PBB cohort). Inhibition of IFN-γ production by IL-1Ra was observed across multiple cell types, including CD3+ T cells and CD56+ NK cells. Our findings highlight the extent to which IL-1β regulates the cellular immune response against two common respiratory pathogens. While blocking the IL-1β pathway has the potential to reduce inflammation, this may come at the cost of protective immunity against NTHi and rhinovirus.
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Affiliation(s)
- Alice C-H Chen
- Diamantina Institute, The University of Queensland, Brisbane, Australia.,These authors contributed equally
| | - Yang Xi
- Diamantina Institute, The University of Queensland, Brisbane, Australia.,These authors contributed equally
| | - Melanie Carroll
- Diamantina Institute, The University of Queensland, Brisbane, Australia
| | - Helen L Petsky
- Queensland University of Technology, CCHR, Brisbane, Australia
| | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia
| | | | | | | | | | - Ian B Masters
- Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Brisbane, Australia
| | | | - Anne B Chang
- Queensland University of Technology, CCHR, Brisbane, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin Hospital, Darwin, Australia
| | - John W Upham
- Diamantina Institute, The University of Queensland, Brisbane, Australia
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33
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Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Chang AB. Response. Chest 2017; 151:940-941. [PMID: 28390631 DOI: 10.1016/j.chest.2016.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, Brisbane, QLD, Australia; Murdoch Childrens Research Institute and The Royal Children's Hospital, Melbourne, VIC.
| | - Julie M Marchant
- Queensland Children's Medical Research Institute, Brisbane, QLD, Australia; Queensland Children's Health Service, Brisbane, QLD, Australia
| | - Stephanie T Yerkovich
- Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, QLD, Australia; School of Medicine, The University of Queensland; School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - John W Upham
- School of Medicine, The University of Queensland; School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Anne B Chang
- Queensland Children's Medical Research Institute, Brisbane, QLD, Australia; Queensland Children's Health Service, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Alghamry A, Ponnuswamy SK, Agarwal A, Moattar H, Yerkovich ST, Vandeleur AE, Thomas J, Croese J, Rahman T, Hodgson R. Split-dose bowel preparation with polyethylene glycol for colonoscopy performed under propofol sedation. Is there an optimal timing? J Dig Dis 2017; 18:160-168. [PMID: 28188978 DOI: 10.1111/1751-2980.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/29/2017] [Accepted: 02/07/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Aspiration risk, especially with propofol sedation, remains a concern after split-dose bowel preparation of up to 1 L polyethylene glycol for the procedure. We aimed to identify the ideal timing of bowel preparation to achieve optimal colon cleansing with no increased risk of aspiration. METHODS A total of 892 consecutive patients undergoing simultaneous esophagogastroduodenoscopy (EGD) and colonoscopy were prospectively recruited. Residual gastric volume (RGV) and pH of gastric contents were measured at EGD, and patients' characteristics, runway time (duration between completion of the final liter of bowel preparation and colonoscopy commencement), and cleansing quality were recorded. RESULTS A shorter runway time resulted in better colon cleansing (r = -0.124, P < 0.001). No correlation between runway time and RGV or pH was found (r = -0.017, P = 0.62 and r = -0.030, P = 0.47, respectively). RGV and pH did not differ significantly with runway time of 4 or 5 h. RGV with runway time ≤3 h was 35.9 ± 11.8 mL and 17.4 ± 0.6 mL after runway time >3 h (P < 0.001). No aspiration pneumonia occurred. The only factors independently related to higher RGV were younger age and male sex. CONCLUSIONS The consumption of bowel preparation agent within 3-4 h before propofol sedation resulted in a similar RGV and pH as those achieved by more prolonged fasting, with no increased risk of aspiration even in patients perceived to be at high risk.
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Affiliation(s)
- Alaa Alghamry
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sureshkumar K Ponnuswamy
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Aditya Agarwal
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Hadi Moattar
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,QLD Lung Transplant Service, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Ann E Vandeleur
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia
| | -
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - James Thomas
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - John Croese
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia.,Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Tony Rahman
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia.,Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Ruth Hodgson
- Department of Gastroenterology and Hepatology, Centre for Service and Quality Improvement, The Prince Charles Hospital, Chermside, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Petsky HL, Smith-Vaughan H, Masters B, Buntain H, Chang AB. Protracted Bacterial Bronchitis in Children: Natural History and Risk Factors for Bronchiectasis. Chest 2016; 150:1101-1108. [PMID: 27400908 DOI: 10.1016/j.chest.2016.06.030] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Protracted bacterial bronchitis (PBB) and bronchiectasis are distinct diagnostic entities that share common clinical and laboratory features. It is postulated, but remains unproved, that PBB precedes a diagnosis of bronchiectasis in a subgroup of children. In a cohort of children with PBB, our objectives were to (1) determine the medium-term risk of bronchiectasis and (2) identify risk factors for bronchiectasis and recurrent episodes of PBB. METHODS One hundred sixty-one children with PBB and 25 control subjects were prospectively recruited to this cohort study. A subset of 106 children was followed for 2 years. Flexible bronchoscopy, BAL, and basic immune function tests were performed. Chest CT was undertaken if clinical features were suggestive of bronchiectasis. RESULTS Of 161 children with PBB (66% boys), 13 were diagnosed with bronchiectasis over the study period (8.1%). Almost one-half with PBB (43.5%) had recurrent episodes (> 3/y). Major risk factors for bronchiectasis included lower airway infection with Haemophilus influenzae (recovered in BAL fluid) (P = .013) and recurrent episodes of PBB (P = .003). H influenzae infection conferred a more than seven times higher risk of bronchiectasis (hazard ratio, 7.55; 95% CI, 1.66-34.28; P = .009) compared with no H influenzae infection. The majority of isolates (82%) were nontypeable H influenzae. No risk factors for recurrent PBB were identified. CONCLUSIONS PBB is associated with a future diagnosis of bronchiectasis in a subgroup of children. Lower airway infection with H influenzae and recurrent PBB are significant predictors. Clinicians should be cognizant of the relationship between PBB and bronchiectasis, and appropriate follow-up measures should be taken in those with risk factors.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, Brisbane, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Julie M Marchant
- Queensland Children's Medical Research Institute, Brisbane, Australia; Queensland Children's Health Service, Brisbane, Australia
| | - Stephanie T Yerkovich
- Queensland Lung Transplant Service, Prince Charles Hospital, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - John W Upham
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Helen L Petsky
- Queensland Children's Medical Research Institute, Brisbane, Australia; Queensland Children's Health Service, Brisbane, Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; School of Medicine, Griffith University, Gold Coast, Australia
| | - Brent Masters
- Queensland Children's Medical Research Institute, Brisbane, Australia; Queensland Children's Health Service, Brisbane, Australia
| | - Helen Buntain
- Queensland Children's Medical Research Institute, Brisbane, Australia
| | - Anne B Chang
- Queensland Children's Medical Research Institute, Brisbane, Australia; Queensland Children's Health Service, Brisbane, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Sinclair KA, Yerkovich ST, Chen T, McQualter JL, Hopkins PMA, Wells CA, Chambers DC. Mesenchymal Stromal Cells are Readily Recoverable from Lung Tissue, but not the Alveolar Space, in Healthy Humans. Stem Cells 2016; 34:2548-2558. [PMID: 27352824 DOI: 10.1002/stem.2419] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/14/2016] [Accepted: 05/06/2016] [Indexed: 12/17/2022]
Abstract
Stromal support is critical for lung homeostasis and the maintenance of an effective epithelial barrier. Despite this, previous studies have found a positive association between the number of mesenchymal stromal cells (MSCs) isolated from the alveolar compartment and human lung diseases associated with epithelial dysfunction. We hypothesised that bronchoalveolar lavage derived MSCs (BAL-MSCs) are dysfunctional and distinct from resident lung tissue MSCs (LT-MSCs). In this study, we comprehensively interrogated the phenotype and transcriptome of human BAL-MSCs and LT-MSCs. We found that MSCs were rarely recoverable from the alveolar space in healthy humans, but could be readily isolated from lung transplant recipients by bronchoalveolar lavage. BAL-MSCs exhibited a CD90Hi , CD73Hi , CD45Neg , CD105Lo immunophenotype and were bipotent, lacking adipogenic potential. In contrast, MSCs were readily recoverable from healthy human lung tissue and were CD90Hi or Lo , CD73Hi , CD45Neg , CD105Int and had full tri-lineage potential. Transcriptional profiling of the two populations confirmed their status as bona fide MSCs and revealed a high degree of similarity between each other and the archetypal bone-marrow MSC. 105 genes were differentially expressed; 76 of which were increased in BAL-MSCs including genes involved in fibroblast activation, extracellular matrix deposition and tissue remodelling. Finally, we found the fibroblast markers collagen 1A1 and α-smooth muscle actin were increased in BAL-MSCs. Our data suggests that in healthy humans, lung MSCs reside within the tissue, but in disease can differentiate to acquire a profibrotic phenotype and migrate from their in-tissue niche into the alveolar space. Stem Cells 2016;34:2548-2558.
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Affiliation(s)
- K A Sinclair
- School of Medicine, The Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia. .,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
| | - S T Yerkovich
- School of Medicine, The Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - T Chen
- The Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
| | - J L McQualter
- Lung and Regenerative Medical Institutes, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - P M-A Hopkins
- School of Medicine, The Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - C A Wells
- The Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
| | - D C Chambers
- School of Medicine, The Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Wood ME, Sherrard LJ, Ramsay KA, Yerkovich ST, Reid DW, Kidd TJ, Bell SC. Methicillin-resistant Staphylococcus aureus acquisition in healthcare workers with cystic fibrosis: a retrospective cross-sectional study. BMC Pulm Med 2016; 16:78. [PMID: 27170040 PMCID: PMC4865022 DOI: 10.1186/s12890-016-0243-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/01/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND People with cystic fibrosis (CF) may work in healthcare settings risking nosocomial pathogen acquisition. The aim of this study was to determine the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in adult healthcare workers with CF (HCWcf). METHODS Data was collected in this observational study on MRSA acquisition from 405 CF patients attending an adult CF centre in Australia between 2001-2012. Demographic and clinical characteristics were compared between HCWcf and non-HCWcf. A sub-analysis was subsequently performed to compare demographic and clinical characteristics between those patients (HCWcf versus non-HCWcf) that acquired MRSA. We also investigated rates of chronic MRSA infection and the outcome of eradication treatment in HCWcf. RESULTS A higher proportion of HCWcf acquired MRSA [n = 10/21] compared to non-HCWcf [n = 40/255] (P <0.001). The odds of MRSA acquisition were 8.4 (95 % CI, 3.0 - 23.4) times greater in HCWcf than non-HCWcf. HCWcf with MRSA were older (P = 0.02) and had better lung function (P = 0.009), yet hospitalisation rates were similar compared to non-HCWcf with MRSA. Chronic MRSA infection developed in 36/50 CF patients (HCWcf, n = 6; non-HCWcf, n = 30), with eradication therapy achieved in 5/6 (83 %) HCWcf. CONCLUSIONS The rate of MRSA incidence was highest in HCWcf and the workplace is a possible source of acquisition. Vocational guidance should include the potential for MRSA acquisition for CF patients considering healthcare professions.
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Affiliation(s)
- Michelle E Wood
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia. .,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia. .,School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia.
| | - Laura J Sherrard
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.,CF & Airways Microbiology Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Kay A Ramsay
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.,School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD, 4032, Australia
| | - David W Reid
- Adult Cystic Fibrosis Centre, The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia.,Lung Inflammation and Infection Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia
| | - Timothy J Kidd
- Centre for Experimental Medicine, The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, UK.,School of Chemistry and Molecular Biosciences, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4072, Australia
| | - Scott C Bell
- Lung Bacteria Group, QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane, QLD, 4006, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, 627 Rode Road, Chermside, Brisbane, QLD, 4032, Australia.,School of Medicine, The University of Queensland, 288 Herston Road, Brisbane, QLD, 4006, Australia
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Abstract
BACKGROUND Chronic neutrophilic inflammation, in both the presence and absence of infection, is a feature of bronchiectasis in adults and children. The anti-inflammatory properties of non-steroid anti-inflammatory drugs (NSAIDs) may be beneficial in reducing airway inflammation, thus potentially improving lung function and quality of life in patients with bronchiectasis. OBJECTIVES To evaluate the efficacy of inhaled NSAIDs in the management of non-cystic fibrosis bronchiectasis in children and adults:• during stable bronchiectasis; and• for reduction of:∘ severity and frequency of acute respiratory exacerbations; and∘ long-term pulmonary decline. SEARCH METHODS We searched the Cochrane Airways Group Trials Register, which includes reports identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched the trial registry ClinicalTrials.gov and the World Health Organization (WHO) trial portal. We carried out the latest searches on 22 September 2015. SELECTION CRITERIA All randomised controlled trials comparing inhaled NSAIDs versus a control (placebo or usual treatment) in children or adults with bronchiectasis not related to cystic fibrosis. DATA COLLECTION AND ANALYSIS We reviewed the results of searches against predetermined criteria for inclusion. MAIN RESULTS One small, short-term trial was eligible for inclusion. We included this study of 25 adults with chronic lung disease (only 32% of people included in the trial had bronchiectasis), as the other conditions were linked to development of bronchiectasis, and all were characterised by chronic sputum production. We were not able to obtain separate data for people with a diagnosis of bronchiectasis. We judged that the study was at a high risk of selection bias.The primary outcome (mean difference in control of bronchiectasis severity, quality of life (Qol), cough scores) was not reported in the included study. The single trial in adults reported a significant reduction in sputum production over 14 days for the treatment group (inhaled indomethacin) compared with the placebo group (mean difference (MD) -75.00 g/day; 95% confidence interval (CI) -134.61 to -15.39) and a significant improvement in the Borg Dyspnoea Scale score (MD -1.90, 95% CI -3.15 to -0.65). We noted no significant differences between groups in lung function or blood indices and no reported adverse events. AUTHORS' CONCLUSIONS No new studies of adults or children have been conducted since the last version of this review was published. Therefore, final conclusions have not changed. Current evidence is insufficient to support or refute the use of inhaled NSAIDs for the management of bronchiectasis in adults or children. One small trial reported a reduction in sputum production and improved dyspnoea among adults with chronic lung disease who were treated with inhaled indomethacin, indicating that additional studies on the efficacy of NSAIDs for treatment of patients with bronchiectasis are warranted.
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Affiliation(s)
- Susan J Pizzutto
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionRoyal Darwin Hospital CampusDarwinNorthern TerritoryAustralia0811
| | - John W Upham
- The University of Queensland & Department of Respiratory Medicine, Princess Alexandra HospitalSchool of MedicineIpswich RoadBrisbaneQueenslandAustralia4102
| | - Stephanie T Yerkovich
- The Prince Charles HospitalQLD Lung Transplant ServiceRode RdChermsideBrisbaneQueenslandAustralia4032
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionRoyal Darwin Hospital CampusDarwinNorthern TerritoryAustralia0811
- Queensland University of TechnologyQueensland Children's Medical Research InstituteBrisbaneAustralia
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Smith DJ, Ramsay KA, Yerkovich ST, Reid DW, Wainwright CE, Grimwood K, Bell SC, Kidd TJ. Pseudomonas aeruginosa antibiotic resistance in Australian cystic fibrosis centres. Respirology 2015; 21:329-37. [PMID: 26711802 DOI: 10.1111/resp.12714] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/20/2015] [Accepted: 08/29/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE In cystic fibrosis (CF), chronic Pseudomonas aeruginosa infection is associated with increased morbidity, antibiotic treatments and mortality. By linking Australian CF registry data with a national microbiological data set, we examined the association between where treatment was delivered, its intensity and P. aeruginosa antibiotic resistance. METHODS Sputa were collected from paediatric and adult CF patients attending 18 Australian CF centres. P. aeruginosa antibiotic susceptibilities determined by local laboratories were correlated with clinical characteristics, treatment intensity and infection with strains commonly shared among Australian CF patients. Between-centre differences in treatment and antibiotic resistance were also compared. RESULTS Large variations in antibiotic usage, maintenance treatment practices and multi-antibiotic resistant P. aeruginosa (MARPA) prevalence exist between Australian CF centres, although the overall proportions of MARPA isolates were similar in paediatric and adult centres (31% vs 35%, P = 0.29). Among paediatric centres, MARPA correlated with intravenous antibiotic usage and the Australian state where treatment was delivered, while azithromycin, reduced lung function and treating state predicted intravenous antibiotic usage. In adult centres, body mass index (BMI) and treating state were associated with MARPA, while intravenous antibiotic use was predicted by gender, BMI, dornase-alpha, azithromycin, lung function and treating state. In adults, P. aeruginosa strains AUST-01 and AUST-02 independently predicted intravenous antibiotic usage. CONCLUSION Increased treatment intensity in paediatric centres and the Australian state where treatment was received are both associated with greater risk of MARPA, but not worse clinical outcomes.
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Affiliation(s)
- Daniel J Smith
- The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,The Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kay A Ramsay
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - David W Reid
- The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,The Infection and Inflammation Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University and Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Scott C Bell
- The Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Children's Medical Research Institute, Children's Health Queensland, Brisbane, Queensland, Australia.,The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Timothy J Kidd
- The Lung Bacteria Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Centre for Infection & Immunity, Queen's University Belfast, Belfast, Northern Ireland, UK
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McKeon NJ, Timmins SN, Stewart H, Yerkovich ST, McKeon JL. Diagnosis of COPD before cardiac surgery. Eur Respir J 2015; 46:1498-500. [PMID: 26293502 DOI: 10.1183/13993003.02339-2014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 06/15/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nicholas J McKeon
- Holy Spirit Lung Function Laboratory, Holy Spirit Northside Private Hospital, Brisbane, Australia
| | - Sjane N Timmins
- Holy Spirit Lung Function Laboratory, Holy Spirit Northside Private Hospital, Brisbane, Australia
| | - Heather Stewart
- Holy Spirit Lung Function Laboratory, Holy Spirit Northside Private Hospital, Brisbane, Australia
| | | | - James L McKeon
- Holy Spirit Lung Function Laboratory, Holy Spirit Northside Private Hospital, Brisbane, Australia
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41
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Chang AB, Marsh RL, Upham JW, Hoffman LR, Smith-Vaughan H, Holt D, Toombs M, Byrnes C, Yerkovich ST, Torzillo PJ, O'Grady KAF, Grimwood K. Toward making inroads in reducing the disparity of lung health in Australian indigenous and new zealand māori children. Front Pediatr 2015; 3:9. [PMID: 25741502 PMCID: PMC4327127 DOI: 10.3389/fped.2015.00009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/26/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; Queensland Children's Medical Research Institute, Queensland University of Technology , Brisbane, QLD , Australia
| | - Robyn L Marsh
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - John W Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital , Brisbane, QLD , Australia ; School of Medicine, The University of Queensland , Brisbane, QLD , Australia
| | - Lucas R Hoffman
- Department of Pediatrics, University of Washington , Seattle, WA , USA ; Department of Microbiology, University of Washington , Seattle, WA , USA
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Deborah Holt
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Maree Toombs
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; Indigenous Health, Toowoomba Rural Clinical School, The University of Queensland , Toowoomba, QLD , Australia
| | - Catherine Byrnes
- Paediatric Department, University of Auckland & Starship Children's Hospital , Auckland , New Zealand
| | - Stephanie T Yerkovich
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; School of Medicine, The University of Queensland , Brisbane, QLD , Australia ; Queensland Lung Transplant Service, The Prince Charles Hospital , Chermside, QLD , Australia
| | - Paul J Torzillo
- Nganampa Health Council, Alice Springs and Royal Prince Alfred Hospital, The University of Sydney , Sydney, NSW , Australia
| | - Kerry-Ann F O'Grady
- Queensland Children's Medical Research Institute, Queensland University of Technology , Brisbane, QLD , Australia
| | - Keith Grimwood
- Gold Coast University Hospital, Griffith University , Gold Coast, QLD , Australia
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Baines KJ, Upham JW, Yerkovich ST, Chang AB, Marchant JM, Carroll M, Simpson JL, Gibson PG. Mediators of neutrophil function in children with protracted bacterial bronchitis. Chest 2014; 146:1013-1020. [PMID: 24874501 DOI: 10.1378/chest.14-0131] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Protracted bacterial bronchitis (PBB) is a common and treatable cause of chronic wet cough in children in which the mechanisms are not understood. This study investigates the IL-1 pathway and a neutrophil gene expression signature in PBB. METHODS BAL was collected from children in an experimental cohort (n = 21, PBB; n = 33, control subjects), and a second validation cohort (n = 36, PBB; n = 11, control subjects). IL-1β, IL-1 receptor antagonist (IL-1RA), and α-defensins 1-3 were assayed by enzyme-linked immunosorbent assay, western blot, and quantitative real-time polymerase chain reaction, together with selected IL-1 pathway members and neutrophil-related molecules. RESULTS In the experimental cohort, children with symptomatic PBB had significantly higher levels of IL-1β and α-defensin gene and protein expression. Expression of the neutrophil chemokine receptor C-X-C motif receptor 2 was also higher in PBB. IL-1RA protein was higher, however, the IL-1RA:IL-1β ratio was lower in children with PBB than control subjects. In the validation cohort, protein and gene expression of IL-1β and α-defensins 1-3 were confirmed higher, as was gene expression of IL-1 pathway members and C-X-C motif receptor 2. IL-1β and α-defensin 1-3 levels lowered when PBB was treated and resolved. In children with recurrent PBB, gene expression of the IL-1β signaling molecules pellino-1 and IL-1 receptor-associated kinase 2 was significantly higher. IL-1β protein levels correlated with BAL neutrophilia and the duration and severity of cough symptoms. IL-1β and α-defensin 1-3 levels were highly correlated. CONCLUSIONS PBB is characterized by increased IL-1β pathway activation. IL-1β and related mediators were associated with BAL neutrophils, cough symptoms, and disease recurrence, providing insight into PBB pathogenesis.
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Affiliation(s)
- Katherine J Baines
- The Priority Research Centre for Asthma and Respiratory Diseases, Callaghan, NSW; The University of Newcastle, Callaghan, NSW.
| | - John W Upham
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW
| | - Stephanie T Yerkovich
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW; Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW
| | - Anne B Chang
- School of Medicine, The University of Queensland, Brisbane, QLD; Qld Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD; Department of Respiratory Medicine, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW; School of Medicine, The University of Queensland, Brisbane, QLD
| | - Melanie Carroll
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW
| | - Jodie L Simpson
- The Priority Research Centre for Asthma and Respiratory Diseases, Callaghan, NSW; The University of Newcastle, Callaghan, NSW
| | - Peter G Gibson
- The Priority Research Centre for Asthma and Respiratory Diseases, Callaghan, NSW; The University of Newcastle, Callaghan, NSW
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Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Mackay IM, Masters IB, Chang AB. Prospective characterization of protracted bacterial bronchitis in children. Chest 2014; 145:1271-1278. [PMID: 24435356 PMCID: PMC7173205 DOI: 10.1378/chest.13-2442] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Prior studies on protracted bacterial bronchitis (PBB) in children have been retrospective or based on small cohorts. As PBB shares common features with other pediatric conditions, further characterization is needed to improve diagnostic accuracy among clinicians. In this study, we aim to further delineate the clinical and laboratory features of PBB in a larger cohort, with a specific focus on concurrent viral detection. METHODS Children with and without PBB (control subjects) undergoing flexible bronchoscopy were prospectively recruited. Basic immune function testing and lymphocyte subset analyses were performed. BAL specimens were processed for cellularity and microbiology. Viruses were identified using polymerase chain reaction (PCR) and bacteria were identified via culture. RESULTS The median age of the 104 children (69% male) with PBB was 19 months (interquartile range [IQR], 12-30 mo). Compared with control subjects, children with PBB were more likely to have attended childcare (OR, 8.43; 95% CI, 2.34-30.46). High rates of wheeze were present in both groups, and tracheobronchomalacia was common. Children with PBB had significantly elevated percentages of neutrophils in the lower airways compared with control subjects, and adenovirus was more likely to be detected in BAL specimens in those with PBB (OR, 6.69; 95% CI, 1.50-29.80). Median CD56 and CD16 natural killer (NK) cell levels in blood were elevated for age in children with PBB (0.7 × 109/L; IQR, 0.5-0.9 cells/L). CONCLUSIONS Children with PBB are, typically, very young boys with prolonged wet cough and parent-reported wheeze who have attended childcare. Coupled with elevated NK-cell levels, the association between adenovirus and PBB suggests a likely role of viruses in PBB pathogenesis.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD.
| | - Julie M Marchant
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD
| | - Stephanie T Yerkovich
- School of Medicine, The University of Queensland, Brisbane, QLD; Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, QLD
| | - John W Upham
- School of Medicine, The University of Queensland, Brisbane, QLD; Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, QLD
| | - Ian M Mackay
- Queensland Paediatric, Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert, Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, The University of Queensland, Herston, QLD
| | - I Brent Masters
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD
| | - Anne B Chang
- Queensland Children's Medical Research Institute, The University of Queensland, and Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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44
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Pizzutto SJ, Yerkovich ST, Upham JW, Hales BJ, Thomas WR, Chang AB. Children with chronic suppurative lung disease have a reduced capacity to synthesize interferon-gamma in vitro in response to non-typeable Haemophilus influenzae. PLoS One 2014; 9:e104236. [PMID: 25111142 PMCID: PMC4128648 DOI: 10.1371/journal.pone.0104236] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/08/2014] [Indexed: 01/01/2023] Open
Abstract
Chronic suppurative lung disease (CSLD) is characterized by the presence of a chronic wet or productive cough and recurrent lower respiratory infections. The aim of this study was to identify features of innate, cell-mediated and humoral immunity that may increase susceptibility to respiratory infections in children with CSLD. Because non-typeable Haemophilus influenzae (NTHi) is commonly isolated from the airways in CSLD, we examined immune responses to this organism in 80 age-stratified children with CSLD and compared their responses with 51 healthy control children. Cytokines involved in the generation and control of inflammation (IFN-γ, IL-13, IL-5, IL-10 at 72 hours and TNFα, IL-6, IL-10 at 24 hours) were measured in peripheral blood mononuclear cells challenged in vitro with live NTHi. We also measured circulating IgG subclass antibodies (IgG1 and IgG4) to two H. influenzae outer membrane proteins, P4 and P6. The most notable finding was that PBMC from children with CSLD produced significantly less IFN-γ in response to NTHi than healthy control children whereas mitogen-induced IFN-γ production was similar in both groups. Overall there were minor differences in innate and humoral immune responses between CSLD and control children. This study demonstrates that children with chronic suppurative lung disease have an altered systemic cell-mediated immune response to NTHi in vitro. This deficient IFN-γ response may contribute to increased susceptibility to NTHi infections and the pathogenesis of CSLD in children.
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Affiliation(s)
- Susan J. Pizzutto
- Menzies School of Health Research, Charles Darwin University, Brinkin, Northern Territory, Australia
- * E-mail:
| | - Stephanie T. Yerkovich
- Menzies School of Health Research, Charles Darwin University, Brinkin, Northern Territory, Australia
- Queensland Lung Transplant Service, The Prince Charles Hospital, Chermside, Queensland, Australia
- School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - John W. Upham
- School of Medicine, The University of Queensland, St Lucia, Queensland, Australia
- Department of Respiratory Medicine, Princess Alexandra Hospital, Wooloongabba, Queensland, Australia
| | - Belinda J. Hales
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia, Australia
| | - Wayne R. Thomas
- Telethon Kids Institute, The University of Western Australia, Crawley, Western Australia, Australia
| | - Anne B. Chang
- Menzies School of Health Research, Charles Darwin University, Brinkin, Northern Territory, Australia
- The Department of Respiratory Medicine, Royal Children's Hospital, Herston, Queensland, Australia
- Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston, Queensland, Australia
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45
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Chambers DC, Enever D, Ilic N, Sparks L, Whitelaw K, Ayres J, Yerkovich ST, Khalil D, Atkinson KM, Hopkins PMA. A phase 1b study of placenta-derived mesenchymal stromal cells in patients with idiopathic pulmonary fibrosis. Respirology 2014; 19:1013-8. [PMID: 25039426 DOI: 10.1111/resp.12343] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/24/2014] [Accepted: 04/29/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Idiopathic pulmonary fibrosis (IPF) is a degenerative disease characterized by fibrosis following failed epithelial repair. Mesenchymal stromal cells (MSC), a key component of the stem cell niche in bone marrow and possibly other organs including lung, have been shown to enhance epithelial repair and are effective in preclinical models of inflammation-induced pulmonary fibrosis, but may be profibrotic in some circumstances. METHODS In this single centre, non-randomized, dose escalation phase 1b trial, patients with moderately severe IPF (diffusing capacity for carbon monoxide (DLCO ) ≥ 25% and forced vital capacity (FVC) ≥ 50%) received either 1 × 10(6) (n = 4) or 2 × 10(6) (n = 4) unrelated-donor, placenta-derived MSC/kg via a peripheral vein and were followed for 6 months with lung function (FVC and DLCO ), 6-min walk distance (6MWD) and computed tomography (CT) chest. RESULTS Eight patients (4 female, aged 63.5 (57-75) years) with median (interquartile range) FVC 60 (52.5-74.5)% and DLCO 34.5 (29.5-40)% predicted were treated. Both dose schedules were well tolerated with only minor and transient acute adverse effects. MSC infusion was associated with a transient (1% (0-2%)) fall in SaO2 after 15 min, but no changes in haemodynamics. At 6 months FVC, DLCO , 6MWD and CT fibrosis score were unchanged compared with baseline. There was no evidence of worsening fibrosis. CONCLUSIONS Intravenous MSC administration is feasible and has a good short-term safety profile in patients with moderately severe IPF.
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Affiliation(s)
- Daniel C Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Wurzel DF, Marchant JM, Clark JE, Masters IB, Yerkovich ST, Upham JW, Chang AB. Wet cough in children: infective and inflammatory characteristics in broncho-alveolar lavage fluid. Pediatr Pulmonol 2014; 49:561-8. [PMID: 23788413 DOI: 10.1002/ppul.22792] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [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: 11/14/2012] [Accepted: 02/11/2013] [Indexed: 01/26/2023]
Abstract
Wet cough is a common feature of many disease processes affecting children. Our aim was to examine the relationships between cough nature, lower airway infection (bacterial, viral, and viral-bacterial) and severity of neutrophilic airway inflammation. We hypothesized that viral-bacterial co-infection of the lower airway would be associated with wet cough and heightened neutrophilic airway inflammation. We prospectively recruited 232 children undergoing elective flexible bronchoscopy. Participants were grouped using a cough nature symptom-based approach, into wet, dry or no cough groups. Broncho-alveolar lavage (BAL) and clinical data, including presence, nature, and duration of cough and key demographic factors, were collected. Children with wet cough (n = 143) were more likely to have lower airway bacterial infection (OR 2.6, P = 0.001), viral infection (OR 2.04, P = 0.045) and viral-bacterial co-infection (OR 2.65, P = 0.042) compared to those without wet cough. Wet cough was associated with heightened airway neutrophilia (median 19%) as compared to dry or no cough. Viral-bacterial co-infection was associated with the highest median %neutrophils (33.5%) compared to bacteria only, virus/es only and no infection (20%, 18%, and 6%, respectively, P < 0.0001). Children with wet cough had higher rates of lower airway infection with bacteria and viruses. Maximal neutrophilic airway inflammation was seen in those with viral-bacterial co-infection. Cough nature may be a useful indicator of infection and inflammation of the lower airways in children.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Queensland, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland, Australia
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Wurzel DF, Mackay IM, Marchant JM, Wang CYT, Yerkovich ST, Upham JW, Smith-Vaughan HC, Petsky HL, Chang AB. Adenovirus species C is associated with chronic suppurative lung diseases in children. Clin Infect Dis 2014; 59:34-40. [PMID: 24748519 PMCID: PMC4305137 DOI: 10.1093/cid/ciu225] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background. The role of human adenoviruses (HAdVs) in chronic respiratory disease pathogenesis is recognized. However, no studies have performed molecular sequencing of HAdVs from the lower airways of children with chronic endobronchial suppuration. We thus examined the major HAdV genotypes/species, and relationships to bacterial coinfection, in children with protracted bacterial bronchitis (PBB) and mild bronchiectasis (BE). Methods. Bronchoalveolar lavage (BAL) samples of 245 children with PBB or mild (cylindrical) BE were included in this prospective cohort study. HAdVs were genotyped (when possible) in those whose BAL had HAdV detected (HAdV+). Presence of bacterial infection (defined as ≥104 colony-forming units/mL) was compared between BAL HAdV+ and HAdV negative (HAdV−) groups. Immune function tests were performed including blood lymphocyte subsets in a random subgroup. Results. Species C HAdVs were identified in 23 of 24 (96%) HAdV+ children; 13 (57%) were HAdV-1 and 10 (43%) were HAdV-2. An HAdV+ BAL was significantly associated with bacterial coinfection with Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae (odds ratio [OR], 3.27; 95% confidence interval, 1.38–7.75; P = .007) and negatively associated with Staphylococcus aureus infection (P = .03). Young age was related to increased rates of HAdV+. Blood CD16 and CD56 natural killer cells were significantly more likely to be elevated in those with HAdV (80%) compared with those without (56.1%) (P = .027). Conclusions. HAdV-C is the major HAdV species detected in the lower airways of children with PBB and BE. Younger age appears to be an important risk factor for HAdV+ of the lower airways and influences the likelihood of bacterial coinfection.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, The University of Queensland Queensland Children's Respiratory Centre, Royal Children's Hospital
| | - Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, The University of Queensland, Herston
| | - Julie M Marchant
- Queensland Children's Medical Research Institute, The University of Queensland Queensland Children's Respiratory Centre, Royal Children's Hospital
| | - Claire Y T Wang
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, The University of Queensland, Herston
| | | | - John W Upham
- School of Medicine, The University of Queensland, Brisbane
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Helen L Petsky
- Queensland Children's Respiratory Centre, Royal Children's Hospital Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane
| | - Anne B Chang
- Queensland Children's Respiratory Centre, Royal Children's Hospital Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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48
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Wurzel DF, Marchant JM, Clark JE, Mackay IM, Wang CYT, Sloots TP, Upham JW, Yerkovich ST, Masters IB, Baker PJ, Anderson-James S, Chang AB. Respiratory virus detection in nasopharyngeal aspirate versus bronchoalveolar lavage is dependent on virus type in children with chronic respiratory symptoms. J Clin Virol 2013; 58:683-8. [PMID: 24125830 PMCID: PMC7173340 DOI: 10.1016/j.jcv.2013.09.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 12/14/2022]
Abstract
Background The comparative yield of respiratory virus detection from nasopharyngeal aspirate (NPA) versus bronchoalveolar lavage (BAL) is uncertain. Furthermore, the significance of virus detection and its relationship to lower airway neutrophilic inflammation is poorly studied. Objectives To evaluate the sensitivity, specificity and predictive values of NPA for detecting respiratory viruses in BAL; and to determine the relationship between viruses and lower airway neutrophilia in children with non-acute respiratory illness. Study design 150 paired NPA and BAL samples were obtained from 75 children aged <18 years undergoing flexible bronchoscopy for investigation of chronic respiratory symptoms. Viral studies were performed using polymerase chain reaction (PCR). Cellularity studies were performed on BALs. Diagnostic parameters of NPA compared to BAL and associations between viruses and lower airway %neutrophils were evaluated. Results NPA had a higher yield than BAL for detection of any respiratory virus (52 versus 38, respectively). NPA had a high sensitivity (92%) and low specificity (57%) for detecting HRV in BAL with poor kappa agreement value of 0.398 (95% CI 0.218–0.578, p < 0.001). NPA had a fair sensitivity (69%) and good specificity (90.3%) for detecting HAdV on BAL, kappa agreement was 0.561 (95% CI 0.321–0.801, p < 0.001). HAdV positivity on NPA, compared to negativity, was independently associated with heightened airway neutrophilia [mean difference (95% CI): 18 (1,35); p = 0.042]. Conclusions NPA has a higher yield for respiratory virus detection than BAL, however its diagnostic accuracy is dependent on viral species. Adenovirus positivity is associated with significantly heightened lower airway neutrophilia in children with chronic respiratory symptoms.
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Affiliation(s)
- Danielle F Wurzel
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia; Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Australia.
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49
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Walsh JR, McKeough ZJ, Morris NR, Yerkovich ST, Wood ME, Paratz JD. Seasonal variation and living alone are related to pulmonary rehabilitation non-completion. World J Respirol 2013; 3:29-37. [DOI: 10.5320/wjr.v3.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/08/2013] [Accepted: 06/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify baseline characteristics that independently predict pulmonary rehabilitation non-completion and compare these findings against the participant’s reasons for non-completion.
METHODS: Participants with chronic obstructive pulmonary disease (COPD) who attended a standardised twice weekly, eight week pulmonary rehabilitation program (located in the sub-tropics, latitude 27°29’ South) between 2010 and 2012 were recruited. The baseline characteristics of program completers and non-completers were compared in a case-controlled design. Participants who attended < 12/16 sessions were classified as a non-completer. Non-completers (those who missed > 4 sessions of the program) were asked by one independent investigator to participate in a survey about their pulmonary rehabilitation experience. Baseline characteristics were assessed for differences between program completers and non-completers. The baseline characteristics included disease severity, exercise capacity, smoking history, participant’s social support and the season when each participant commenced rehabilitation. Non-completers that agreed to participate in the survey were asked to indicate what personal factors or external factors contributed to their program non-completion. Comparisons of completers and non-completers baseline characteristics were performed using cross-tabulations and t-tests, with significant measures analysed in a multivariate binary logistic regression model. Non-completers survey responses were compared to the identified independent predictors using cross-tabulations.
RESULTS: Twenty-six participants (23.4%) of the 111 participants with COPD [(mean ± SD) age was 67.4 ± 9.2 years and FEV1 54.6% ± 22.3%)], were classified as non-completers. Forty-five participants (40.5%) commenced pulmonary rehabilitation during winter. Thirty-six participants (32.4%) were living alone at program commencement. In the multivariate analysis (n = 111), only programs that commenced in winter (Exp B: 0.255, 95%CI: 0.090-0.727, P = 0.011) and participants that lived alone (Exp B: 2.925, 95%CI: 1.039-8.229, P = 0.042) were identified as independent predictors of program non-completion. Twenty participants of the twenty-six non-completers agreed to participate in the survey about their pulmonary rehabilitation experience. The reasons given for non-completion were grouped into: medical reasons (75%), other personal reasons (30%) and external barriers (45%), with ten non-completers reporting more than one reason. No participant reported living alone or that the program commenced during winter as a reason for non-completion. There was no relationship between illness being the participant’s reason for non-completion and the programs that commenced in winter (P = 0.135).
CONCLUSION: Despite winter commencing programs and participants who lived alone being independent predictors of program non-completion, neither measure was reported by participants as a reason for non-completion.
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Walsh JR, Chambers DC, Davis RJ, Morris NR, Seale HE, Yerkovich ST, Hopkins PMA. Impaired exercise capacity after lung transplantation is related to delayed recovery of muscle strength. Clin Transplant 2013; 27:E504-11. [PMID: 23815281 DOI: 10.1111/ctr.12163] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 12/24/2022]
Abstract
Lung transplant recipients report reduced exercise capacity despite satisfactory graft function. We analysed changes in lung function, six-min walk distance (6MWD), and quadriceps strength in the first 26-wk post-transplant and examined what factors predict 6MWD recovery. All lung transplant recipients at a single institution between June 2007 and January 2011 were considered for inclusion. Lung function, 6MWD, and quadriceps strength corrected for body weight (QS%) were recorded pre- and two-, six-, 13-, and 26-wk post-transplant. Fifty recipients, of mean (± SD) age 42 (± 13) yr, were studied. Mean FEV1 % and 6MWD improved from 26.4% to 88.9% and from 397 to 549 m at 26 wk, respectively (both p < 0.001). QS% declined in the first two wk but had improved to above pre-transplant levels by 26 wk (p = 0.027). On multivariate analysis (n = 35), lower pre-transplant exercise capacity and greater recovery in muscle strength explained most of the improvement in exercise capacity. Delayed recovery of exercise capacity after lung transplantation is unrelated to delay in improvement in graft function, but occurs secondary to the slow recovery of muscle strength. Our findings show that additional controlled trials are needed to better understand the influence of exercise rehabilitation on improvement in exercise capacity post-transplantation.
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Affiliation(s)
- James R Walsh
- Queensland Lung Transplant Service, The Prince Charles Hospital, Brisbane, Qld, Australia.
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