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Ahmed A, Brown A, Pollack Y, Vazhappilly J, Perry C, Thomas ER, Krishnan S, Dozor AJ. Relationship between FEV 1/FVC and age in children with asthma. Pediatr Pulmonol 2024; 59:1402-1409. [PMID: 38426807 DOI: 10.1002/ppul.26927] [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: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) normally decreases through childhood, increases briefly during early adolescence, and then declines throughout life. The physiology behind this temporary increase during early adolescence is not well understood. The objective of this study was to determine if this pattern occurs in children with asthma. DESIGN Single-center, cross-sectional, retrospective analysis of pulmonary function tests obtained over a 5-year period in children 5-18 years of age with persistent asthma. RESULTS A total of 1793 patients satisfied all inclusion and exclusion criteria. The mean age (±SD) was 10.4 ± 3.8 years. Forty-eight percent were female. Mean FEV1/FVC was 0.83 ± 0.09. FEV1/FVC was lower at 5 years of age than in healthy children, declined from age 5 to 11 by 5.7% compared to 7.3% in healthy girls, and 5.8% compared to 9.4% in healthy boys. FEV1/FVC increased in early adolescence, but at age 16, was 5.6% lower in male children compared to healthy children, and 5.4% lower in females. The ratio was lower in obese children at all ages but demonstrated the same curvilinear shape as healthy children. In absolute terms, FEV1 grew proportionately more than FVC during early adolescence, so the ratio of FEV1/FVC increased during that period. The curvilinear shape of the curve remained in postbronchodilator testing, though significantly blunted. CONCLUSIONS FEV1/FVC is lower in children with persistent asthma than healthy children, but the "Shepherd's Hook" pattern is preserved. This was true in obese patients with asthma, although their FEV1/FVC ratios were lower throughout all stages of childhood and adolescence.
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Affiliation(s)
- Amal Ahmed
- Boston Children's Health Physicians, Valhalla, New York, USA
| | - Amy Brown
- Boston Children's Health Physicians, Valhalla, New York, USA
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Yehudit Pollack
- Boston Children's Health Physicians, Valhalla, New York, USA
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
| | | | | | | | - Sankaran Krishnan
- Boston Children's Health Physicians, Valhalla, New York, USA
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
| | - Allen J Dozor
- Boston Children's Health Physicians, Valhalla, New York, USA
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
- New York Medical College, Valhalla, New York, USA
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Zhou MJ, Fu L, Lin WQ, Wu ZN, Nie F, Ye CY, Zhao WH. Impact of the pulmonary ventilation function on the prognosis of suspected asthma patients: a retrospective observational study. J Asthma 2024:1-5. [PMID: 38385570 DOI: 10.1080/02770903.2024.2303771] [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: 12/23/2022] [Accepted: 01/07/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Asthma is a common chronic respiratory diseases, and the relationship between pulmonary ventilation function and the prognosis of patients with suspected asthma is not well understood. This study aims to explore the impact of pulmonary ventilation functions on the prognosis of patients with suspected asthma. METHODS This retrospective observational study included patients with suspected asthma who were diagnosed and treated at the Guangdong Provincial Hospital of Traditional Chinese Medicine between August 2015 and January 2020. The primary outcome of interest was improvement in asthma symptoms, as measured by bronchial provocation test (BPT) results within one year after diagnosis. The impact of pulmonary ventilation functions on prognosis was explored by multivariable logistic regression analysis. RESULTS Seventy-two patients were included in the study. Patients with normal (OR = 0.123, p = .004) or generally normal (OR = 0.075, p = .039) pulmonary ventilation function were more likely to achieve improvement in asthma symptoms compared with patients with mild obstruction. There were no significant differences between the improvement and non-improvement groups in baseline characteristics. CONCLUSION These results suggest that suspected asthma patients with normal or generally normal pulmonary ventilation function are more likely to achieve improvement in asthma symptoms within one year compared to patients with mild obstruction.
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Affiliation(s)
- Ming-Juan Zhou
- Department of Pulmonary Function, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Li Fu
- Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wen-Qian Lin
- Department of Rehabilitation, General Hospital of Southern Theater Command, Guangzhou, China
| | - Zhen-Ni Wu
- Department of Pulmonary Function, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Fang Nie
- Department of Pulmonary Function, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Chu-Yin Ye
- Department of Pulmonary Function, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wen-Han Zhao
- Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Jeong YH, Lee H, Jang HJ, Park DW, Choi YY, Lee SJ. Predicting postoperative lung function using ventilation SPECT/CT in patients with lung cancer. J Thorac Dis 2024; 16:1054-1062. [PMID: 38505088 PMCID: PMC10944722 DOI: 10.21037/jtd-23-1563] [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: 10/08/2023] [Accepted: 12/21/2023] [Indexed: 03/21/2024]
Abstract
Background Single-photon emission computed tomography/computed tomography (SPECT/CT) has the advantage of assessing regional lung function. We aimed to investigate the potential of ventilation (SPECT/CT) for predicting postoperative lung function in patients with lung cancer. Methods This retrospective study included consecutive patients with lung cancer who underwent lobectomy, preoperative ventilation, and perfusion SPECT/CT between January 2020 and December 2021. The percentage of predicted postoperative forced expiratory volume in 1 s (ppoFEV1%) and the percentage of predicted postoperative diffusion capacity of the lung for carbon monoxide (ppoDLCO%) were calculated from the % counts of each scan based on anatomical segments for lobar function. Correlation tests were performed between the predicted lung function values and actual ppoFEV1% and ppoDLCO%. Results Among the 47 patients, 29 men and 18 women aged 67.5±9.6 years were included. Moreover, 46 ventilation and 41 perfusion SPECT/CT scans were obtained. The pulmonary function on ventilation SPECT/CT strongly correlated with perfusion SPECT/CT (correlation coefficient r=0.939 for ppoFEV1%, P<0.001; r=0.938 for ppoDLCO%, P<0.001). Both ppoFEV1% and ppoDLCO% values obtained from the ventilation and perfusion scans strongly correlated with postoperative FEV1% and DLCO% (correlation coefficient, r=0.774 and r=0.768 for ventilation; r=0.795 and r=0.751 for perfusion, each P<0.001). Conclusions Ventilation SPECT/CT was comparable to perfusion SPECT/CT in predicting postoperative lung function.
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Affiliation(s)
- Yong Ho Jeong
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Hyo Jun Jang
- Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University College of Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Soo Jin Lee
- Department of Nuclear Medicine, Hanyang University College of Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
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4
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Abdullahi A, Wong TWL, Ng SSM. Efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor function outcomes in patients with stroke: a systematic review and meta-analysis. Front Neurol 2024; 14:1233408. [PMID: 38283673 PMCID: PMC10811179 DOI: 10.3389/fneur.2023.1233408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Background Stroke disrupts the functions carried out by the brain such as the control of movement, sensation, and cognition. Disruption of movement control results in hemiparesis that affects the function of the diaphragm. Impaired function of the diaphragm can in turn affect many outcomes such as respiratory, cognitive, and motor function. The aim of this study is to carry out a systematic review and meta-analysis to determine the efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor outcomes after stroke. Method The study was registered in PROSPERO (CRD42023422293). PubMED, Embase, Web of Science (WoS), PEDro, Scopus, and CENTRAL databases were searched until September 2023. Only randomized controlled trials comparing diaphragmatic breathing exercise with a control were included. Information on the study authors, time since stroke, mean age, height, weight, sex, and the protocols of the experimental and control interventions including intensity, mean scores on the outcomes such as respiratory, cognitive, and motor functions were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were used to summarize the results, which were then presented in tables, risk-of-bias graph, and forest plots. The meta-analysis was carried out on respiratory function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF)] and motor function (trunk impairment, and internal and external oblique muscles activity). Results Six studies consisting of 151 participants were included. The results of the meta-analyses showed that diaphragmatic breathing exercise is only superior to the control at improving respiratory function, FVC (MD = 0.90, 95% CI = 0.76 to 1.04, P < 0.00001), FEV1 (MD = 0.32, 95% CI = 0.11 to 0.52, P = 0.002), and PEF (MD = 1.48, 95% CI = 1.15 to 1.81, P < 0.00001). Conclusion There is limited evidence suggesting that diaphragmatic breathing exercise may help enhance respiratory function, which may help enhance recovery of function post stroke. Systematic Review Registration PROSPERO, identifier CRD42023422293.
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Affiliation(s)
| | | | - Shamay SM Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Cannon MF, Goldfarb DG, Zeig-Owens RA, Hall CB, Choi J, Cohen HW, Prezant DJ, Weiden MD. Normal Lung Function and Mortality in World Trade Center Responders and NHANES III Participants. Am J Respir Crit Care Med 2024. [PMID: 38163381 DOI: 10.1164/rccm.202309-1654oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024] Open
Abstract
RATIONALE Low forced expiratory volume at one second (FEV1) is a biomarker of increased mortality. The association of normal lung function and mortality is not well described. OBJECTIVE To evaluate the FEV1-mortality association among participants with normal lung function. METHODS 10,999 Fire Department of the City of New York (FDNY) responders and 10,901 NHANES III participants, ages 18-65 with FEV1 ≥80% predicted, were analyzed, with FEV1 percent predicted calculated using Global Lung Function Initiative Global race-neutral reference equations. Mortality data were obtained from linkages to the National Death Index. Cox proportional hazards models estimated the association between FEV1 and all-cause mortality, controlling for age, sex, race/ethnicity, smoking history, and, for FDNY, work assignment. Cohorts were followed for a maximum of 20.3 years. MEASUREMENTS AND MAIN RESULTS We observed 504/10,999 deaths (4.6%) for FDNY and 1,237/10,901 deaths (9.4% [weighted]) for NHANES III. Relative to FEV1 ≥120% predicted, mortality was significantly higher for FEV1 100-109%, 90-99%, and 80-89% predicted in the FDNY cohort. In the NHANES III cohort, mortality was significantly higher for FEV1 90-99% and 80-89% predicted. Each 10% higher predicted FEV1 was associated with 15% (HR=0.85, 95% CI 0.80-0.91) and 23% (HR=0.77, 95% CI 0.71-0.84) lower mortality for FDNY and NHANES III, respectively. CONCLUSIONS In both cohorts, higher FEV1 is associated with lower mortality, suggesting higher FEV1 is a biomarker of better health. These findings demonstrate that a single cross-sectional measurement of FEV1 is predictive of mortality over two decades, even when FEV1 is in the normal range.
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Affiliation(s)
- Madeline F Cannon
- Montefiore Medical Center, 2013, Department of Medicine, Bronx, New York, United States
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, United States
| | - David G Goldfarb
- Montefiore Medical Center, 2013, Department of Medicine, Bronx, New York, United States
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, United States
- Albert Einstein College of Medicine, 2006, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Rachel A Zeig-Owens
- Montefiore Medical Center, 2013, Department of Medicine, Bronx, New York, United States
- Fire Department of the City of New York, 101588, Bureau of Health Services, Brooklyn, New York, United States
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Charles B Hall
- Albert Einstein College of Medicine, 2006, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Jaeun Choi
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Hillel W Cohen
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - David J Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, United States
- Montefiore Medical Center, Department of Medicine, Bronx, New York, United States
- Albert Einstein College of Medicine, 2006, Department of Epidemiology and Population Health, Bronx, New York, United States
| | - Michael D Weiden
- Fire Department of the City of New York, 101588, Bureau of Health Services, Brooklyn, New York, United States
- New York University Grossman School of Medicine, 12296, Division of Pulmonary, Critical Care, and Sleep Medicine, New York, New York, United States;
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Oguri G, Fujiu K, Oshima T, Shimizu Y, Hasumi E, Kojima T, Komuro I. Cryoballoon ablation for paroxysmal atrial fibrillation mildly improves lung function: An observational study. Medicine (Baltimore) 2023; 102:e35991. [PMID: 37986317 PMCID: PMC10659717 DOI: 10.1097/md.0000000000035991] [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: 06/15/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and a major public health burden. Catheter ablation (CA) is an effective treatment of AF. Although radiofrequency catheter ablation (RFCA) is the standard practice, cryoballoon ablation (CBA) has become increasingly popular. Pulmonary dysfunction is also associated with AF. As CA targets the pulmonary vasculature, it poses a risk to lung function. However, the effect of CA on respiration in patients with paroxysmal atrial fibrillation (PAF) post-ablation has not yet been assessed. We assessed pulmonary function after CA in a cohort of patients with AF. This prospective, single-center study included 26 patients with symptomatic PAF and 18 patients without PAF. CA techniques include RFCA, CBA, hot balloon ablation, and laser balloon-mediated ablation. Spirometry parameters included vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV1), and peak expiratory flow, which were all measured 6 months post-ablation. AF ablation significantly improved VC (P = .04), FVC (P = .01), and peak expiratory flow (P = .006) in all the patients. In the patients with PAF, we observed a significant increase in FEV1 (P = .04). CBA significantly improved VC (P = .012) and FVC (P = .013). A significant improvement in these pulmonary parameters was achieved, specifically in patients with PAF treated with an ablation protocol with CBA, but not with RFCA or hot balloon ablation. A significant decrease in FEV1 was observed with hot balloon ablation (P = .035). Significant improvement in pulmonary parameters was observed specifically in patients with PAF who underwent CBA. CBA may be a more suitable treatment strategy for patients with PAF, particularly those with compromised pulmonary function.
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Affiliation(s)
- Gaku Oguri
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Oshima
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Shimizu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Eriko Hasumi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiya Kojima
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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Fraughen DD, Ghosh AJ, Hobbs BD, Funk GC, Meischl T, Clarenbach CF, Sievi NA, Schmid-Scherzer K, McElvaney OJ, Murphy MP, Roche AD, Clarke L, Strand M, Vafai-Tabrizi F, Kelly G, Gunaratnam C, Carroll TP, McElvaney NG. Augmentation Therapy for Severe Alpha-1 Antitrypsin Deficiency Improves Survival and Is Decoupled from Spirometric Decline-A Multinational Registry Analysis. Am J Respir Crit Care Med 2023; 208:964-974. [PMID: 37624745 PMCID: PMC10870866 DOI: 10.1164/rccm.202305-0863oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 08/27/2023] Open
Abstract
Rationale: Intravenous plasma-purified alpha-1 antitrypsin (IV-AAT) has been used as therapy for alpha-1 antitrypsin deficiency (AATD) since 1987. Previous trials (RAPID and RAPID-OLE) demonstrated efficacy in preserving computed tomography of lung density but no effect on FEV1. This observational study evaluated 615 people with severe AATD from three countries with socialized health care (Ireland, Switzerland, and Austria), where access to standard medical care was equal but access to IV-AAT was not. Objectives: To assess the real-world longitudinal effects of IV-AAT. Methods: Pulmonary function and mortality data were utilized to perform longitudinal analyses on registry participants with severe AATD. Measurements and Main Results: IV-AAT confers a survival benefit in severe AATD (P < 0.001). We uncovered two distinct AATD phenotypes based on an initial respiratory diagnosis: lung index and non-lung index. Lung indexes demonstrated a more rapid FEV1 decline between the ages of 20 and 50 and subsequently entered a plateau phase of minimal decline from 50 onward. Consequentially, IV-AAT had no effect on FEV1 decline, except in patients with a Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 2 lung index. Conclusions: This real-world study demonstrates a survival advantage from IV-AAT. This improved survival is largely decoupled from FEV1 decline. The observation that patients with severe AATD fall into two major phenotypes has implications for clinical trial design where FEV1 is a primary endpoint. Recruits into trials are typically older lung indexes entering the plateau phase and, therefore, unlikely to show spirometric benefits. IV-AAT attenuates spirometric decline in lung indexes in GOLD stage 2, a spirometric group commonly outside current IV-AAT commencement recommendations.
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Affiliation(s)
- Daniel D. Fraughen
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Auyon J. Ghosh
- Division of Pulmonary, Critical Care, and Sleep Medicine, SUNY Upstate University Hospital, Syracuse, New York
| | - Brian D. Hobbs
- Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Georg-Christian Funk
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Tobias Meischl
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Noriane A. Sievi
- Department of Pneumology, University Hospital Zurich, Zurich, Switzerland
| | - Karin Schmid-Scherzer
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Oliver J. McElvaney
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Mark P. Murphy
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Adam D. Roche
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Clarke
- Department of Respiratory Physiology, Beaumont Hospital, Dublin, Ireland; and
| | - Matthew Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado
| | - Florian Vafai-Tabrizi
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology and Department of Medicine II with Pneumology, Klinik Ottakring, Vienna, Austria
| | - Geraldine Kelly
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Respiratory Physiology, Beaumont Hospital, Dublin, Ireland; and
| | - Tomás P. Carroll
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Noel G. McElvaney
- Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
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8
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Yeom R, Gorgone M, Malinovic M, Panzica P, Maslow A, Augoustides JG, Marchant BE, Fernando RJ, Nampi RG, Pospishil L, Neuburger PJ. Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease. J Cardiothorac Vasc Anesth 2023; 37:2335-2349. [PMID: 37657996 DOI: 10.1053/j.jvca.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Richard Yeom
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Michelle Gorgone
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Matea Malinovic
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Peter Panzica
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bryan E Marchant
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
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Ahmed AS, Gassas RS, Ahmed ME, Osman G, Alsaeed AS, Absi AN, Alamoudi SM, Alahmadi MD, Khalil MM, ElDadah SK, Hemaidi IY, Rajkhan WA. The Role of Pre-bone Marrow Transplantation Pulmonary Function Test in Predicting Post-transplant Noninfectious Pulmonary Complications. Saudi J Med Med Sci 2023; 11:339-344. [PMID: 37970453 PMCID: PMC10634462 DOI: 10.4103/sjmms.sjmms_65_23] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/08/2023] [Accepted: 08/09/2023] [Indexed: 11/17/2023]
Abstract
Background Pulmonary function test (PFT) is used as a tool for pre-transplant risk assessment and as a predictor of post-transplant outcomes. As there are currently few studies that discuss the role of PFT in bone marrow transplantation (BMT) patients in Saudi settings, and as the number of transplant patients with benign and malignant conditions continues to increase, this study was conducted with the aim of assessing the local practice. Methods This retrospective cohort study included all adult patients who underwent BMT at Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, between 2014 and 2020. The association between established patient-related risk factors and the incidence of pulmonary complications among autologous and allogeneic groups was assessed. Results A total of 186 patients were included (autologous = 143; allogenic = 43), of which 115 (61.8%) were male. At the pre-BMT phase, about 30% of the patients had comorbidities and 51% had received two rounds of salvage chemotherapy, while 16.1% had received radiation therapy. In the autologous group, the only PFT parameter that was a significant predictor of post-BMT pulmonary complications was forced vital capacity <80% (P = 0.012), while in the allogenic group, no parameter was significantly associated with pulmonary complications. The patient-related factors that were associated with respiratory distress in the autologous group were lung involvement (P = 0.03) and pre-transplant radiation (P = 0.044). Conclusion The findings of this study indicated that forced vital capacity <80% was a significant factor in predicting non-infectious complications in the autologous group. Furthermore, lung involvement and pre-transplant radiation were the patient-related factors associated with pulmonary complications.
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Affiliation(s)
- Amani S. Ahmed
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
| | - Roaa S. Gassas
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
| | - Mohamed E. Ahmed
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Department of Basic Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ghaya Osman
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
| | - Ahmed S. Alsaeed
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ahmed N. Absi
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Sameer M. Alamoudi
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Majed D. Alahmadi
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Manar M. Khalil
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
| | - Saleem K. ElDadah
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Ihab Y. Hemaidi
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Walaa A. Rajkhan
- Department of Adult Hematology/Bone Marrow Transplant Section, King Abdulaziz Medical City, Ministry of National Guard–Health Affairs, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Uytun S, Cinel G, Eryılmaz Polat S, Özkan Tabakçı S, Kiper N, Yalçın E, Ademhan Tural D, Özsezen B, Şen V, Selimoğlu Şen H, Ufuk Altıntaş D, Çokuğraş H, Kılınç AA, Başkan AK, Yazan H, Çollak A, Uzuner S, Ünal G, Yılmaz Aİ, Çağlar HT, Damadoğlu E, Irmak İ, Demir E, Kartal Öztürk G, Bingöl A, Başaran E, Sapan N, Canıtez Y, Tana Aslan A, Asfuroğlu P, Harmancı K, Köse M, Hangül M, Özdemir A, Çobanoğlu N, Özcan G, Keskin Ö, Yüksel H, Özdoğan Ş, Topal E, Çaltepe G, Can D, Korkmaz Ekren P, Kılıç M, Emiralioğlu N, Şişmanlar Eyüboğlu T, Pekcan S, Çakır E, Özçelik U, Doğru D. Patients with cystic fibrosis who could not receive the CFTR modulator treatment: What did they lose in 1 year? Pediatr Pulmonol 2023; 58:2505-2512. [PMID: 37278544 DOI: 10.1002/ppul.26535] [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: 10/09/2022] [Revised: 04/29/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is an autosomal recessive disorder caused by CF transmembrane conductance regulator (CFTR) genetic variants. CFTR modulators improve pulmonary function and reduce respiratory infections in CF. This study investigated the clinical and laboratory follow-up parameters over 1 year in patients with CF who could not receive this treatment. METHODS This retrospective cohort study included 2018 and 2019 CF patient data from the CF registry of Turkey. Demographic and clinical characteristics of 294 patients were assessed, who had modulator treatment indications in 2018 but could not reach the treatment. RESULTS In 2019, patients younger than 18 years had significantly lower BMI z-scores than in 2018. During the 1-year follow-up, forced expiratory volumes (FEV1) and FEV1 z-scores a trend toward a decrease. In 2019, chronic Staphylococcus aureus colonization, inhaled antipseudomonal antibiotic use for more than 3 months, oral nutritional supplement requirements, and oxygen support need increased. CONCLUSIONS Patients who had indications for modulator treatments but were unable to obtain them worsened even after a year of follow-up. This study emphasized the importance of using modulator treatments for patients with CF in our country, as well as in many countries worldwide.
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Affiliation(s)
- Salih Uytun
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
| | - Güzin Cinel
- Division of Pediatric Pulmonology, Ankara City Hospital, Ankara, Turkey
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | | | | | - Nural Kiper
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalçın
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Dilber Ademhan Tural
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Beste Özsezen
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Şen
- Division of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Hadice Selimoğlu Şen
- Department of Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Derya Ufuk Altıntaş
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Haluk Çokuğraş
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Ayşe Ayzıt Kılınç
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Azer Kılıç Başkan
- Division of Pediatric Pulmonology, Cerrahpaşa Faculty of Medicine, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Abdulhamit Çollak
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Gökçen Ünal
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Aslı İmran Yılmaz
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hanife Tuğçe Çağlar
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ebru Damadoğlu
- Department of Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İlim Irmak
- Department of Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Esen Demir
- Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Gökçen Kartal Öztürk
- Division of Pediatric Pulmonology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Ayşen Bingöl
- Division of Pediatric Pulmonology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Erdem Başaran
- Division of Pediatric Pulmonology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Nihat Sapan
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Yakup Canıtez
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Ayşe Tana Aslan
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pelin Asfuroğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Koray Harmancı
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mehmet Köse
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Melih Hangül
- Division of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Özdemir
- Division of Pediatric Pulmonology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Nazan Çobanoğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Gizem Özcan
- Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem Keskin
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Hasan Yüksel
- Division of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Şebnem Özdoğan
- Division of Pediatric Pulmonology, Sarıyer Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Erdem Topal
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Gönül Çaltepe
- Division of Pediatric Gastroenterology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Demet Can
- Division of Pediatric Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | | | - Mehmet Kılıç
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Nagehan Emiralioğlu
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sevgi Pekcan
- Division of Pediatric Pulmonology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Erkan Çakır
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakıf University, İstanbul, Turkey
| | - Uğur Özçelik
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Doğru
- Division of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Twinkle RH, Sain Y, Pinjar MJ, Manik KA, Mondal H. Comparative Dynamic Pulmonary Function Tests Between Apparently Healthy Young Adult Offspring of Asthmatic and Non-asthmatic Parents: A Pilot Study. Cureus 2023; 15:e44259. [PMID: 37772245 PMCID: PMC10526921 DOI: 10.7759/cureus.44259] [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] [Accepted: 08/28/2023] [Indexed: 09/30/2023] Open
Abstract
Background While the hereditary component of asthma has been established, its influence on early respiratory function changes in otherwise healthy offspring remains to be explored. Dynamic lung function tests assess airflow in and out of the lungs, providing valuable insights into respiratory health and detecting potential airflow limitations. This study aimed to compare the dynamic lung functions between offspring of asthmatic and non-asthmatic parents. Methodology A case-control design was employed comprising 30 cases (offspring of asthmatic parents) and 30 controls (offspring of non-asthmatic parents). Lung function parameters including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, forced expiratory flow between 25% and 75% of the FVC (FEF 25-75%), and maximum mid-expiratory flow at 50% of the FVC (Vmax 50%) were measured. Statistical analysis was conducted to compare the parameters between cases and controls using the unpaired t-test. Results The mean age of controls was 20.46 ± 2.82 years and the cases was 19.83 ± 1.41 years. The study revealed that cases exhibited lower FEV1 and Vmax 50% values compared to controls, indicating potential airflow limitations and altered mid-exhalation flow rates in the offspring of asthmatic parents. While trends were observed in FVC, FEV1/FVC ratio, and FEF 25-75%, these differences were not statistically significant. Conclusions The findings suggest a potential association between parental asthma and altered lung function parameters, specifically in FEV1 and Vmax 50%, among their offspring. These early respiratory function changes underscore the potential impact of hereditary factors on lung health. Healthcare professionals should take parental asthma into account when evaluating lung functions. This may lead to earlier detection and intervention. Further investigation is warranted to elucidate the underlying mechanisms and long-term implications of these findings.
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Affiliation(s)
| | - Yukta Sain
- Medical School, Great Eastern Medical School and Hospital, Ragolu, IND
| | | | - Khaleel Ahmed Manik
- Physiology, Integral Institute of Medical Sciences & Research, Faculty of Medicine & Health Sciences, Integral University, Lucknow, IND
| | - Himel Mondal
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Derakhshan A, Sadeghi M, Asnaashari AMH, Dehghani M, Salari R, Khadem-Rezaiyan M, Mirsadraee M, Saeidinejat S, Jalali S, Jalali S. Efficacy of Herbal Medicines on Lung Function in Asthma: a systematic review and meta-analysis of randomized controlled trials. J Pharmacopuncture 2023; 26:124-138. [PMID: 37405115 PMCID: PMC10315876 DOI: 10.3831/kpi.2023.26.2.124] [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: 09/14/2022] [Revised: 09/20/2022] [Accepted: 02/17/2023] [Indexed: 07/06/2023] Open
Abstract
Objectives The present study was designed to conduct a comprehensive systematic review and meta-analysis to assess the efficacy of herbal medicines as add-on therapy on lung function in asthmatic patients. Methods A comprehensive search of online databases was performed up to December 2021 to identify randomized controlled trials that used orally herbal preparations for asthma as add-on therapy. Studies were assessed for methodological quality using the Cochrane Collaboration's Risk of Bias tool. The main outcome was percent predicted value of forced expiratory volume (% predicted FEV1). Pooled weighted mean difference (WMD) estimate with corresponding 95% confidence interval (CI) was calculated using inverse-variance weights method while random effects meta-analysis was used, taking into account clinical and conceptual heterogeneity. Results As a result, 1,525 studies were identified. 169 studies were reviewed in-depth and 23 studies met our systematic review inclusion criteria. Finally, nine randomized controlled trials were included in the meta-analysis. Findings indicated that use of herbal medicines in patients with asthma significantly improved % predicted FEV1 (WMD 3.73, 95% CI 1.76-5.70), with no evidence for significant heterogeneity (p = 0.56 [Q statistic], I2 = 0.0%). In subgroup analysis by age, improvement in % predicted FEV1 was higher and significant in adults (WMD 5.16; 95% CI 2.68-7.63) compared to children (WMD = 1.27; 95% CI -1.98-4.51). Sensitivity analysis showed the significant effect of herbal medicine consumption on improving FEV1 was consistently (range of summary WMDs 3.27-4.59), indicating that the meta-analysis model was robust. There was no evidence of publication bias both visually and statistically. Conclusion Findings support, the complementary use of herbal medicines resulted in significant improvement in the lung function compared to standard treatment in asthmatic patients with no considerable adverse events. This improvement is more likely to be observed amongst adults.
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Affiliation(s)
- Alireza Derakhshan
- Faculty of Traditional Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohsen Dehghani
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Roshanak Salari
- Faculty of Traditional Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khadem-Rezaiyan
- Department of Community Medicine and Public Health, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Mirsadraee
- Department of Internal Medicine, Faculty of Medicine, Islamic Azad University-Mashhad Branch, Mashhad, Iran
| | - Shahin Saeidinejat
- Faculty of Traditional Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Jalali
- Department of Internal, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shabnam Jalali
- Department of Internal, Mashhad University of Medical Sciences, Mashhad, Iran
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Abstract
BACKGROUND Cystic fibrosis (CF) is an inherited progressive life-limiting disease characterised by the build-up of abnormally thick, sticky mucus affecting mostly the lungs, pancreas, and digestive system. Airway clearance techniques (ACTs), traditionally referred to as chest physiotherapy, are recommended as part of a complex treatment programme for people with CF. The aim of an ACTs is to enhance mucociliary clearance and remove viscous secretions from the airways within the lung to prevent distal airway obstruction. This reduces the infective burden and associated inflammatory effects on the airway epithelia. There are a number of recognised ACTs, none of which have shown superiority in improving short-term outcomes related to mucus transport. This systematic review, which has been updated regularly since it was first published in 2000, considers the efficacy of ACTs compared to not performing any ACT in adults and children with CF. It is important to continue to review this evidence, particularly the long-term outcomes, given the recent introduction of highly effective modulator therapies and the improved health outcomes and potential changes to CF management associated with these drugs. OBJECTIVES To determine the effectiveness and acceptability of airway clearance techniques compared to no airway clearance techniques or cough alone in people with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings, to 17 October 2022. We searched ongoing trials registers (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) to 7 November 2022. SELECTION CRITERIA We included randomised or quasi-randomised studies that compared airway clearance techniques (chest physiotherapy) with no airway clearance techniques or spontaneous cough alone in people with CF. DATA COLLECTION AND ANALYSIS Both review authors independently assessed study eligibility, extracted data, and assessed the risk of bias of the included studies. We used GRADE methodology to assess the certainty of the evidence. MAIN RESULTS We included 11 cross-over studies (153 participants) and one parallel study (41 participants). There were differences between studies in how the interventions were delivered, with several intervention groups combining more than one ACT. One study used autogenic drainage; five used conventional chest physiotherapy; nine used positive expiratory pressure (PEP), with one study varying the water pressure between arms; three studies used oscillating PEP; two used exercise; and two used high-frequency chest wall oscillation (HFCWO). Of the 12 included studies, 10 were single-treatment studies, and two delivered the intervention over two consecutive days (once daily in one study, twice daily in the second). This substantial heterogeneity in the treatment interventions precluded pooling of data for meta-analysis. Blinding of participants, caregivers, and clinicians is impossible in airway clearance studies; we therefore judged all studies at unclear risk of performance bias. Lack of information in eight studies made assessment of risk of bias unclear for most other domains. We rated the certainty of evidence as low or very low due to the short-term cross-over trial design, small numbers of participants, and uncertain risk of bias across most or all domains. Six studies (84 participants) reported no effect on pulmonary function variables following intervention; but one study (14 participants) reported an improvement in pulmonary function following the intervention in some of the treatment groups. Two studies reported lung clearance index: one (41 participants) found a variable response to treatment with HFCWO, whilst another (15 participants) found no effect on lung clearance index with PEP therapy (low-certainty evidence). Five studies (55 participants) reported that ACTs, including coughing, increased radioactive tracer clearance compared to control, while a further study (eight participants) reported no improvement in radioactive tracer clearance when comparing PEP to control, although coughing was discouraged during the PEP intervention. We rated the certainty of evidence on the effect of ACTs on radioactive tracer clearance as very low. Four studies (46 participants) investigated the weight of mucus cleared from the lungs and reported greater secretions during chest physiotherapy compared to a control. One study (18 participants) reported no differences in sputum weight (very low-certainty evidence). AUTHORS' CONCLUSIONS The evidence from this review shows that ACTs may have short-term effects on increasing mucus transport in people with CF. All included studies had short-term follow-up; consequently, we were unable to draw any conclusions on the long-term effects of ACTs compared to no ACTs in people with CF. The evidence in this review represents the use of airway clearance techniques in a CF population before widespread use of cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Further research is needed to determine the effectiveness and acceptability of airway clearance in those treated with highly effective CFTR modulators.
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Affiliation(s)
- Louise Warnock
- Oxford Adult Cystic Fibrosis Centre, Oxford Centre for Respiratory Medicine, The Churchill Hospital, Oxford, UK
| | - Alison Gates
- Oxford Adult Cystic Fibrosis Centre, Oxford Centre for Respiratory Medicine, The Churchill Hospital, Oxford, UK
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Turner H, McManus R, Kiely P. What Are the Effects of Posterior Corrective Surgery, With or Without Thoracoplasty, on Pulmonary Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis. Global Spine J 2023; 13:910-924. [PMID: 36377069 DOI: 10.1177/21925682221133750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES This study's objective is to provide a critical review of the current literature regarding the changes in pulmonary function (PF) in Adolescent idiopathic scoliosis (AIS) patients who have undergone posterior spinal fusion and instrumentation (PSF), with and without thoracoplasty (TP). METHODS A comprehensive search was performed using the following databases: EMBASE, PubMed, EBSCOhost (CINAHL and Medline) and OpenGrey. Our focus was on studies that compared pre-and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume in 1 second (%FEV1) in AIS patients who had undergone PSF, with and without TP, with a minimum 2-year follow-up. The risk of bias for included studies was assessed using the ROBINS-I ("Risk Of Bias In Non-randomised Studies - of Interventions") tool. Mean change scores were depicted using forest plots. RESULTS Fifteen studies met our inclusion criteria. The results of our analysis suggest that PSF with TP caused a significant deterioration of %FVC in individuals with moderate AIS, with no significant effect on %FEV1. It also showed a minor improvement of FEV1% in individuals with moderate AIS after PSF only, but no significant change in %FVC. CONCLUSIONS PSF with TP caused a significant deterioration of % FVC while PSF alone caused a minor improvement of FEV1% in individuals with moderate AIS with a minimum 2-year follow-up.
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Affiliation(s)
- Henry Turner
- Trauma and Orthopaedic Surgery, 575376Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Robin McManus
- Trauma and Orthopaedic Surgery, 575376Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Pat Kiely
- Trauma and Orthopaedic Surgery, 575376Children's Health Ireland at Crumlin, Dublin, Ireland
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Kim JH, Shin KE, Chang HS, Lee JU, Park SL, Park JS, Park JS, Park CS. Relationships Between High-Resolution Computed Tomographic Features and Lung Function Trajectory in Patients With Asthma. Allergy Asthma Immunol Res 2023; 15:174-185. [PMID: 37021504 PMCID: PMC10079522 DOI: 10.4168/aair.2023.15.2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/01/2022] [Accepted: 10/17/2022] [Indexed: 04/07/2023]
Abstract
PURPOSE A subset of asthmatics suffers from persistent airflow limitation, known as remodeled asthma, despite optimal treatment. Typical quantitative scoring methods to evaluate structural changes of airway remodeling on high-resolution computed tomography (HRCT) are time-consuming and laborious. Thus, easier and simpler methods are required in clinical practice. We evaluated the clinical usefulness of a simple, semi-quantitative method based on 8 HRCT parameters by comparing asthmatics with a persistent decline of post-bronchodilator (BD)-FEV1 to those with a BD-FEV1 that normalized over time and evaluated the relationships of the parameters with BD-FEV1. METHODS Asthmatics (n = 59) were grouped into 5 trajectories (Trs) according to the changes of BD-FEV1 over 1 year. After 9-12 months of guideline-based treatment, HRCT parameters including emphysema, bronchiectasis, anthracofibrosis, bronchial wall thickening (BWT), fibrotic bands, mosaic attenuation on inspiration, air-trapping on expiration, and centrilobular nodules were classified as present (1) or absent (0) in 6 zones. RESULTS The Tr5 group (n = 11) was older and exhibited a persistent decline in BD-FEV1. The Tr5 and Tr4 groups (n = 12), who had a lower baseline BD-FEV1 that normalized over time, had longer durations of asthma, frequent exacerbations, and higher doses of steroid use compared to the Tr1-3 groups (n = 36), who had a normal baseline BD-FEV1. The Tr5 group had higher emphysema and BWT scores than the Tr4 (P = 8.25E-04 and P = 0.044, respectively). Scores for the other 6 parameters were not significantly different among the Tr groups. BD-FEV1 was inversely correlated with the emphysema and BWT scores in multivariate analysis (P = 1.70E-04, P = 0.006, respectively). CONCLUSIONS Emphysema and BWT are associated with airway remodeling in asthmatics. Our simple, semi-quantitative scoring system based on HRCT may be an easy-to-use method for estimating airflow limitation.
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Affiliation(s)
- Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Eun Shin
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hun Soo Chang
- Department of Anatomy and BK21 FOUR Project, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong-Uk Lee
- Department of Interdisciplinary Program in Biomedical Science Major, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seung-Lee Park
- Department of Interdisciplinary Program in Biomedical Science Major, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jai Soung Park
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Sook Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
| | - Choon-Sik Park
- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
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Vesper SJ, Wymer L, Coull BA, Koutrakis P, Cunningham A, Petty CR, Metwali N, Sheehan WJ, Gaffin JM, Permaul P, Lai PS, Bartnikas LM, Hauptman M, Gold DR, Baxi SN, Phipatanakul W. HEPA filtration intervention in classrooms may improve some students' asthma. J Asthma 2023; 60:479-486. [PMID: 35341426 PMCID: PMC9548522 DOI: 10.1080/02770903.2022.2059672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The School Inner-City Asthma Intervention Study 2 (SICAS 2) tested interventions to reduce exposures in classrooms of students with asthma. The objective of this post-hoc analysis was limited to evaluating the effect of high-efficiency particulate (HEPA) filtration interventions on mold levels as quantified using the Environmental Relative Moldiness Index (ERMI) and the possible improvement in the students' asthma, as quantified by spirometry testing. METHODS Pre-intervention dust samples were collected at the beginning of the school year from classrooms and corresponding homes of students with asthma (n = 150). Follow-up dust samples were collected in the classrooms at the end of the HEPA or Sham intervention. For each dust sample, ERMI values and the Group 1 and Group 2 mold levels (components of the ERMI metric) were quantified. In addition, each student's lung function was evaluated by spirometry testing, specifically the percentage predicted forced expiratory volume at 1 sec (FEV1%), before and at the end of the intervention. RESULTS For those students with a higher Group 1 mold level in their pre-intervention classroom than home (n = 94), the FEV1% results for those students was significantly (p < 0.05) inversely correlated with the Group 1 level in their classrooms. After the HEPA intervention, the average Group 1 and ERMI values were significantly lowered, and the average FEV1% test results significantly increased by an average of 4.22% for students in HEPA compared to Sham classrooms. CONCLUSIONS HEPA intervention in classrooms reduced Group 1 and ERMI values, which corresponded to improvements in the students' FEV1% test results.
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Affiliation(s)
- Stephen J. Vesper
- US Environmental Protection Agency, Center for Environmental Measurement and Modeling, Cincinnati, OH, USA
| | - Larry Wymer
- US Environmental Protection Agency, Center for Environmental Measurement and Modeling, Cincinnati, OH, USA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amparito Cunningham
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Nervana Metwali
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - William J. Sheehan
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan M. Gaffin
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Perdita Permaul
- Division of Pediatric Pulmonology, Allergy and Immunology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Peggy S. Lai
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa M. Bartnikas
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, MA, USA
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sachin N. Baxi
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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17
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Noubiap JJ, Tu SJ, Emami M, Middeldorp ME, Elliott AD, Sanders P. Incident atrial fibrillation in relation to ventilatory parameters: a prospective cohort study. Can J Cardiol 2023; 39:614-622. [PMID: 36773703 DOI: 10.1016/j.cjca.2023.02.004] [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: 08/07/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND There is a paucity of data on the association between respiratory function and atrial fibrillation (AF). This study aimed to assess the relationship between forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC and incident AF. METHODS We performed an analysis of prospectively collected data from the UK Biobank. We included all participants with available spirometry and excluded those with a prior AF. Incident AF was ascertained through hospitalization and death records, and dose-response associations were assessed using multivariable Cox regression analysis with adjustment for known AF risk factors. RESULTS We studied 348,219 white individuals (54.1% female) with a median age of 58.1 (IQR 50.8-63.5) years. Over a median follow-up time of 11.5 years (IQR: 11.0-12.6 years), a total of 18,188 incident AF events occurred. After standardization to sex, age, and height, the risk of AF consistently increased with decreasing FEV1 percentage predicted, FEV1 z-score, and FVC z-score. The risk of AF linearly increased with decreasing FEV1/FVC ratio, and those that had airway obstruction as defined by an FEV1/FVC ratio < 0.70 had a 23% greater risk of incident AF (aHR 1.23, 95% CI 1.19-1.28) compared to those without airway obstruction. Patients with known chronic obstructive pulmonary disease and asthma were at 40% (aHR 1.40, 95% CI 1.29-1.51) and 17% (aHR 1.17, 95% CI 1.12-1.22) increased risk of incident AF. CONCLUSION These findings indicate that reduced ventilatory function is associated with increased risk of AF independently of age, sex, smoking, and other known AF risk factors.
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Affiliation(s)
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Mehrdad Emami
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Melissa E Middeldorp
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, Australia; Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia.
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18
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Çolak Y, Nordestgaard BG, Lange P, Vestbo J, Afzal S. Prognosis of Patients with Chronic Obstructive Pulmonary Disease Not Eligible for Major Clinical Trials. Am J Respir Crit Care Med 2022; 206:271-280. [PMID: 35438616 PMCID: PMC9890252 DOI: 10.1164/rccm.202110-2441oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Rationale: Randomized controlled trials only include a subset of patients with chronic obstructive pulmonary disease (COPD) fulfilling strict inclusion criteria. Thus, most patients with COPD in a real-world setting do not have the necessary evidence to support treatment effectiveness. Objectives: To test the hypotheses that most individuals with COPD in the general population are not represented in major clinical trials despite clinically significant disease with exacerbations and early death. Methods: In 105,630 adults from a Danish contemporary population-based cohort, we defined COPD as age 40 or more years, chronic respiratory symptoms, history of smoking exposure, and airflow limitation with FEV1/FVC < 0.70. Outcomes included acute exacerbations and all-cause mortality. Symptomatic smokers without COPD were used as a reference group. Measurements and Main Results: Of all, 7,516 (7%) and 16,079 (15%) were symptomatic smokers with and without COPD. Only 44% of those with COPD were eligible for major clinical trials when applying FEV1 < 80% predicted, smoking history of 10 or more pack-years, and no comorbid asthma as common inclusion criteria. During the median 8.9 years of follow-up, we observed 2,130 acute exacerbations and 3,973 deaths in symptomatic smokers. Compared with symptomatic smokers without COPD, multivariable-adjusted hazard ratios for exacerbations were 7.45 (95% confidence interval, 5.41-10.3) and 29.0 (21.1-39.8) in those with COPD, respectively, excluded and eligible for clinical trials. Corresponding hazard ratios for all-cause mortality were 1.21 (1.11-1.31) and 1.67 (1.54-1.81), respectively. Conclusions: More than half of individuals with COPD in the general population are excluded from major clinical trials; however, these individuals have a clinically significant disease with exacerbations and early death compared with symptomatic smokers without COPD.
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Affiliation(s)
- Yunus Çolak
- Department of Respiratory Medicine,,The Copenhagen General Population Study, and,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and
| | - Børge G. Nordestgaard
- The Copenhagen General Population Study, and,Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and
| | - Peter Lange
- Department of Respiratory Medicine,,The Copenhagen General Population Study, and,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, and Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Shoaib Afzal
- The Copenhagen General Population Study, and,Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark;,Department of Clinical Medicine, Faculty of Health and Medical Sciences, and
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19
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Göpel W, Kribs A, Roll C, Wieg C, Teig N, Hoehn T, Welzing L, Vochem M, Hoppenz M, Bührer C, Mehler K, Hubert M, Eichhorn J, Schmidtke S, Rausch TK, König IR, Härtel C, Roth B, Herting E. Multicentre randomised trial of invasive and less invasive surfactant delivery methods showed similar spirometry results at 5-9 years of age. Acta Paediatr 2022; 111:2108-2114. [PMID: 35896864 DOI: 10.1111/apa.16499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
AIM We explored whether subnormal forced expiratory volume within one second (FEV1 ) at 5-9 years of age was lower in children born preterm who received less invasive surfactant administration (LISA) rather than surfactant via an endotracheal tube. METHODS The multicentre, randomised Nonintubated Surfactant Application trial enrolled 211 preterm infants born at 23-26 weeks of gestation from 13 level III neonatal intensive care units from April 2009 to March 2012. They received surfactant via LISA (n=107) or after conventional endotracheal intubation (n=104). The follow-up assessments were carried out by a single team blinded to the group assignments. The main outcome was FEV1 <80% of predicted values. RESULTS Spirometry was successful in 102/121 children. The other children died or were lost to follow up. Median FEV1 was 93% (interquartile range 80-113%) of predicted values in the LISA group and 86% (interquartile range 77-102%) in the control group (p=0.685). Rates of FEV1 < 80% were 11/57 (19%) and 15/45 (33 %) respectively, which was an absolute risk reduction of 14% (95% confidence interval -3.1% to 31.2%, p=0.235). There were no differences in other outcome measures. CONCLUSION The proportion of children aged 5-9 years with subnormal FEV1 was not significantly different between the groups.
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Affiliation(s)
- W Göpel
- Department of Paediatrics, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
| | - A Kribs
- Department of Paediatrics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - C Roll
- Department of Neonatology, Vest Children's Hospital Datteln, University Witten-Herdecke, Datteln, Germany
| | - C Wieg
- Children's Hospital Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - N Teig
- Department of Neonatology, University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - T Hoehn
- Department of General Paediatrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - L Welzing
- Department of Paediatrics, Hospital Köln-Porz, Germany
| | - M Vochem
- Olgahospital Stuttgart, Stuttgart, Germany
| | - M Hoppenz
- Department of Neonatology and Paediatric Intensive Care Medicine, Children's Hospital, Cologne, Germany
| | - C Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - K Mehler
- Department of Paediatrics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - M Hubert
- Department of Neonatology and Paediatric Intensive Care, DRK-Children's Hospital, Siegen, Germany
| | - J Eichhorn
- Children's Hospital Leverkusen, Leverkusen, Germany
| | - S Schmidtke
- Department of Neonatology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - T K Rausch
- Institute of Medical Biometry and Statistics, University of Lübeck, Germany
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Germany
| | - C Härtel
- Children's Hospital, University of Würzburg, Würzburg, Germany
| | - B Roth
- Department of Paediatrics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - E Herting
- Department of Paediatrics, University Hospital of Schleswig-Holstein, University of Lübeck, Lübeck, Germany
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20
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Takahashi K, Nishikawa K, Tanishima Y, Ishikawa Y, Kurogochi T, Yuda M, Tanaka Y, Matsumoto A, Yano F, Eto K. Risk Stratification of Postoperative Pneumonia in Patients Undergoing Subtotal Esophagectomy for Esophageal Cancer. Anticancer Res 2022; 42:3023-3028. [PMID: 35641299 DOI: 10.21873/anticanres.15787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Despite recent progress in surgical techniques and perioperative management, postesophagectomy pneumonia remains the most common complication. Thus, it is important to identify the risk factors of postoperative pneumonia and to improve perioperative management. This study aimed to clarify risk factors for postoperative pneumonia and subsequently stratify the risk of pneumonia. PATIENTS AND METHODS A total of 154 patients who underwent subtotal esophagectomy were divided into two groups: patients without pneumonia and those with pneumonia. Their backgrounds and operative outcomes were compared. Furthermore, risk factors of postoperative pneumonia were evaluated using a logistic regression model. RESULTS Postoperative pneumonia developed in 18.8% (n=29) of the study cohort. In the multivariate analysis, the independent risk factors for postoperative pneumonia were forced expiratory volume at 1 s (FEV1) <1.98 l [p=0.011; odds ratio (OR)=3.960; 95% confidence interval (CI)=1.380-11.400], thoracotomy (p=0.043; OR=3.110; 95%CI=1.030-9.320), operative blood loss ≥390 ml (p=0.013; OR=3.900; 95%CI=1.340-11.400), and recurrent laryngeal nerve palsy (RLNP) (p=0.014; OR=3.740; 95%CI=1.310-10.700). Patients were also stratified into the following four groups as per the number of significant risk factors: the incidence of pneumonia in patients with no risk factor, one risk factor, two risk factors, three risk factors were 7.0% (5/71), 13.7% (7/51), 43.5% (10/23), and 77.7% (7/9), respectively. CONCLUSION FEV1 <1.98 l, thoracotomy, operative blood loss ≥390 ml, and RLNP were independent risk factors of postoperative pneumonia. Additionally, patients could be stratified into four groups according to the incidence of pneumonia.
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Affiliation(s)
- Keita Takahashi
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Katsunori Nishikawa
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichiro Tanishima
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yoshitaka Ishikawa
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takanori Kurogochi
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masami Yuda
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yujiro Tanaka
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Akira Matsumoto
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Fumiaki Yano
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Ken Eto
- Department of Gastrointestinal Surgery, Jikei University School of Medicine, Tokyo, Japan
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21
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Mao X, Zhang W, Ni YQ, Niu Y, Jiang LY. A Prediction Model for Postoperative Pulmonary Complication in Pulmonary Function-Impaired Patients Following Lung Resection. J Multidiscip Healthc 2021; 14:3187-3194. [PMID: 34815673 PMCID: PMC8604645 DOI: 10.2147/jmdh.s327285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Most patients with lung cancer have impaired pulmonary function. Single pulmonary function parameters have been suggested as good indices for predicting postoperative pulmonary complications (PPC). The purpose of this retrospective study was to construct a prediction model, including more than one pulmonary function parameter, for better prediction of PPC in patients with lung cancer and impaired pulmonary function. Patients and Methods Our database of patients who underwent lung resection for non-small cell lung cancer was reviewed and those with impaired pulmonary function were enrolled. Clinical data, including PPC, were recorded. Univariate and logistic regression analyses were applied to explore potential predictors and a prediction model constructed based on the results of logistic regression. Results Patients with impaired pulmonary function (n = 124) were enrolled. Most patients were male, current smokers, >60 years old, and had adenocarcinoma and mild ventilatory dysfunction or diffusion dysfunction. In univariate analysis, we identified six pulmonary function parameters that differed significantly between the PPC and non-PPC groups. Receiver operating characteristic curves were used to determine the best cutoff values. In logistic regression, only forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC%), peak expiratory flow (PEF%), and post predictive operation (ppo)-FEV1% remained significant. Based on these results, we constructed a prediction model for PPC including FEV1/FVC%, PEF%, and ppo-FEV1%, which had an good diagnostic performance of, with 76.7% sensitivity and 67.6% specificity. Conclusion Our prediction model, including the pulmonary function parameters, FEV1/FVC%, PEF%, and ppo-FEV1%, shows excellent performance for predicting PPC in patients with lung cancer and impaired pulmonary function following resection, and has potential for wide application in clinical practice.
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Affiliation(s)
- Xiaowei Mao
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People's Republic of China.,Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Wei Zhang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People's Republic of China.,Department of Internal Medicine, American-Sino Women's & Children's Hospital, Shanghai, People's Republic of China
| | - Yi-Qian Ni
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People's Republic of China
| | - Yanjie Niu
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People's Republic of China
| | - Li-Yan Jiang
- Pulmonary and Critical Care Medicine, Shanghai Jiao Tong University, Shanghai Chest Hospital, Shanghai, People's Republic of China
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22
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Alwekhyan SA, Alshraideh JA, Yousef KM, Hayajneh F. Nurse-guided incentive spirometry use and postoperative pulmonary complications among cardiac surgery patients: A randomized controlled trial. Int J Nurs Pract 2021; 28:e13023. [PMID: 34676618 DOI: 10.1111/ijn.13023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 09/11/2021] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
Abstract
AIMS To assess the effect of nurse-guided use of incentive spirometer on postoperative oxygenation and pulmonary complications after coronary artery bypass graft surgery. BACKGROUND Deep breathing exercises have been shown to improve postoperative lung expansion and reduce pulmonary complications. An incentive spirometer is a deep breathing exercises device that imitates continuous sigh-like maximal inspiration. DESIGN Randomized control trial, two groups nonblinded parallel design. METHODS A total of n = 89 eligible patients were randomized to either control or intervention group. Patients in the intervention group received bihourly nurse-guided incentive spirometry for 48-h postextubation. The endpoints were: the number and duration of hypoxic events during the first 24-hr postsurgery, pneumonia and pulmonary function parameters. Data were collected May to September 2019. RESULTS Patients in the intervention group had a significantly lower mean number of hypoxic events with shorter duration and shorter length of stay in the hospital and the ICU. Patients in the intervention group also had greater postoperative forced expiratory volume in 1 second. CONCLUSION Nurse-guided use of the incentive spirometer reduces the risk of pulmonary complications and hospital length of stay after cardiac surgery.
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Affiliation(s)
| | | | - Khalil Moh'd Yousef
- School of Nursing, University of Jordan, Amman, Jordan.,School of Humanities, Social Sciences and Health University of Wollongong, Dubai
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23
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Park HJ, Lee HY, Suh CH, Kim HC, Kim HC, Park YJ, Lee SW. The Effect of Particulate Matter Reduction by Indoor Air Filter Use on Respiratory Symptoms and Lung Function: A Systematic Review and Meta-analysis. Allergy Asthma Immunol Res 2021; 13:719-732. [PMID: 34486257 PMCID: PMC8419638 DOI: 10.4168/aair.2021.13.5.719] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Exposure to particulate matter (PM) is a key public health issue, but effective intervention has not yet been established. A systematic literature review and meta-analysis has been conducted to assess the relationship between the use of air filters, one of the most commonly studied interventions, and respiratory outcomes in patients with chronic respiratory diseases. METHODS We systematically reviewed intervention studies on PM using PubMed, EMBASE, and Cochrane databases up to September 2019. Studies that included data on PM concentration changes and respiratory symptoms or lung function in patients with respiratory diseases were eligible for inclusion. Effect estimates were quantified separately using the random-effects model. RESULTS Six studies were included in the quantitative analysis. Air filter use reduced indoor PM2.5 by 11.45 µg/m3 (95% confidence interval [CI], 6.88, 16.01 µg/m3). Air filter use was not associated with improvements in respiratory symptoms in 5 of the 6 studies or significant changes in the predicted forced expiratory volume in one second (FEV1) (mean change, -1.77%; 95% CI, -8.25%, 4.71%). Air filter use was associated with improved peak expiratory flow rate by 5.86 (95% CI, 3.5, 8.19 of standardized difference). CONCLUSIONS The findings of this systematic review suggest that air filters may reduce indoor PM and increase peak expiratory rate in asthmatic patients. However, most studies showed no significant effects of air filters on respiratory symptoms or FEV1. Further studies in regions with high-density PM may provide additional information on this issue. TRIAL REGISTRATION PROSPERO Identifier: CRD42020156258.
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Affiliation(s)
- Hyung Jun Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Young Lee
- Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwan Cheol Kim
- Department of Occupational and Environmental Medicine, College of Medicine, Inha University, Incheon, Korea
| | - Young-Jun Park
- Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea
| | - Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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24
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Kalaycıoğlu E, Çetin M, Kırış T, Özyıldız AG, Turan T, Yılmaz AS. FEV1 is independently related with impaired left atrial strain in chronic obstructive pulmonary disease patients: A speckle tracking study. Clin Respir J 2021; 15:1359-1367. [PMID: 34435743 DOI: 10.1111/crj.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is common in chronic obstructive pulmonary disease (COPD) patients. It is known that impaired forced expiratory volume in 1 s (FEV1) is one of the risk factors of cardiovascular disease. Two-dimensional speckle tracking echocardiography (2D-STE) can detect deterioration of left atrial mechanical functions in the subclinical stage. We hypothesized that reduced lung functions, measured by FEV1 in COPD patients, may be associated with impaired left atrial (LA) mechanical functions. OBJECTIVES Present study included 127 consecutive COPD patients. We divided study population into two groups: patients with normal LA strain (n = 20) or with impaired LA strain (n = 107). RESULTS In univariate logistic regression analysis, age (p: 0.001), FEV1% (p < 0.001), FEV1 (p < 0.001), FEV1/forced vital capacity (FVC) (p: 0.014), white blood cell (p: 0.012), LA Max vol (p: 0.026), C-reactive protein (p :0.001), arterial oxygen pressure (PaO2 ) (p: 0.019), arterial oxygen saturation (SO2 ) (p: 0.021), left ventricle ejection fraction (LVEF) (p: 0.042), and mitral A-wave velocity (p: 0.017) were associated with impaired LA-strain. In multivariate logistic regression analysis, age (p: 0.043), FEV1 (p < 0.001), LA Max vol (p: 0.004), and LVEF (p: 0.004) were independently associated with impaired LA strain. CONCLUSION FEV1 is associated with impaired left atrial strain independently of arterial blood gas and left ventricular diastolic dysfunction parameters in COPD patients with preserved left ventricular systolic function.
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Affiliation(s)
- Ezgi Kalaycıoğlu
- Department of Cardiology, University of Health Sciences Turkey Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Mustafa Çetin
- Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
| | - Tuncay Kırış
- Department of Cardiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey
| | - Ali Gökhan Özyıldız
- Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
| | - Turhan Turan
- Department of Cardiology, University of Health Sciences Turkey Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey
| | - Ahmet Seyda Yılmaz
- Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
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Çolak Y, Afzal S, Nordestgaard BG, Lange P, Vestbo J. Importance of Early COPD in Young Adults for Development of Clinical COPD: Findings from the Copenhagen General Population Study. Am J Respir Crit Care Med 2021; 203:1245-1256. [PMID: 33142077 DOI: 10.1164/rccm.202003-0532oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Individuals who will develop chronic obstructive pulmonary disease (COPD) could be identified at an early age before clinical manifestations appear. Objectives: We investigated risk of clinical COPD 10 years later in young adults from the general population with and without early COPD with a focus on smoking exposure. Methods: We included 14,870 individuals aged 20-100 years from the Copenhagen General Population Study with spirometry 10 years apart. Early COPD was defined as baseline FEV1/FVC less than the lower limit of normal in individuals aged <50 years. Outcomes included clinical COPD at final examination 10 years later (chronic respiratory symptoms with FEV1/FVC <0.70 and FEV1 <80% predicted) and acute exacerbation hospitalizations during follow-up. Measurements and Main Results: Among 5,497 individuals aged <50 years at baseline with FEV1/FVC ≥0.70, 104 (3%) developed clinical COPD 10 years later; 4% of smokers with ≥10 pack-years had early COPD; 3% of smokers with <10 pack-years had early COPD; and 2% of never-smokers had early COPD. Among smokers with ≥10 pack-years, 24% developed clinical COPD in those with early COPD versus 4% in those without early COPD. Corresponding numbers were 10% and 1% in smokers with <10 pack-years and 3% and <1% in never-smokers, respectively. Among individuals with early COPD, odds ratios for clinical COPD 10 years later were 7.77 (95% confidence interval [CI], 4.10-14.7) in smokers with ≥10 pack-years and 8.56 (95% CI, 4.92-14.9) in all smokers, whereas hazard ratios for acute exacerbation hospitalizations were 4.16 (95% CI, 1.66-10.5) and 4.33 (95% CI, 1.89-9.93), respectively. Results were validated in the Copenhagen City Heart Study. Conclusions: Depending on amount of smoking exposure, <24% of young adults in the general population with early COPD develop clinical COPD 10 years later. A smoking exposure threshold for early COPD should be reconsidered, as younger individuals are less represented in those with high smoking exposure.
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Affiliation(s)
- Yunus Çolak
- Department of Clinical Biochemistry.,The Copenhagen General Population Study, and.,Faculty of Health and Medical Sciences and
| | - Shoaib Afzal
- Department of Clinical Biochemistry.,The Copenhagen General Population Study, and.,Faculty of Health and Medical Sciences and
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry.,The Copenhagen General Population Study, and.,Faculty of Health and Medical Sciences and
| | - Peter Lange
- The Copenhagen General Population Study, and.,Section of Respiratory Medicine, Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences and.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, and Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
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26
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Matsumoto S, Yamada Y, Yamada M, Chubachi S, Yokoyama Y, Matsuoka S, Tanabe A, Niijima Y, Murata M, Fukunaga K, Jinzaki M. Difference in the airway luminal area between the standing and supine positions using upright and conventional computed tomography. Clin Anat 2021; 34:1150-1156. [PMID: 34218460 DOI: 10.1002/ca.23763] [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: 04/25/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 11/09/2022]
Abstract
No clinical studies to date have compared the airway luminal area between supine and standing positions. Our aim was therefore to compare the airway luminal area between these two positions on computed tomography (CT) and to determine its correlation with forced expiratory volume in 1 s (FEV1). Thirty-two asymptomatic volunteers underwent both conventional (supine position) and upright (standing position) CT during deep inspiration breath-holding. Pulmonary function tests were conducted on the same day. We measured the airway luminal area on CT in each position. Paired t-tests and Pearson's correlation coefficients were used for statistical analysis. The average luminal areas of the trachea, right and left main bronchi, and average third-generation airway were greater in the standing than the supine position by 3.4%, 6.1%, 5.5%, and 5.2%, respectively. The correlation coefficients between airway luminal areas and FEV1 tended to be higher in the standing than the supine position; this correlation was highest for the average third-generation airway (r = 0.70, P < 0.0001). The airway luminal areas of the trachea, bilateral main bronchi, and average third-generation airway were greater in the standing than the supine position. The average third-generation airway area in the standing position had the highest correlation with FEV1.
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Affiliation(s)
- Shunsuke Matsumoto
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shiho Matsuoka
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Akiko Tanabe
- Department of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Yuki Niijima
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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27
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Celli BR, Anderson JA, Cowans NJ, Crim C, Hartley BF, Martinez FJ, Morris AN, Quasny H, Yates J, Vestbo J, Calverley PMA. Pharmacotherapy and Lung Function Decline in Patients with Chronic Obstructive Pulmonary Disease. A Systematic Review. Am J Respir Crit Care Med 2021; 203:689-698. [PMID: 32966751 PMCID: PMC7958521 DOI: 10.1164/rccm.202005-1854oc] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Whether pharmacological therapy alters decline in FEV1 in chronic obstructive pulmonary disease remains controversial. Because pharmacotherapy improves health status, exacerbation rate, and symptoms, it may be unethical to complete placebo-controlled long-term studies aimed at modifying FEV1 decline. Objectives: We conducted a systematic review of placebo-controlled pharmacological trials lasting ≥1 year to address the question of whether therapy alters FEV1 decline. Methods: A literature search for randomized trials that included repeated spirometry with at least one active and one placebo arm was conducted. Articles were excluded if study duration was <1 year, <3 spirometric measurements, or <100 subjects per arm. Study design was assessed using the Jadad score. To combine studies and find the estimated effect, we used random effects methodology to account for both within-study and between-study variation. Measurements and Main Results: There were 33,051 patients in the analysis (active component, n = 21,941; placebo, n = 11,110 in nine studies). The active treatment arms demonstrated a 5.0 ml/yr reduction (95% confidence interval, 0.8–9.1 ml/yr; P < 0.001) in the rate of FEV1 decline compared with the placebo arms. The relative FEV1 differences between active and placebo arms were within the range of differences reported for health status and for the exacerbation rate in the same studies. Conclusions: In chronic obstructive pulmonary disease, pharmacotherapy ameliorates rate of lung function decline. The relative benefit observed is within the range of those reported for health status and exacerbations in the same studies. Guidelines should be adjusted according to these findings.
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Affiliation(s)
- Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julie A Anderson
- Research & Development, GlaxoSmithKline, Stockley Park, Middlesex, United Kingdom
| | | | - Courtney Crim
- Research & Development, GlaxoSmithKline, Research Triangle Park, North Carolina
| | | | - Fernando J Martinez
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Andrea N Morris
- Research & Development, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Holly Quasny
- Research & Development, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Julie Yates
- Research & Development, GlaxoSmithKline, Research Triangle Park, North Carolina
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; and
| | - Peter M A Calverley
- Department of Medicine, Clinical Sciences Centre, University of Liverpool, University Hospital Aintree, Liverpool, United Kingdom
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Katiyar N, Negi S, Negi SL, Puri GD, Thingnam SKS. Assessment of factors affecting short-term pulmonary functions following cardiac surgery: A prospective observational study. Asian Cardiovasc Thorac Ann 2021; 30:156-163. [PMID: 33853386 DOI: 10.1177/02184923211010079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pulmonary complications after cardiac surgery are very common and lead to an increased incidence of post-operative morbidity and mortality. Several factors, either modifiable or non-modifiable, may contribute to the associated unfavorable consequences related to pulmonary function. This study was aimed to investigate the degree of alteration and factors influencing pulmonary function (forced expiratory volume in one second (FEV1) and forced vital capacity), on third, fifth, and seventh post-operative days following cardiac surgery. METHODS This study was executed in 71 patients who underwent on-pump cardiac surgery. Pulmonary function was assessed before surgery and on the third, fifth, and seventh post-operative days. Data including surgical details, information about risk factors, and assessment of pulmonary function were obtained. RESULTS The FEV1 and forced vital capacity were significantly impaired on post-operative days 3, 5, and 7 compared to pre-operative values. The reduction in FEV1 was 41%, 29%, and 16% and in forced vital capacity was 42%, 29%, and 19% consecutively on post-operative days 3, 5, and 7. Multivariate analysis was done to detect the factors influencing post-operative FEV1 and forced vital capacity. DISCUSSION This study observed a significant impairment in FEV1 and forced vital capacity, which did not completely recover by the seventh post-operative day. Different factors affecting post-operative FEV1 and forced vital capacity were pre-operative FEV1, age ≥60, less body surface area, lower pre-operative chest expansion at the axillary level, and having more duration of cardiopulmonary bypass during surgery. Presence of these factors enhances the chance of developing post-operative pulmonary complications.
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Affiliation(s)
- Neetika Katiyar
- Physiotherapy Section, Department of Physical Rehabilitation and Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Negi
- Physiotherapy Section, Department of Physical Rehabilitation and Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunder Lal Negi
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan Dutt Puri
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiothoracic Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Dadgostar A, Nassiri S, Quon BS, Manji J, Alsalihi S, Javer A. Effect of endoscopic sinus surgery on clinical outcomes in DeltaF508 cystic fibrosis patients. Clin Otolaryngol 2021; 46:941-947. [PMID: 33686728 DOI: 10.1111/coa.13751] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/22/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Chronic rhinosinusitis (CRS) is prevalent in the Cystic Fibrosis (CF) population. CRS exacerbations in CF are thought to contribute to pulmonary exacerbations. Literature regarding the impact of endoscopic sinus surgery (ESS) is inconclusive. This study examines rates of lung function decline and pulmonary exacerbation in CF patients who have undergone ESS. DESIGN Retrospective review of medical records. SETTING Academic Hospital. PARTICIPANTS 40 adult CF patients. MAIN OUTCOME MEASURES Rate of lung function decline (% predicted Forced Expiratory Volume in 1 second [ppFEV1 ]), number of pulmonary exacerbations (IV/oral antibiotic therapy ± hospital admission) and total number days hospitalised 2-year postoperatively was collected. CRS patients undergoing ESS were matched to those without ESS by gender, age, and F508del genotype. RESULTS Forty patients (mean age 37.4, 60% male) were reviewed. No significant difference was found between the surgical group and controls in baseline ppFEV1 (72.5% vs. 72.7%, P = .98), 2-year preoperative number of pulmonary exacerbations (3.05 vs. 1.65, P = .10), or Lund-Mackay scores (12.25 vs. 11.55, P = .71). No significant difference was found in 1-year (70.5% vs. 72.8%, P = .84) or 2-year (70.4% vs. 72.6% P = .80) postoperative ppFEV1 and 2-year postoperative pulmonary exacerbations (1.7 vs. 1.45, P = .87). A significant increase was identified in total number days hospitalised postoperatively (4.85, P = .02). In the surgical group, no significant difference was identified between preoperative and postoperative ppFEV1 , 1 year (-2.51%, P = .32) and 2 years after ESS (-3.10%, P = .51), postoperative rate of pulmonary exacerbations (-1.28, P = .11), or in total number days hospitalised (3.74, P = .14). CONCLUSIONS In this study, ESS does not appear to significantly improve ppFEV1 or decrease the number of pulmonary exacerbations postoperatively.
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Affiliation(s)
- Anali Dadgostar
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Sepehr Nassiri
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Bradley S Quon
- Adult Cystic Fibrosis Clinic, University of British Columbia, Vancouver, BC, Canada
| | - Jamil Manji
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada.,Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Salahuddin Alsalihi
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Amin Javer
- St. Paul's Sinus Centre, Division of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
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Kuroda H, Sakata S, Takahashi Y, Nakada T, Oya Y, Sugita Y, Sakakura N, Matushita H, Sakao Y. Subsegmental resection preserves regional pulmonary function: A focus on thoracoscopy. Thorac Cancer 2021; 12:1033-1040. [PMID: 33586330 PMCID: PMC8017248 DOI: 10.1111/1759-7714.13841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to evaluate regional postoperative preserved pulmonary function (PPPF) and three‐dimensional (3D) volumetric changes according to the number of resected subsegments and investigate the factors that most affected pre‐/post PPPF. Methods Patients who underwent thoracoscopic lobectomy (n = 73), and segmentectomy (n = 87) were eligible for inclusion in the study. They were classified according to the number of resected subsegments which ranged from 1 to 10. The percentage of pre‐/postoperative forced expiratory volume in 1 s (FEV1) was used for comparison. Furthermore, lung volumetric changes were calculated using 3D computed tomography (CT) volumetry. Results The percentage of pre‐/postoperative EFV1 between 4 and 5–7 and between 5–7 and 10 were significant (p = 0.03 and p < 0.01, respectively), but not between 1–2 to 4 (p = 0.99). The difference between volumetric changes in the left lower lobe of patients with a number of resected subsegments was significant (p < 0.01). On univariate and multivariate analyses, chronic inflammation was significant for decrease in recovery percentages. When the PPPF was compared among resected subsegments, it gradually decreased with an increase in the number of patients without a postoperative procrastination of inflammation (p < 0.01). Conclusions Segmentectomy is feasible and useful for PPPF. Even a relatively large‐volume resection procedure where 5–7 subsegments are resected can preserve pulmonary function. Chronic inflammation was statistically identified as a risk factor for postoperative preserved pulmonary function. Key points
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Affiliation(s)
- Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shozo Sakata
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Takahashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan
| | - Takeo Nakada
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yuko Oya
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yusuke Sugita
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroakazu Matushita
- Department of Translational Oncoimmunology, Aichi Cancer Research Institute, Nagoya, Japan
| | - Yukinori Sakao
- Department of Surgery, Division of Thoracic Surgery, The Teikyo University, Tokyo, Japan
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31
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Kawai K, Dombrowski N, Sawicki GS, Adil EA. Improvement of Pulmonary Function in Cystic Fibrosis Patients following Endoscopic Sinus Surgery. Laryngoscope 2021; 131:1930-1938. [PMID: 33538334 DOI: 10.1002/lary.29409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS To compare pre-and post-operative pulmonary function relative to disease severity in cystic fibrosis (CF) patients following endoscopic sinus surgery (ESS). STUDY DESIGN Retrospective chart review. METHODS Patients with CF who underwent ESS between January 1996 and July 2018 were identified, with subsequent study exclusions based upon surgical indications or incomplete records. CF disease severity was based upon percentage predicted of forced expiratory volume in 1 second (%FEV1) with <40% considered severe disease, 40% to 70% as moderate disease, and >70% as mild disease. The changes in %FEV1 before and after ESS were examined using multivariable mixed-effects models controlling for age, gender, genotype, medications, nutritional status, diabetes status, microbiology results, extent of surgery, and number of surgeries. RESULTS A total of 427 surgeries were performed in 188 patients during the study period. Mean age at first ESS was 12.7 years (SD 6.0 years, range 4-38) and 54.8% were females. The effect of ESS varied by severity of lung disease. After surgery, %FEV1 increased by 8.1% (95% CI: 2.3, 13.9%) among patients with severe lung disease and by 3.0% (95% CI: 0.7, 5.2%) among patients with moderate disease. %FEV1 also increased by 7.3% (95% CI: 4.2, 10.5%) among patients with mild disease whose %FEV1 value was 70% to 80% at baseline. No improvement was observed in patients with a baseline %FEV1 >80%. CONCLUSIONS When controlling for important confounding factors, lung function improved following ESS among CF patients with severe and moderate disease and in select patients with mild disease. This improvement was sustained at 12 months following surgery. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1930-1938, 2021.
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Affiliation(s)
- Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Natasha Dombrowski
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Eelam A Adil
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Horie J, Takahashi K, Shiranita S, Anami K, Hayashi S. Validation of Clinical Characteristics and Effectiveness of Pulmonary Rehabilitation in a COPD Population with Discrepancy between Exercise Tolerance and FEV1. Healthcare (Basel) 2021; 9:53. [PMID: 33419024 DOI: 10.3390/healthcare9010053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 01/31/2023] Open
Abstract
This study’s objective was to examine the characteristics of patients with chronic obstructive pulmonary disease (COPD) presenting with various exercise tolerance levels. A total of 235 patients with stable COPD were classified into 4 groups: (1) LoFlo + HiEx—patients with a six-minute walking distance (6MWD) ≥350 m and percentage of predicted forced expiratory volume in 1 s (%FEV1.0) <50%; (2) HiFlo + HiEx—patients with a 6MWD ≥350 m and a %FEV1.0 ≥50%; (3) LoFlo + LoEx—patients with a 6MWD < 350 m and %FEV1.0 < 50%; and (4) HiFlo + LoEx—patients with a 6MWD <350 m and %FEV1.0 ≥ 50%. Aspects of physical ability in the HiFlo + LoEx group were significantly lower than those in the HiFlo + HiEx group. The HiFlo + LoEx group was characterized by a history of hospitalization for respiratory illness within the past year, treatment with at-home oxygen therapy, and lacking daily exercise habits. Following three months of pulmonary rehabilitation, the LoFlo + HiEx group significantly improved in the modified Medical Research Council dyspnea score, maximum gait speed, and 6MWD, while the HiFlo + LoEx group significantly improved in the percentage of maximal expiratory pressure, maximum gait speed, 6MWD, incremental shuttle walking distance, and St. George’s Respiratory Questionnaire score. The HiFlo + LoEx group had the greatest effect of three-month pulmonary rehabilitation compared to other groups.
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Ayyoub Z, Brashear A, Banach M, Schoene R, Stringer W, Boodhoo T, Yushmanova I, Dimitrova R, Brin MF. Safety and Stability of Pulmonary Function in Patients with Decreased Respiratory Function Treated for Spasticity with OnabotulinumtoxinA. Toxins (Basel) 2020; 12:toxins12100661. [PMID: 33086749 PMCID: PMC7589715 DOI: 10.3390/toxins12100661] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022] Open
Abstract
Two randomized, placebo-controlled studies evaluated the pulmonary function safety of onabotulinumtoxinA (onabotA) for treatment of upper and/or lower limb spasticity. Patients with stable baseline respiratory status received one or two treatments with placebo, 240 U, or 360 U of onabotA. Pulmonary function tests, adverse events, and efficacy were measured at least every 6 weeks for 18 weeks (Study 1) or 30 weeks (Study 2). Study 1 enrolled 109 patients (n = 36–37/group) and Study 2 enrolled 155 patients (n = 48–54/group). Mean baseline forced vital capacity (FVC) was 76–78% of predicted per group in Study 1 and 71% of predicted per group in Study 2. In Study 1, change from baseline FVC values were significantly (p < 0.05) decreased vs. placebo at weeks 3 (240 U −57 mL vs. placebo +110 mL) and 12 (360 U −6 mL vs. +167 mL placebo). In Study 2, change from baseline FVC values were significantly decreased in the 360 U group vs. placebo at weeks 6 (−78 mL vs. +49 mL placebo), 13 (−60 mL vs. +119 mL placebo), 18 (−128 mL vs. +80 mL placebo), and 24 (−82 mL vs. +149 mL placebo). Individual pulmonary function-related adverse events were not correlated with PFT decreases. The most frequent pulmonary-related adverse events were nasopharyngitis (Study 1) and upper respiratory tract infection (Study 2). Ashworth scores were significantly improved at multiple time points in both studies. Injection of onabotA for spasticity in patients with decreased pulmonary function, at single and repeated doses of up to 360 U, was associated with small but statistically significant decreases in FVC or forced expiratory volume 1 s (FEV1) (>12% and 200 mL) that were subclinical and not correlated with any adverse clinical pulmonary events.
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Affiliation(s)
- Ziyad Ayyoub
- Rancho Los Amigos National Rehabilitation Center, Downey, CA 90242, USA;
- Clinical Professor of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, USA
- Department of Physical Medicine and Rehabilitation, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Allison Brashear
- Department of Neurology, University of California, Sacramento, CA 95817, USA;
| | - Marta Banach
- Department of Neurology, Jagiellonian University, 31-007 Krakow, Poland;
| | | | - William Stringer
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA;
| | - Terry Boodhoo
- Allergan plc, an AbbVie Company, Irvine, CA 92612, USA; (T.B.); (I.Y.); (R.D.)
| | - Irina Yushmanova
- Allergan plc, an AbbVie Company, Irvine, CA 92612, USA; (T.B.); (I.Y.); (R.D.)
| | - Rozalina Dimitrova
- Allergan plc, an AbbVie Company, Irvine, CA 92612, USA; (T.B.); (I.Y.); (R.D.)
| | - Mitchell F. Brin
- Allergan plc, an AbbVie Company, Irvine, CA 92612, USA; (T.B.); (I.Y.); (R.D.)
- Department of Neurology, University of California, Irvine, CA 92697, USA
- Correspondence: ; Tel.: +1-714-246-4429
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Lawrence KG, Keil AP, Garantziotis S, Umbach DM, Stewart PA, Stenzel MR, McGrath JA, Jackson WB, Kwok RK, Curry MD, Engel LS, Sandler DP. Lung function in oil spill responders 4-6 years after the Deepwater Horizon disaster. J Toxicol Environ Health A 2020; 83:233-248. [PMID: 32249687 PMCID: PMC7837370 DOI: 10.1080/15287394.2020.1745111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Oil spill response and clean-up (OSRC) workers were exposed to hazardous airborne chemicals following the 2010 Deepwater Horizon disaster. The aim of this study was to evaluate lung function in workers 4-6 years following the disaster using a prospective cohort. Participants who completed two spirometry test sessions 1-3 years, and 4-6 years after the spill (N = 1,838) were included and forced expiratory volume in 1 s (FEV1; ml), forced vital capacity (FVC; ml), and ratio (FEV1/FVC; %) determined. Linear mixed models were utilized to estimate relationships between OSRC exposures and lung function 4-6 years after the spill and changes since the prior measurement. Despite suggestive reduced lung function at 1-3 years, at the 4-6-year exam workers with total hydrocarbon (THC) exposure 1-2.99 ppm and ≥3 ppm compared to those with ≤0.29 ppm exhibited higher FEV1 (β: 108 ml, 95% CI: 17, 198) and (β: 118 ml, 95% CI: 5, 232), respectively. Compared with support workers, those in higher exposed jobs displayed greater improvement in FEV1 between visits: cleanup on water (β: 143 ml, 95% CI: 35, 250), operations (β: 132 ml, 95% CI: 30, 234) and response (β: 149 ml, 95% CI: 43, 256). Greater FEV1 improvement was also associated with higher versus the lowest level THC exposure: 1-2.99 ppm (β: 134 ml, 95% CI: 57, 210) and ≥3 ppm (β: 205 ml, 95% CI: 109, 301). Lung function decrements seen shortly after the spill were no longer apparent 4-6 years later, with the greatest improvement among those with the highest exposures.
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Affiliation(s)
- Kaitlyn G. Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Alexander P. Keil
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Stavros Garantziotis
- Clinical Research Unit, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - David M. Umbach
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | | | | | | | - Richard K. Kwok
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | | | - Lawrence S. Engel
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
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Kumar P, Mukherjee A, Randev S, Medigeshi GR, Jat KR, Kapil A, Lodha R, Kabra SK. Effect of acute respiratory infections in infancy on pulmonary function test at 3 years of age: a prospective birth cohort study. BMJ Open Respir Res 2020; 7:7/1/e000436. [PMID: 32079606 PMCID: PMC7047475 DOI: 10.1136/bmjresp-2019-000436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/04/2019] [Revised: 09/27/2019] [Accepted: 11/03/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Acute respiratory infections (ARIs) in infancy may have a long-term impact on the developing respiratory system. We planned a prospective cohort study to determine the impact of ARI during infancy on the pulmonary function test indices at 3 years of age. METHODS A cohort of normal, full-term newborns were followed up 6 monthly and during ARI episodes. Infant pulmonary function tests (IPFTs) were performed at baseline and each follow-up visit using tidal breathing flow-volume loop, rapid thoracoabdominal compression (RTC) and raised volume RTC manoeuvres. During each ARI episode, nasopharyngeal aspirates were tested for respiratory pathogens by real-time PCR. RESULTS We screened 3421 neonates; 310 were enrolled; IPFT was performed in 225 (boys: 125 (55.6%)) at 3 years. During infancy, 470 ARI episodes were documented in 173 infants. At 3 years, children with history of any ARI episode during infancy had lower forced expiratory volume in 1 s (FEV1.0), forced expiratory volume in 0.75 s (FEV0.75), forced expiratory volume in 0.5 s (FEV0.5), forced expiratory flow between 25% and 75% of FVC (FEF25-75), and maximal expiratory flow at 25% of FVC (MEF25) as compared with those without any ARI episode during infancy. The ratio of tidal expiratory flow (TEF) at 25% or 50% of tidal expiratory volume to peak TEF (TEF50 or TEF25/peak TEF) at 3 years was significantly increased in children who had ARI in infancy. CONCLUSIONS ARI during infancy is associated with impaired pulmonary function indices such as increased resistance and decreased forced expiratory flow and volume at 3 years of age.
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Affiliation(s)
- Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shivani Randev
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Guruprasad R Medigeshi
- Vaccine and Infectious Disease Research Center, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sushil Kumar Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Saini M, Kulandaivelan S, Bansal VK, Saini V, Sharma S, Kaur J, Sondh A. Pulmonary Pathology Among Patients with Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-analysis. Curr Diabetes Rev 2020; 16:759-769. [PMID: 31333139 DOI: 10.2174/1573399815666190716130324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/17/2019] [Revised: 05/18/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Restrictive lung pathology was reported in the previous meta-analysis among patients with Type 2 Diabetes mellitus (T2DM) which is date back to 2010. OBJECTIVE To see the effect of T2DM on pulmonary functions through updated systematic review and meta-analysis. DATA SOURCE PubMed. STUDY ELIGIBILITY CRITERIA English language case-control or cross-sectional studies, published between 1 January 2010 to 31 August 2018. PARTICIPANTS AND INTERVENTION T2DM and non-diabetic subjects were compared for at least one of the pulmonary function variables i.e. Forced expiratory volume in 1st second (FEV1), % FEV1, Forced vital capacity (FVC), % FVC and % FEV1/FVC. STUDY APPRAISAL AND SYNTHESIS METHODS Methodological quality of the study was assessed using Newcastle-Ottawa Quality Assessment Scale. Meta-analysis was done using Review Manager 5.3 (RevMan 5.3) and meta-regression was conducted using R statistical software. RESULTS We selected 22 articles that met our inclusion and exclusion criteria. Results reveal that among patients with T2DM all variables were reduced except %FEV1/FVC which shows statistically nonsignificant results with P=0.46. This confirms that T2DM patients have a restrictive type of lung pathology. LIMITATION Only articles from the PubMed database were included. Conclusion and Implications of Key Findings: This review affirms the existing evidence of restrictive pathology among patients with T2DM. The future study could be conducted to see the effect of various rehabilitation protocols on pulmonary function among patients with T2DM.
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Affiliation(s)
- Minaxi Saini
- Mother Teresa Saket College of Physiotherapy, Chandimandir, Panchkula, India
| | | | | | - Vikram Saini
- Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Suresh Sharma
- Department of Statistics, Panjab University, Chandigarh, India
| | - Jaspreet Kaur
- Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - Aparajita Sondh
- Mother Teresa Haryana Saket Council, Panchkula, Haryana, India
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Ohara DG, Pegorari MS, Oliveira Dos Santos NL, de Fátima Ribeiro Silva C, Oliveira MSR, Matos AP, Jamami M. Cross-Sectional Study on the Association between Pulmonary Function and Sarcopenia in Brazilian Community-Dwelling Elderly from the Amazon Region. J Nutr Health Aging 2020; 24:181-187. [PMID: 32003408 DOI: 10.1007/s12603-019-1290-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the obtained and expected values of pulmonary function variables between sarcopenic and non-sarcopenic elderly; verify the association between the pulmonary function and the indicators and diagnosis of sarcopenia; and establish cut-off points for pulmonary function variables to predict sarcopenia. DESIGN Cross-sectional study. LOCATION Macapá, Brazil. PARTICIPANTS community-dwelling elderly ≥ 60 years old (n=383), both sexes. MEASURES Were evaluated according to variables of pulmonary function (spirometry) and sarcopenia, according to the EWGSOP consensus. The association between pulmonary function and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve. RESULTS The prevalence of sarcopenia was 12.53% (n = 48). Sarcopenic individuals had significantly lower mean values for FVC, FEV1, FEF25-75% and PEF than non-sarcopenic. After adjustment, spirometric variables were inversely associated with sarcopenia (the increase by one unit of liter in FVC, FEV1 and FEF25-75% decreased the probability of sarcopenia by 59%, 67% and 39%, respectively), and the majority of these variables with the muscular strength indicator. Cut-off points, for elderly men and women, were discriminant criteria for the presence of sarcopenia: FVC (≤2.52 L and ≤1.82 L), FEV1 (≤2.1 L and ≤1.39 L), PEF (≤3.45 L/s and ≤2.93 L/s) and FEF5-75% (≤1.97 L/s and ≤1.74 L/s). CONCLUSIONS There was loss of pulmonary function in sarcopenic elderly patients and an inverse association with the diagnosis of sarcopenia and its indicators. Cut-off points of pulmonary function variables can be used as a useful tool to discriminate sarcopenia.
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Affiliation(s)
- D G Ohara
- Maycon Sousa Pegorari, Federal University of Amapá, Department of biological and health sciences, Physical Therapy Course. Address: Road Juscelino Kubitschek, Km - 02, Jardim Marco Zero, Macapá - AP, CEP 68903-419 - Phone number: (+55 96) 4009-2944 E-mail:
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Wu Z, Bian X, Hui L, Zhang J. Nebulized step-down budesonide vs. fluticasone in infantile asthma: A retrospective cohort study. Exp Ther Med 2019; 19:1665-1672. [PMID: 32104218 PMCID: PMC7027130 DOI: 10.3892/etm.2019.8401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/04/2019] [Indexed: 11/08/2022] Open
Abstract
The United States Food and Drug Administration has approved budesonide in infantile asthma but nebulization of infants under budesonide has the risk of relapse of asthma. The objective of the present study was to compare the effectiveness and safety of fluticasone step-down treatment with budesonide step-down treatment in infantile asthma. The data of 778 infants with confirmed asthma were included in the analysis. Infants who had received nebulized 500 µg budesonide twice daily for 6 weeks followed by 250 µg budesonide twice daily for 6 weeks were included in the BS group (n=389), while infants who had received nebulized 250 µg fluticasone twice daily for 6 weeks followed by 125 µg fluticasone twice daily for 6 weeks were included in the FC group (n=389). The data of lung function tests and a safety study were collected and analyzed. Budesonide treatment achieved a reduced specific airway resistance (sRaw; 1.28±0.11 vs. 1.21±0.10 kPa/sec; P<0.0001, q=13.45) and improved forced expiratory volume in 1 sec (FEV1; 0.977±0.068 vs. 0.997±0.085 l/sec; P<0.0001, q=5.54). In addition, fluticasone treatment achieved a reduced sRaw (1.27±0.1 vs. 1.23±0.11 kPa/sec, P<0.0001, q=7.39) and improved FEV1 (0.971±0.069 vs. 0.992±0.085 l/sec; P=0.0003, q=5.46). Of note, the efficacy of budesonide to reduce sRaw (P=0.008, q=3.69) and improve FEV1 (P<0.0001, q=6.93) was greater than that of fluticasone. The budesonide treatment group had more post-treatment symptom-free days than the fluticasone treatment group (165.56±23.15 vs. 112.21±9.45 days; P<0.0001). The step-down approach of budesonide nebulization may better support the functional and clinical outcomes with an increased number of post-treatment symptom-free days compared with fluticasone in infantile asthma (level of evidence, 3).
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Affiliation(s)
- Zhimin Wu
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
| | - Xiangli Bian
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
| | - Lei Hui
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
| | - Jinping Zhang
- Department of Pediatrics, Shanghai University of Medicine and Health Science, Shanghai 201318, P.R. China
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Khan N, Eliopoulos H, Han L, Kinane TB, Lowes LP, Mendell JR, Gordish-Dressman H, Henricson EK, McDonald CM. Eteplirsen Treatment Attenuates Respiratory Decline in Ambulatory and Non-Ambulatory Patients with Duchenne Muscular Dystrophy. J Neuromuscul Dis 2019; 6:213-225. [PMID: 30856119 PMCID: PMC6598025 DOI: 10.3233/jnd-180351] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) patients experience skeletal muscle degeneration, including respiratory muscles. Respiratory decline in glucocorticoid-treated DMD patients, measured by percent predicted forced vital capacity (FVC% p), is typically 5% annually in patients aged 10 to 18 years. OBJECTIVE Evaluate the effects of eteplirsen on FVC% p annual change in 3 trials versus matched Cooperative International Neuromuscular Research Group Duchenne Natural History Study (CINRG DNHS) controls. METHODS Eteplirsen studies 201/202 evaluated eligible ambulatory DMD patients for at least 4 years, study 204 evaluated primarily non-ambulatory DMD patients for 2 years, and ongoing study 301 is evaluating ambulatory DMD patients for 2 years (interim analysis is included). Eteplirsen-treated patients (n = 74) were amenable to exon 51 skipping and were receiving glucocorticoids. Three CINRG DNHS cohorts included: glucocorticoid-treated patients amenable to exon 51 skipping (Exon 51 CINRG DNHS; n = 20), all glucocorticoid-treated CINRG patients (All CINRG DNHS; n = 172), and all glucocorticoid-treated genotyped CINRG DNHS patients (Genotyped CINRG DNHS; n = 148). FVC% p assessments between ages 10 and <18 years were included for all patients; mixed-model analyses characterized FVC% p annual change. RESULTS FVC% p annual change was greater for CINRG DNHS Exon 51 controls (- 6.00) versus patients in studies 201/202, study 204, and study 301 (- 2.19, P < 0.001; - 3.66, P 0.004; and - 3.79, P 0.017, respectively). FVC% p annual change in all eteplirsen studies suggested treatment benefit compared with the Genotyped CINRG DNHS (- 5.67) and All CINRG DNHS (- 5.56) cohorts (P < 0.05, all comparisons). CONCLUSIONS Significant, clinically meaningful attenuation of FVC%p decline was observed in eteplirsen-treated patients versus CINRG DNHS controls.
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Affiliation(s)
- Navid Khan
- Sarepta Therapeutics, Inc., Cambridge, MA, USA
| | | | - Lixin Han
- Sarepta Therapeutics, Inc., Cambridge, MA, USA
| | - T Bernard Kinane
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | | | | | - Heather Gordish-Dressman
- Center for Genetic Medicine, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington DC, USA
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Shen DD, Yang ZH, Huang J, Yang F, Lin ZW, Ou YF, Hu MH. Liuweibuqi capsules improve pulmonary function in stable chronic obstructive pulmonary disease with lung-qi deficiency syndrome by regulating STAT4/STAT6 and MMP-9/TIMP-1. Pharm Biol 2019; 57:744-752. [PMID: 31679431 PMCID: PMC6844411 DOI: 10.1080/13880209.2019.1666151] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Context: Liuweibuqi (LWBQ) capsule has been reported to influence symptoms of patients with chronic obstructive pulmonary disease (COPD); however, specific function of LWBQ capsules in COPD with lung-qi deficiency syndrome remains elusive.Objective: This study investigates effect of LWBQ capsules on STAT4/STAT6 and MMP-9/TIMP-1 expression and pulmonary function in stable COPD with lung-qi deficiency syndrome.Materials and methods: Totally, 429 patients diagnosed with stable COPD and lung-qi deficiency syndrome were treated with starch capsules (each time for 9 capsules), or different doses: low (each dose for 8 capsules and 1 LWBQ capsules), medium (each time for 6 capsules and 3 LWBQ capsules), or high (each time for 9 LWBQ capsules) of LWBQ capsules for 30 days, 3 times a day. Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC% and DLco%pred were evaluated by pulmonary function meter. STAT4/STAT6 and MMP-9/TIMP-1 expression was assessed by RT-qPCR and western blot analysis, and serum concentrations of IL-4, IFN-γ and IL-6 by ELISA.Results: Spearman rank correlation analysis and ROC curve showed that STAT4/STAT6 and MMP-9/TIMP-1 affected pulmonary functions and curative effect of stable COPD with lung-qi deficiency syndrome. After LWBQ capsule treatment, FEV1, FVC, FEV1/FVC% and DLco%pred elevated; STAT4/STAT6, MMP-9/TIMP-1, IFN-γ and IL-6 expression declined whereas IL-4 expression increased (p < 0.05). Logistic regression analysis demonstrated that FEV1/FVC was negatively correlated with STAT4/STAT6 and MMP-9/TIMP-1 expression in COPD patients.Conclusions: LWBQ capsules play a beneficial role in pulmonary function of stable COPD with lung-qi deficiency syndrome via STAT4/STAT6 and MMP-9/TIMP-1.
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Affiliation(s)
- Dan-Dan Shen
- Department of Pharmacy, The First People’s Hospital of Taicang, Affiliated Hospital of Soochow University, Taicang, P. R. China
- CONTACT Dan-Dan Shen Department of Pharmacy, The First People’s Hospital of Taicang, Soochow University, Affiliated Hospital of Soochow University, No. 58, Changsheng South Road, Taicang 215400, Jiangsu Province, P. R. China
| | - Zhong-Hui Yang
- Office of the Party and Government, The First People’s Hospital of Taicang, Affiliated Hospital of Soochow University, Taicang, P. R. China
| | - Ji Huang
- Department of Pharmacy, The First People’s Hospital of Taicang, Affiliated Hospital of Soochow University, Taicang, P. R. China
| | - Fei Yang
- Nanjing University of Chinese Medicine, Nanjing, P. R. China
| | - Zi-Wei Lin
- Nanjing University of Chinese Medicine, Nanjing, P. R. China
| | - Ying-Fei Ou
- Department of Rehabilitation Medicine, The First People’s Hospital of Taicang, Affiliated Hospital of Soochow University, Taicang, P. R. China
| | - Min-Hao Hu
- Department of Pharmacy, The First People’s Hospital of Taicang, Affiliated Hospital of Soochow University, Taicang, P. R. China
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Kato S, Murray JC, Ganau M, Tan Y, Oshima Y, Tanaka S. Does Posterior Scoliosis Correction Improve Respiratory Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis. Global Spine J 2019; 9:866-873. [PMID: 31819853 PMCID: PMC6882091 DOI: 10.1177/2192568218811312] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 11/24/2022] Open
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVES Pulmonary dysfunction is often advocated among the indications for surgical correction of adolescent idiopathic scoliosis (AIS). Previous studies have discussed the effect of scoliosis correction on respiratory function without reaching a definitive conclusion: Some showed that the respiratory function can improve after scoliosis surgery without defining the precise role of anterior, posterior, and combined approaches on this improvement; furthermore, the majority of these studies did not take normal growth into account. As a result, the role of surgery remains to be clarified. The object of the present study was to synthesize the current knowledge regarding changes in respiratory function after posterior corrective surgery for AIS. METHODS A comprehensive systematic search was performed to identify all relevant studies in the following electronic databases: MEDLINE, EMBASE, CINAHL (EBSCO). We focused on the studies (1) that discussed posterior fusion surgery for AIS without thoracoplasty, (2) that discussed comparisons of pre- and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume (%FEV), and (3) with minimum 2-year follow-up. Forest plots were depicted and Z value was calculated as a test for overall effect. RESULTS Ten studies (6 prospective and 4 retrospective studies) met our inclusion criteria. The overall effect showed that there was no significant difference in %FVC or %FEV between pre- and postoperative measurements (very low evidence). CONCLUSIONS Posterior correction surgery for mild to moderate AIS patients showed no significant improvement of postoperative respiratory function measured by relative, percent-predicted values at minimum 2-year follow-up.
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Affiliation(s)
- So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,The Hospital for Sick Children, Toronto, Ontario, Canada,So Kato, Department of Orthopaedic Surgery, The University of Tokyo, Tokyo 113-8655, Japan.
| | | | - Mario Ganau
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yongyao Tan
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
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Bikbov MM, Kazakbaeva GM, Zainullin RM, Salavatova VF, Arslangareeva II, Panda-Jonas S, Gilmanshin TR, Nikitin NA, Mukhamadieva SR, Yakupova DF, Khikmatullin RI, Aminev SK, Nuriev IF, Zaynetdinov AF, Uzianbaeva YV, Jonas JB. Prevalence, Awareness, and Associated Factors of Airflow Obstruction in Russia: The Ural Eye and Medical Study. Front Public Health 2019; 7:350. [PMID: 31824912 PMCID: PMC6879424 DOI: 10.3389/fpubh.2019.00350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Although chronic obstructive pulmonary disease and asthma belong to the most important causes of disability and death in all world regions, data about the prevalence of airflow obstruction and asthma in Russia and the associated parameters have been scarce so far. We therefore assessed the prevalence of airflow obstruction and asthma in a Russian population. Methods: The population-based Ural Eye and Medical Study, conducted in a rural and urban region of Bashkortostan/Russia, included 5,392 participants (mean age: 58.6 ± 10.6 years; range: 40-94 years) out of 7,328 eligible individuals. Airflow obstruction was defined spirometrically and asthma by self-reported diagnosis. Results: Airflow obstruction was present in 369 individuals (6.8%; 95% confidence interval (CI): 6.2, 7.5) with an awareness rate of 63.4% (95%CI: 58.5, 68.4) and known duration of 19.5 ± 15.8 years (median: 16 years). Prevalence of undiagnosed airflow obstruction was 2.6% (95%CI: 2.2, 3.1). Higher prevalence of airflow obstruction was associated (multivariable analysis) with higher prevalence of current smoking [P < 0.001; odds ratio (OR): 2.91; 95%CI: 1.76, 4.83] and number of cigarette package years (P < 0.001; OR: 1.03; 95%CI: 1.02, 1.08), female gender (P = 0.03; OR: 1.42; 95%CI: 1.04, 1.93), urban region (P = 0.003; OR: 1.43; 95% CI: 1.12, 1.79), higher prevalence of cardiovascular diseases/stroke (P < 0.001; OR: 1.86; 95%CI: 1.45, 2.39), higher depression score (P = 0.002; OR: 1.05; 95%CI: 1.02, 1.08), and lower physical activity (P = 0.01; OR: 0.71; 95%CI: 0.54, 0.93). Asthma prevalence (2.6%; 95%CI: 2.0, 3.1; known duration: 17.2 ± 15.0 years) was associated with less alcohol consumption (OR: 0.53; 95%CI: 0.33, 0.87; P = 0.01), higher depression score (OR: 1.08; 95%CI: 1.03, 1.12; P < 0.001), and urban region (OR: 0.68; 95CI: 0.49, 0.95; P = 0.0.03). Conclusions: In this Russian population aged 40+ years, the prevalence of airflow obstruction was 6.8% with an awareness rate of 63.4% and smoking as main risk factor. Asthma prevalence was 2.6%.
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Affiliation(s)
| | | | | | | | | | - Songhomitra Panda-Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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Monga S, Malik J, Sharma AP, Jan S, Nabi N, Bahadur S. Deranged Pulmonary Function Tests in Allergic Rhinitis in North Indian Patients. Clin Med Insights Ear Nose Throat 2019; 12:1179550619888856. [PMID: 31798306 PMCID: PMC6859672 DOI: 10.1177/1179550619888856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/24/2019] [Indexed: 11/16/2022]
Abstract
Introduction: Significant associations between allergic rhinitis and bronchial asthma have been established and as a result of bronchial hyper-responsiveness, patients can have deranged pulmonary function tests. We aim to compare previous such studies with the result of our study done in India wherein we identify among allergic rhinitis patients who despite not having overt asthmatic symptoms, have pulmonary function derangements, quite possibly at a subclinical disease level. Materials and Methods: We studied 74 patients of allergic rhinitis and after meticulous clinical work up, they underwent blood tests including hemogram, absolute eosinophil count, and total serum IgE followed by pulmonary function tests. Results: Out of 74 patients 60 (81%) had intermittent allergic rhinitis whereas only 14 (19%) had persistent allergic rhinitis. Pulmonary function tests showed reversible obstruction, ie, >10% improvement in FEV1 with inhaled bronchodilators (as seen in asthma) in 18 (24.3%), mild obstruction in 14, and moderate obstruction in 4 cases. Conclusion: The study emphasizes the importance of pulmonary symptoms and the performance of pulmonary function tests in cases of allergic rhinitis patients to rule out latent asthma.
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Affiliation(s)
- Seema Monga
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - Junaid Malik
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - Arun Parkash Sharma
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - Sabeena Jan
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - Nighat Nabi
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
| | - Sudhir Bahadur
- Department of Otorhinolaryngology and Head & Neck Surgery, Hamdard Institute of Medical Sciences & Research and HAHC Hospital, Jamia Hamdard University, Delhi, India
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Mori S, Shibazaki T, Noda Y, Kato D, Nakada T, Asano H, Matsudaira H, Ohtsuka T. Recovery of pulmonary function after lung wedge resection. J Thorac Dis 2019; 11:3738-3745. [PMID: 31656646 DOI: 10.21037/jtd.2019.09.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pulmonary function following lung wedge resection is not fully understood. This study aimed to assess the influence of wedge resection upon postoperative pulmonary function. Methods We retrospectively evaluated pulmonary function at 3, 6, and 12 months postoperatively in 29 patients who underwent lung wedge resection. The values of the pulmonary function tests (PFTs) were compared among the time points using a paired t-test. Results The vital capacity (VC) values before surgery and at 3, 6 and 12 months postoperatively were 2,994±793, 2,845±799, 2,941±801, and 2,964±839 mL, respectively. The VC decreased at 3 months postoperatively (P=0.002) and recovered by 6 and 12 months postoperatively (P=0.003 and 0.003, respectively). The VC values at 6 and 12 months postoperatively did not significantly differ from that before surgery (P=0.152 and 0.361, respectively). The forced expiratory volume in one second (FEV1) values before surgery and at 3, 6, and 12 months postoperatively were 2,156±661, 2,034±660, 2,091±672 and 2,100±666 mL, respectively. The values decreased at 3 months postoperatively (P<0.001) and recovered; however, they remained lower than the preoperative value (P=0.036). Conclusions The postoperative VC decreased temporarily but recovered to near the preoperative level after 12 months. We concluded that the loss of VC following lung wedge resection is minimal. These findings are beneficial for planning surgery and explaining the procedure to patients who are undergoing lung wedge resection.
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Affiliation(s)
- Shohei Mori
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takamasa Shibazaki
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Noda
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Daiki Kato
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Nakada
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hisatoshi Asano
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Matsudaira
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Ohtsuka
- Department of Surgery, Division of Thoracic Surgery, Jikei University School of Medicine, Tokyo, Japan
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Larcher R, Lounnas M, Dumont Y, Michon AL, Bonzon L, Chiron R, Carriere C, Klouche K, Godreuil S. Mycobacterium chimaera Pulmonary Disease in Cystic Fibrosis Patients, France, 2010-2017. Emerg Infect Dis 2019; 25:611-613. [PMID: 30789330 PMCID: PMC6390743 DOI: 10.3201/eid2503.181590] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report Mycobacterium chimaera pulmonary disease in 4 patients given a diagnosis of cystic fibrosis in a university hospital in Montpellier, France. All patients had M. chimaera–positive expectorated sputum specimens, clinical symptoms of pulmonary exacerbation, or a decrease in spirometry test results that improved after specific treatment.
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Donaldson SH, Pilewski JM, Griese M, Cooke J, Viswanathan L, Tullis E, Davies JC, Lekstrom-Himes JA, Wang LT. Tezacaftor/Ivacaftor in Subjects with Cystic Fibrosis and F508del/F508del-CFTR or F508del/G551D-CFTR. Am J Respir Crit Care Med 2019; 197:214-224. [PMID: 28930490 DOI: 10.1164/rccm.201704-0717oc] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Tezacaftor (formerly VX-661) is an investigational small molecule that improves processing and trafficking of the cystic fibrosis transmembrane conductance regulator (CFTR) in vitro, and improves CFTR function alone and in combination with ivacaftor. OBJECTIVES To evaluate the safety and efficacy of tezacaftor monotherapy and of tezacaftor/ivacaftor combination therapy in subjects with cystic fibrosis homozygous for F508del or compound heterozygous for F508del and G551D. METHODS This was a randomized, placebo-controlled, double-blind, multicenter, phase 2 study (NCT01531673). Subjects homozygous for F508del received tezacaftor (10 to 150 mg) every day alone or in combination with ivacaftor (150 mg every 12 h) in a dose escalation phase, as well as in a dosage regimen testing phase. Subjects compound heterozygous for F508del and G551D, taking physician-prescribed ivacaftor, received tezacaftor (100 mg every day). MEASUREMENTS AND MAIN RESULTS Primary endpoints were safety through Day 56 and change in sweat chloride from baseline through Day 28. Secondary endpoints included change in percent predicted FEV1 (ppFEV1) from baseline through Day 28 and pharmacokinetics. The incidence of adverse events was similar across treatment arms. Tezacaftor (100 mg every day)/ivacaftor (150 mg every 12 h) resulted in a 6.04 mmol/L decrease in sweat chloride and 3.75 percentage point increase in ppFEV1 in subjects homozygous for F508del, and a 7.02 mmol/L decrease in sweat chloride and 4.60 percentage point increase in ppFEV1 in subjects compound heterozygous for F508del and G551D from baseline through Day 28 (P < 0.05 for all). CONCLUSIONS These results support continued clinical development of tezacaftor (100 mg every day) in combination with ivacaftor (150 mg every 12 h) in subjects with cystic fibrosis. Clinical trial registered with www.clinicaltrials.gov (NCT01531673).
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Affiliation(s)
- Scott H Donaldson
- 1 University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Joseph M Pilewski
- 2 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthias Griese
- 3 Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jon Cooke
- 4 Vertex Pharmaceuticals (Europe) Limited, London, United Kingdom
| | | | - Elizabeth Tullis
- 6 St. Michael's Hospital and Keenan Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada; and
| | - Jane C Davies
- 7 Paediatric Respiratory Medicine, Imperial College and Royal Brompton and Harefield Foundation Trust, London, United Kingdom
| | | | - Linda T Wang
- 5 Vertex Pharmaceuticals Incorporated, Boston, Massachusetts
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Yu B, Flexeder C, McGarrah RW 3rd, Wyss A, Morrison AC, North KE, Boerwinkle E, Kastenmüller G, Gieger C, Suhre K, Karrasch S, Peters A, Wagner GR, Michelotti GA, Mohney RP, Schulz H, London SJ. Metabolomics Identifies Novel Blood Biomarkers of Pulmonary Function and COPD in the General Population. Metabolites 2019; 9:E61. [PMID: 30939782 DOI: 10.3390/metabo9040061] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Abstract
Determination of metabolomic signatures of pulmonary function and chronic obstructive pulmonary disease (COPD) in the general population could aid in identification and understanding of early disease processes. Metabolome measurements were performed on serum from 4742 individuals (2354 African-Americans and 1529 European-Americans from the Atherosclerosis Risk in Communities study and 859 Europeans from the Cooperative Health Research in the Region of Augsburg study). We examined 368 metabolites in relation to cross-sectional measures of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), their ratio (FEV1/FVC) and COPD using multivariable regression followed by meta-analysis. At a false discovery rate of 0.05, 95 metabolites were associated with FEV1 and 100 with FVC (73 overlapping), including inverse associations with branched-chain amino acids and positive associations with glutamine. Ten metabolites were associated with FEV1/FVC and seventeen with COPD (393 cases). Enriched pathways of amino acid metabolism were identified. Associations with FEV1 and FVC were not driven by individuals with COPD. We identified novel metabolic signatures of pulmonary function and COPD in African and European ancestry populations. These may allow development of biomarkers in the general population of early disease pathogenesis, before pulmonary function has decreased to levels diagnostic for COPD.
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Wen Y, Wang D, Zhou M, Zhou Y, Guo Y, Chen W. Potential Effects of Lung Function Reduction on Health-Related Quality of Life. Int J Environ Res Public Health 2019; 16:ijerph16020260. [PMID: 30658477 PMCID: PMC6352019 DOI: 10.3390/ijerph16020260] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 01/06/2023]
Abstract
Health-related quality of life (HRQOL) was reported to reflect overall quality of life and individual perceptions related to health. Decreased lung function is associated with reduced ventilation and oxygen intake and reported to affect body functions. However, the effect of lung function reduction on HRQOL is still unclear. A total of 8398 retired workers from Dongfeng-Tongji Cohort Study were included in this cross section study. Lung function was measured using an electronic spirometer. HRQOL was evaluated through a questionnaire designed according to the WHOQOL-BREF. The mean of the HRQOL scores of its four domains (physical health, psychological state, social relationships and environment) is the total HRQOL score. A general linear model was used to analyse the association between lung function and HRQOL. In the continuous analysis by the general linear model, FVC was associated with the total HRQOL, physical health domain and social relationships domain scores. In the categorical analysis, there was a linear trend between FVC and the total HRQOL and physical health scores. We also found a similar relationship between FEV1 and HRQOL scores. Further analysis suggested that elevated lung function could improve the scores of pain and discomfort facet and independence facet of physical health domain. The lung function was significantly positively associated with HRQOL in middle-aged and older Chinese.
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Affiliation(s)
- Yuhan Wen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Dongming Wang
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Min Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yun Zhou
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yanjun Guo
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Weihong Chen
- Department of Occupational & Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Loh LC, Ong CK, Koo HJ, Lee SM, Lee JS, Oh YM, Seo JB, Lee SD. A novel CT-emphysema index/FEV 1 approach of phenotyping COPD to predict mortality. Int J Chron Obstruct Pulmon Dis 2018; 13:2543-2550. [PMID: 30174423 PMCID: PMC6110287 DOI: 10.2147/copd.s165898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background COPD-associated mortality was examined using a novel approach of phenotyping COPD based on computed tomography (CT)-emphysema index from quantitative CT (QCT) and post-bronchodilator (BD) forced expiratory volume in 1 second (FEV1) in a local Malaysian cohort. Patients and methods Prospectively collected data of 112 eligible COPD subjects (mean age, 67 years; male, 93%; mean post-BD FEV1, 45.7%) was available for mortality analysis. Median follow-up time was 1,000 days (range, 60–1,400). QCT and clinicodemographic data were collected at study entry. Based on CT-emphysema index and post-BD FEV1% predicted, subjects were categorized into “emphysema-dominant,” “airway-dominant,” “mild mixed airway-emphysema,” and “severe mixed airway-emphysema” diseases. Results Sixteen patients (14.2%) died of COPD-associated causes. There were 29 (25.9%) “mild mixed,” 23 (20.5%) “airway-dominant,” 15 (13.4%) “emphysema-dominant,” and 45 (40.2%) “severe mixed” cases. “Mild mixed” disease was proportionately more in Global Initiative for Chronic Obstructive Lung Disease (GOLD) Group A, while “severe mixed” disease was proportionately more in GOLD Groups B and D. Kaplan–Meier survival estimates showed increased mortality risk with “severe mixed” disease (log rank test, p=0.03) but not with GOLD groups (p=0.08). Univariate Cox proportionate hazard analysis showed that age, body mass index, long-term oxygen therapy, FEV1, forced volume capacity, COPD Assessment Test score, modified Medical Research Council score, St Georges’ Respiratory Questionnaire score, CT-emphysema index, and “severe mixed” disease (vs “mild mixed” disease) were associated with mortality. Multivariate Cox analysis showed that age, body mass index, and COPD Assessment Test score remain independently associated with mortality. Conclusion “Severe mixed airway-emphysema” disease may predict COPD-associated mortality. Age, body mass index, and COPD Assessment Test score remain as key mortality risk factors in our cohort.
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Affiliation(s)
- Li-Cher Loh
- Department of Medicine, RCSI & UCD Malaysia Campus, Penang, Malaysia
| | - Choo-Khoon Ong
- Department of Medicine, RCSI & UCD Malaysia Campus, Penang, Malaysia
| | - Hyun-Jung Koo
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
| | - Sang Min Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
| | - Jae-Seung Lee
- Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon-Beom Seo
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea,
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lee J, Park HK, Kwon MJ, Song JU. Decline in lung function is associated with elevated lipoprotein (a) in individuals without clinically apparent disease: A cross-sectional study. Respirology 2018; 24:68-75. [PMID: 30039523 DOI: 10.1111/resp.13370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/07/2018] [Revised: 06/08/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Reduced lung function and high lipoprotein (a) (Lp(a)) levels are both recognized risk factors for cardiovascular disease. Few studies have investigated the association between serum Lp(a) and lung function in the general population. We evaluated the association between reduced lung function and high Lp(a) levels in healthy individuals without known medical disease diagnoses. METHODS We performed a cross-sectional study on 64 082 Korean health screening examinees (33 049 males, 38 ± 7 years) who underwent a health examination in 2015. RESULTS The median Lp(a) level was 12 (6-25)mg/dL. The prevalence of high Lp(a) (defined as >30 mg/dL) was 19.5%. Subjects with a high Lp(a) had both lower values of measured forced expiratory volume in 1 s (FEV1 ) and forced vital capacity (FVC; L) than those with a low Lp(a) (P < 0.001). However, FEV1 /FVC ratio was not significantly different between groups (P = 0.112). Comparison of the second, third and fourth measured FVC (L) quartiles with that of the lowest quartile (1Q) group (reference) on regression analysis revealed adjusted odd ratios (OR) for a high Lp(a) of 0.928 (95% CI: 0.876-0.982), 0.860 (0.808-0.916) and 0.895 (0.839-0.954), respectively (P for trend < 0.001). In addition, adjusted OR for high Lp(a) compared with reference was 0.894 (0.844-0.947), 0.857 (0.806-0.912) and 0.882 (0.8727-0.940) across the measured FEV1 (L) quartiles in increasing order (P for trend < 0.001). CONCLUSION High Lp(a) levels were associated with reduced lung function in this cross-sectional population study. Longitudinal follow-up studies will be required to validate our findings.
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Affiliation(s)
- Jonghoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Hye Kyeong Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Ilsan, Republic of Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Uk Song
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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