1
|
Karamooz E, Brixey AG, Rydzak CE, Primack SL, Markwardt S, Barker AF. Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: a computed tomography analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry. J Thorac Dis 2024; 16:1496-1502. [PMID: 38505050 PMCID: PMC10944741 DOI: 10.21037/jtd-23-1316] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/05/2024] [Indexed: 03/21/2024]
Abstract
Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship with nontuberculous mycobacteria (NTM) is unknown. The Bronchiectasis and NTM Research Registry is a multicenter registry created to foster research in non-cystic fibrosis (CF) bronchiectasis and NTM lung disease. The majority of patients with non-CF bronchiectasis at Oregon Health & Science University have NTM infections. To determine the prevalence of PA dilation in these patients and its association with supplemental oxygen use, severity of bronchiectasis, tobacco use, and NTM in the sputum culture, we evaluated the chest computed tomography (CT) scans from 321 patients in a cross-sectional analysis. We measured the severity of bronchiectasis by applying modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio >0.9. In our cohort, the mean age was 67.3 years and 83.2% were female. The mean modified Reiff score was 7.1, indicating moderate disease severity. Forty-two patients (13.1%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (P<0.001), but there was no association between PA dilation and NTM infection.
Collapse
Affiliation(s)
- Elham Karamooz
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Anupama G. Brixey
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Chara E. Rydzak
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Steven L. Primack
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Sheila Markwardt
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alan F. Barker
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
2
|
Karamooz E, Brixey AG, Rydzak CE, Primack SL, Markwardt S, Barker AF. Prevalence of pulmonary artery dilation in non-cystic fibrosis bronchiectasis: A CT analysis from a cohort of the US Bronchiectasis and Nontuberculous Mycobacteria Research Registry. Res Sq 2023:rs.3.rs-2711488. [PMID: 36993456 PMCID: PMC10055630 DOI: 10.21203/rs.3.rs-2711488/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Although pulmonary artery (PA) dilation is independently associated with significant morbidity and mortality in patients with pulmonary diseases irrespective of diagnosed pulmonary hypertension, its relationship to nontuberculous mycobacteria (NTM) is unknown. To determine the prevalence of PA dilation in patients with NTM-predominant non-CF bronchiectasis, we evaluated the chest computed tomography (CT) scans from 321 patient in the United States based Bronchiectasis and NTM Research Registry. The majority of our cohort had NTM infection. We measured the severity of bronchiectasis using modified Reiff criteria and measured the diameters of the PA and aorta (Ao), with PA dilation defined as a PA:Ao ratio > 0.9. Forty-two patients (13%) were found to have PA dilation. PA dilation was positively associated with the use of supplemental oxygen (p < 0.001), but there was no association between PA dilation and NTM infection.
Collapse
Affiliation(s)
- Elham Karamooz
- Oregon Health & Science University Pulmonary & Critical Care
| | - Anupama G Brixey
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Chara E Rydzak
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Steven L Primack
- Cardiothoracic Imaging Section, Department of Diagnostic Radiology, Oregon Health & Science University
| | - Sheila Markwardt
- Oregon Health & Science University-Portland State University School of Public Health
| | - Alan F Barker
- Oregon Health & Science University Pulmonary & Critical Care
| |
Collapse
|
3
|
|
4
|
Aliberti S, Goeminne PC, O'Donnell AE, Aksamit TR, Al-Jahdali H, Barker AF, Blasi F, Boersma WG, Crichton ML, De Soyza A, Dimakou KE, Elborn SJ, Feldman C, Tiddens H, Haworth CS, Hill AT, Loebinger MR, Martinez-Garcia MA, Meerburg JJ, Menendez R, Morgan LC, Murris MS, Polverino E, Ringshausen FC, Shteinberg M, Sverzellati N, Tino G, Torres A, Vandendriessche T, Vendrell M, Welte T, Wilson R, Wong CA, Chalmers JD. Criteria and definitions for the radiological and clinical diagnosis of bronchiectasis in adults for use in clinical trials: international consensus recommendations. Lancet Respir Med 2022; 10:298-306. [PMID: 34570994 DOI: 10.1016/s2213-2600(21)00277-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/27/2021] [Accepted: 06/03/2021] [Indexed: 12/26/2022]
Abstract
Bronchiectasis refers to both a clinical disease and a radiological appearance that has multiple causes and can be associated with a range of conditions. Disease heterogeneity and the absence of standardised definitions have hampered clinical trials of treatments for bronchiectasis and are important challenges in clinical practice. In view of the need for new therapies for non-cystic fibrosis bronchiectasis to reduce the disease burden, we established an international taskforce of experts to develop recommendations and definitions for clinically significant bronchiectasis in adults to facilitate the standardisation of terminology for clinical trials. Systematic reviews were used to inform discussions, and Delphi processes were used to achieve expert consensus. We prioritised criteria for the radiological diagnosis of bronchiectasis and suggest recommendations on the use and central reading of chest CT scans to confirm the presence of bronchiectasis for clinical trials. Furthermore, we developed a set of consensus statements concerning the definitions of clinical bronchiectasis and its specific signs and symptoms, as well as definitions for chronic bacterial infection and sustained culture conversion. The diagnosis of clinically significant bronchiectasis requires both clinical and radiological criteria, and these expert recommendations and proposals should help to optimise patient recruitment into clinical trials and allow reliable comparisons of treatment effects among different interventions for bronchiectasis. Our consensus proposals should also provide a framework for future research to further refine definitions and establish definitive guidance on the diagnosis of bronchiectasis.
Collapse
Affiliation(s)
- Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
| | - Pieter C Goeminne
- Department of Respiratory Disease, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Timothy R Aksamit
- Mayo Clinic Pulmonary Disease and Critical Care Medicine, Rochester, MN, USA
| | | | - Alan F Barker
- Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, USA
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | | | - Megan L Crichton
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Anthony De Soyza
- Population and Health Science Institute, Newcastle University, National Institute for Health Research Biomedical Research Centre for Ageing and Freeman Hospital, Newcastle, UK
| | - Katerina E Dimakou
- Fifth Respiratory Department, Sotiria Hospital for Chest Diseases, Athens, Greece
| | - Stuart J Elborn
- Faculty of Medicine, Health and Life Sciences at Queen's University Belfast, Belfast, UK
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Harm Tiddens
- Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Charles S Haworth
- Cambridge Centre for Lung Infection, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | | | - Michael R Loebinger
- Host Defence Unit, Royal Brompton Hospital and Imperial College London, London, UK
| | | | | | - Rosario Menendez
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lucy C Morgan
- Concord Clinical School, Sydney Medical School, The University of Sydney, NSW, Australia
| | - Marlene S Murris
- Department of Pulmonology, Transplantation, and Cystic Fibrosis Centre, Larrey Hospital, Toulouse, France
| | - Eva Polverino
- Adult Cystic Fibrosis and Bronchiectasis Unit, Respiratory Disease Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Felix C Ringshausen
- Hannover Medical School, Department of Respiratory Medicine, Member of the German Centre for Lung Research, Hannover, Germany
| | - Michal Shteinberg
- Pulmonology Institute and Cystic Fibrosis Centre, Carmel Medical Centre and the Technion-Israel Institute of Technology, Haifa, Israel
| | - Nicola Sverzellati
- Scienze Radiologiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Gregory Tino
- Penn Presbyterian Medical Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Antoni Torres
- Pulmonology Department, Hospital Clinic, Universitat of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Ciber de Enfermedades Respiratorias, ICREA Academia, Barcelona, Spain
| | | | - Montserrat Vendrell
- Department of Pneumology Dr Josep Trueta Hospital, Biomedical Research Institute of Girona, Universitat de Girona, Girona, Spain
| | - Tobias Welte
- Hannover Medical School, Department of Respiratory Medicine, Member of the German Centre for Lung Research, Hannover, Germany
| | - Robert Wilson
- Host Defence Unit, Royal Brompton Hospital and Imperial College London, London, UK
| | - Conroy A Wong
- Department of Respiratory Medicine, Middlemore Hospital, Counties Manukau District Health Board and University of Auckland, Auckland, New Zealand
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| |
Collapse
|
5
|
Crichton ML, Lonergan M, Barker AF, Sibila O, Goeminne P, Shoemark A, Chalmers JD. Inhaled aztreonam improves symptoms of cough and sputum production in patients with bronchiectasis: a post hoc analysis of the AIR-BX studies. Eur Respir J 2020; 56:13993003.00608-2020. [PMID: 32265309 DOI: 10.1183/13993003.00608-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Inhaled antibiotics may improve symptom scores, but it is not known which specific symptoms improve with therapy. Item-level analysis of questionnaire data may allow us to identify which specific symptoms respond best to treatment. METHODS Post hoc analysis of the AIR-BX1 studies and two trials of inhaled aztreonam versus placebo in bronchiectasis. Individual items from the quality of life bronchiectasis (QOL-B) respiratory symptom scale, were extracted as representing severity of nine distinct symptoms. Generalised linear models were used to evaluate changes in symptoms with treatment versus placebo from baseline to end of first on-treatment cycle and mixed models were used to evaluate changes across the full 16-week trial. RESULTS Aztreonam improved cough (difference 0.22, 95% CI 0.08-0.37; p=0.002), sputum production (0.30, 95% CI 0.15-0.44; p<0.0001) and sputum colour (0.29, 95% CI 0.15-0.43; p<0.0001) versus placebo equating to a 20% improvement in cough and 25% improvement in sputum production and colour. Similar results were observed for cough, sputum production and sputum purulence across the trial duration (all p<0.05). Patients with higher sputum production and sputum colour scores had a greater response on the overall QOL-B (difference 4.82, 95% CI 1.12-8.53; p=0.011 for sputum production and 5.02, 95% CI 1.19-8.86; p=0.01 for sputum colour). In contrast, treating patients who had lower levels of bronchitic symptoms resulted in shorter time to next exacerbation (hazard ratio 1.83, 95% CI 1.02-3.28; p=0.042). CONCLUSION Baseline bronchitic symptoms predict response to inhaled aztreonam in bronchiectasis. More sensitive tools to measure bronchitic symptoms may be useful to better identify inhaled antibiotic responders and to evaluate patient response to treatment.
Collapse
Affiliation(s)
- Megan L Crichton
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Mike Lonergan
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Alan F Barker
- Division of Pulmonology and Critical Care, Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Oriol Sibila
- Dept of Respiratory Medicine, Hospital Clinic, Barcelona, Spain
| | - Pieter Goeminne
- Dept of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Amelia Shoemark
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| |
Collapse
|
6
|
Hill AT, Gold PM, El Solh AA, Metlay JP, Ireland B, Irwin RS, Adams TM, Altman KW, Azoulay E, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Gibson P, Gold P, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lim K, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Moore A, Murad MH, Narasimhan M, Newcombe P, Nguyen HQ, Oppenheimer J, Rosen M, Rubin B, Russell RJ, Ryu JH, Singh S, Smith J, Smith MP, Tarlo SM, Turmel J, Vertigan AE, Wang G, Weinberger M. Response. Chest 2019; 155:1082-1083. [DOI: 10.1016/j.chest.2019.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/14/2019] [Indexed: 10/26/2022] Open
|
7
|
Gupta N, Lee HS, Young LR, Strange C, Moss J, Singer LG, Nakata K, Barker AF, Chapman JT, Brantly ML, Stocks JM, Brown KK, Lynch JP, Goldberg HJ, Downey GP, Taveira-DaSilva AM, Krischer JP, Setchell K, Trapnell BC, Inoue Y, McCormack FX. Analysis of the MILES cohort reveals determinants of disease progression and treatment response in lymphangioleiomyomatosis. Eur Respir J 2019; 53:13993003.02066-2018. [PMID: 30846465 DOI: 10.1183/13993003.02066-2018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/19/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Multicenter International Lymphangioleiomyomatosis (LAM) Efficacy of Sirolimus (MILES) trial revealed that sirolimus stabilised lung function in patients with moderately severe LAM. The purpose of this study was to further examine the MILES cohort for the effects of racial, demographic, clinical and physiological patient characteristics on disease progression and treatment response in LAM. METHODS MILES subjects were stratified on the basis of menopausal status (pre-menopausal/post-menopausal), race (Asian/Caucasian), bronchodilator responsiveness (present/absent), initial forced expiratory volume in 1 s (FEV1; 51-70% versus ≤50% predicted) and tuberous sclerosis complex (TSC) association (yes/no). A linear mixed effects model was used to compare slope differences, and nonparametric tests were used to compare medians and proportions between treatment groups in each stratum. RESULTS In the MILES placebo group, pre-menopausal patients declined 5-fold faster than post-menopausal patients (mean±se FEV1 slope -17±3 versus -3±3 mL·month-1; p=0.003). Upon treatment with sirolimus, both the pre-menopausal (-17±3 versus -1±2 mL·month-1; p<0.0001) and post-menopausal patients (-3±3 versus 6±3 mL·month-1; p=0.04) exhibited a beneficial response in mean±se FEV1 slope compared with the placebo group. Race, LAM subtype, bronchodilator responsiveness or baseline FEV1 did not impact the rate of disease progression in the placebo group or treatment response in the sirolimus group. Menopausal status and race had differential effects on the adverse event profile of sirolimus. Baseline serum vascular endothelial growth factor (VEGF)-D >600 pg·mL-1 identified subgroups of patients who were more likely to decline on placebo and respond to treatment with sirolimus. CONCLUSIONS In LAM patients, treatment with sirolimus is beneficial regardless of menopausal status, race, bronchodilator responsiveness, baseline FEV1 or TSC association. Serum VEGF-D and menopausal status can help inform therapeutic decisions.
Collapse
Affiliation(s)
| | | | - Lisa R Young
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Joel Moss
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Koh Nakata
- Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Alan F Barker
- Oregon Health and Science University, Portland, OR, USA
| | | | | | - James M Stocks
- University of Texas Health Sciences Center, Tyler, TX, USA
| | - Kevin K Brown
- National Jewish Health and the University of Colorado, Denver, CO, USA
| | | | | | - Gregory P Downey
- National Jewish Health and the University of Colorado, Denver, CO, USA
| | | | | | - Kenneth Setchell
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bruce C Trapnell
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | | | | |
Collapse
|
8
|
Karamooz E, Yap VL, Barker AF, Metersky ML. Bordetella bronchiseptica in non-cystic fibrosis bronchiectasis. Respir Med Case Rep 2018; 25:187-188. [PMID: 30191122 PMCID: PMC6125826 DOI: 10.1016/j.rmcr.2018.08.023] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/27/2018] [Indexed: 10/31/2022] Open
Abstract
Bordetella bronchiseptica is a rare pulmonary infection, often associated with zoonotic transmission. It has been described in immunocompromised patients and those with underlying pulmonary disease. However, there are no case series describing the spectrum of disease caused by Bordetella bronchiseptica in patients with non-cystic fibrosis bronchiectasis. Here, we report three cases of Bordetella bronchiseptica infection in patients with non-cystic fibrosis bronchiectasis and highlight the pathophysiology of the microbe. While the clinical presentation can be quite variable, it is important to note that Bordetella bronchiseptica can be a cause of pulmonary exacerbations and can be difficult to eradicate.
Collapse
Affiliation(s)
- Elham Karamooz
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Vanessa L Yap
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT 06030, USA
| | - Alan F Barker
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| | - Mark L Metersky
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut, Farmington, CT 06030, USA
| |
Collapse
|
9
|
Hill AT, Barker AF, Bolser DC, Davenport P, Ireland B, Chang AB, Mazzone SB, McGarvey L. Treating Cough Due to Non-CF and CF Bronchiectasis With Nonpharmacological Airway Clearance: CHEST Expert Panel Report. Chest 2018; 153:986-993. [PMID: 29355548 PMCID: PMC6689075 DOI: 10.1016/j.chest.2018.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/27/2017] [Revised: 12/24/2017] [Accepted: 01/02/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In bronchiectasis due to cystic fibrosis (CF) and other causes, airway clearance is one of the mainstays of management. We conducted a systematic review on airway clearance by using non-pharmacological methods as recommended by international guidelines to develop recommendations or suggestions to update the 2006 CHEST guideline on cough. METHODS The systematic search for evidence examined the question, "Is there evidence of clinically important treatment effects for non-pharmacological therapies in cough treatment for patients with bronchiectasis?" Populations selected were all patients with bronchiectasis due to CF or non-CF bronchiectasis. The interventions explored were the non-pharmacological airway clearance therapies. The comparison populations included those receiving standard therapy and/or placebo. Clinically important outcomes that were explored were exacerbation rates, quality of life, hospitalizations, and mortality. RESULTS In both CF and non-CF bronchiectasis, there were systematic reviews and overviews of systematic reviews identified. Despite these findings, there were no large randomized controlled trials that explored the impact of airway clearance on exacerbation rates, quality of life, hospitalizations, or mortality. CONCLUSIONS Although the cough panel was not able to make recommendations, they have made consensus-based suggestions and provided direction for future studies to fill the gaps in knowledge.
Collapse
Affiliation(s)
- Adam T Hill
- Royal Infirmary and University of Edinburgh, Edinburgh, Scotland.
| | | | - Donald C Bolser
- College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Paul Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL
| | | | - Anne B Chang
- Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland University of Technology, Brisbane, QLD, Australia
| | | | | |
Collapse
|
10
|
Barker AF, Campos MA, Brantly ML, Stocks JM, Sandhaus RA, Lee D, Steinmann K, Lin J, Sorrells S. Bioequivalence of a Liquid Formulation of Alpha 1-Proteinase Inhibitor Compared with Prolastin®-C (Lyophilized Alpha 1-PI) in Alpha 1-Antitrypsin Deficiency. COPD 2017; 14:590-596. [PMID: 28985109 DOI: 10.1080/15412555.2017.1376044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study evaluated the bioequivalence, safety, and immunogenicity of a new liquid formulation of human plasma-derived alpha1-proteinase inhibitor, Liquid Alpha1-PI, compared with the Lyophilized Alpha1-PI formulation (Prolastin®-C), for augmentation therapy in patients with alpha1-antitrypsin deficiency (AATD). In this double-blind, randomized, 20-week crossover study, 32 subjects with AATD were randomized to receive 8 weekly infusions of 60 mg/kg of Liquid Alpha1-PI or Lyophilized Alpha1-PI. Serial blood samples were drawn for 7 days after the last dose followed by 8 weeks of the alternative treatment. The primary endpoint was bioequivalence at steady state, as measured by area under the concentration versus time curve from 0 to 7 days (AUC0-7 days) postdose using an antigenic content assay. Bioequivalence was defined as 90% confidence interval (CI) for the ratio of the geometric least squares (LS) mean of AUC0-7 days for both products within the limits of 0.80 and 1.25. Safety and immunogenicity were assessed. Mean alpha1-PI concentration versus time curves for both formulations were superimposable. Mean AUC0-7 days was 20 320 versus 19 838 mg × h/dl for Liquid Alpha1-PI and Lyophilized Alpha1-PI, respectively. The LS mean ratio of AUC0-7 days (90% CI) for Liquid Alpha1-PI versus Lyophilized Alpha1-PI was 1.05 (1.03-1.08), indicating bioequivalence. Liquid Alpha1-PI was well tolerated and adverse events were consistent with Lyophilized Alpha1-PI. Immunogenicity to either product was not detected. In conclusion, Liquid Alpha1-PI is bioequivalent to Lyophilized Alpha1-PI, with a similar safety profile. The liquid formulation would eliminate the need for reconstitution and shorten preparation time for patients receiving augmentation therapy for AATD.
Collapse
Affiliation(s)
- Alan F Barker
- a Department of Medicine , Oregon Health and Science University , Portland , Oregon , USA
| | - Michael A Campos
- b Department of Medicine , University of Miami School of Medicine , Miami , Florida , USA
| | - Mark L Brantly
- c Department of Medicine , University of Florida School of Medicine , Gainesville , Florida , USA
| | - James M Stocks
- d Department of Medicine , University of Texas Health Science Center at Tyler , Tyler , Texas , USA
| | - Robert A Sandhaus
- e Division of Pulmonary, Critical Care Medicine and Sleep , National Jewish Health , Denver , Colorado , USA
| | - Douglas Lee
- f Division of Pulmonary, Allergy, and Sleep Medicine , Wilmington Health , Wilmington , North Carolina , USA
| | - Kimberly Steinmann
- g Clinical Development , Grifols Therapeutics Inc. , Research Triangle Park , North Carolina , USA
| | - Jiang Lin
- g Clinical Development , Grifols Therapeutics Inc. , Research Triangle Park , North Carolina , USA
| | - Susan Sorrells
- g Clinical Development , Grifols Therapeutics Inc. , Research Triangle Park , North Carolina , USA
| |
Collapse
|
11
|
Schoenberg NC, Barker AF, Bernardo J, Deterding RR, Ellner JJ, Hess DR, MacIntyre NR, Martinez FJ, Wilson KC. A Comparative Analysis of Pulmonary and Critical Care Medicine Guideline Development Methodologies. Am J Respir Crit Care Med 2017; 196:621-627. [PMID: 28731387 PMCID: PMC5955064 DOI: 10.1164/rccm.201705-0926oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 05/10/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The Institute of Medicine (IOM) standards for guideline development have had unintended negative consequences. A more efficient approach is desirable. OBJECTIVES To determine whether a modified Delphi process early during guideline development discriminates recommendations that should be informed by a systematic review from those that can be based upon expert consensus. METHODS The same questions addressed by IOM-compliant pulmonary or critical care guidelines were addressed by expert panels using a modified Delphi process, termed the Convergence of Opinion on Recommendations and Evidence (CORE) process. The resulting recommendations were compared. Concordance of the course of action, strength of recommendation, and quality of evidence, as well as the duration of recommendation development, were measured. MEASUREMENTS AND MAIN RESULTS When 50% agreement was required to make a recommendation, all questions yielded recommendations, and the recommended courses of action were 89.6% concordant. When 70% agreement was required, 17.9% of questions did not yield recommendations, but for those that did, the recommended courses of action were 98.2% concordant. The time to completion was shorter for the CORE process (median, 19.3 vs. 1,309.0 d; P = 0.0002). CONCLUSIONS We propose the CORE process as an early step in guideline creation. Questions for which 70% agreement on a recommendation cannot be achieved should go through an IOM-compliant process; however, questions for which 70% agreement on a recommendation can be achieved can be accepted, avoiding a lengthy systematic review.
Collapse
Affiliation(s)
| | | | | | | | | | - Dean R. Hess
- Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Kevin C. Wilson
- Boston University, Boston, Massachusetts
- American Thoracic Society, New York, New York
| |
Collapse
|
12
|
Henkle E, Aksamit TR, Barker AF, Curtis JR, Daley CL, Anne Daniels ML, DiMango A, Eden E, Fennelly K, Griffith DE, Johnson M, Knowles MR, Leitman A, Leitman P, Malanga E, Metersky ML, Noone PG, O'Donnell AE, Olivier KN, Prieto D, Salathe M, Thomashow B, Tino G, Turino G, Wisclenny S, Winthrop KL. Pharmacotherapy for Non-Cystic Fibrosis Bronchiectasis: Results From an NTM Info & Research Patient Survey and the Bronchiectasis and NTM Research Registry. Chest 2017; 152:1120-1127. [PMID: 28479113 DOI: 10.1016/j.chest.2017.04.167] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-cystic fibrosis bronchiectasis ("bronchiectasis") is a chronic inflammatory lung disease often associated with nontuberculous mycobacteria (NTM) infection. Very little data exist to guide bronchiectasis management decisions. We sought to describe patterns of inhaled corticosteroid (ICS) and antibiotic therapy in the United States. METHODS We invited 2,000 patients through NTM Info & Research (NTMir) to complete an anonymous electronic survey. We separately queried baseline clinical and laboratory data from the US Bronchiectasis and NTM Research Registry (BRR). RESULTS Among 511 NTMir survey responders with bronchiectasis, whose median age was 67 years, 85 (17%) reported asthma and 99 (19%) reported COPD. History of ICS use was reported by 282 (55%), 171 (61%) of whom were treated 1 year or longer, and 150 (53%) were currently taking ICSs. Fewer reported ever taking azithromycin for non-NTM bronchiectasis (203 responders [40%]) or inhaled tobramycin (78 responders [15%]). The median age of 1,912 BRR patients was 69 years; 528 (28%) had asthma and 360 (19%) had COPD. Among 740 patients (42%) without NTM, 314 were taking ICSs at baseline. Among patients without NTM who were taking ICSs, only 178 (57%) had a concurrent diagnosis of COPD or asthma that could explain ICS use. Fewer were taking suppressive macrolides (96 patients [13%]), and of the 70 patients (10%) taking inhaled suppressive antibiotics, 48 (68%) had chronic Pseudomonas aeruginosa infection. CONCLUSIONS ICS use was common in two national samples of patients with bronchiectasis, with relatively few patients taking suppressive antibiotic therapies. Further research is needed to clarify the safety and effectiveness of these therapies in patients with bronchiectasis.
Collapse
Affiliation(s)
| | - Timothy R Aksamit
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Alan F Barker
- Division of Pulmonology and Critical Care, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham AL
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO
| | - M Leigh Anne Daniels
- Department of Medicine and the Marsico Lung Institute, and UNC Center for Bronchiectasis Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Angela DiMango
- Center for Chest Disease, Columbia College of Physicians and Surgeons, New York, NY
| | | | - Kevin Fennelly
- Pulmonary Clinical Medicine Section, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - David E Griffith
- Pulmonary Infectious Disease Section, University of Texas Health Science Center Northesast, Tyler, TX
| | - Margaret Johnson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Michael R Knowles
- Department of Medicine and the Marsico Lung Institute, and UNC Center for Bronchiectasis Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Mark L Metersky
- Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Peadar G Noone
- Department of Medicine and the Marsico Lung Institute, and UNC Center for Bronchiectasis Care, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Georgetown University Hospital, Washington, DC
| | - Kenneth N Olivier
- Pulmonary Clinical Medicine Section, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Matthias Salathe
- Division of Pulmonary and Critical Care Medicine, Miller School of Medicine, University of Miami, Miami, FL
| | - Byron Thomashow
- Center for Chest Disease, Columbia College of Physicians and Surgeons, New York, NY
| | - Gregory Tino
- Department of Medicine, Penn Presbyterian Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Kevin L Winthrop
- OHSU-PSU School of Public Health, Portland, OR; Division of Infectious Disease, Department of Medicine, Oregon Health & Science University, Portland, OR
| |
Collapse
|
13
|
Young L, Lee HS, Inoue Y, Moss J, Singer LG, Strange C, Nakata K, Barker AF, Chapman JT, Brantly ML, Stocks JM, Brown KK, Lynch JP, Goldberg HJ, Downey GP, Swigris JJ, Taveira-DaSilva AM, Krischer JP, Trapnell BC, McCormack FX. Serum VEGF-D a concentration as a biomarker of lymphangioleiomyomatosis severity and treatment response: a prospective analysis of the Multicenter International Lymphangioleiomyomatosis Efficacy of Sirolimus (MILES) trial. Lancet Respir Med 2017; 1:445-52. [PMID: 24159565 DOI: 10.1016/s2213-2600(13)70090-0] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND VEGF-D is a lymphangiogenic growth factor that has a key role in tumour metastasis. Serum VEGF-D concentrations are increased in most patients with lymphangioleiomyomatosis, a rare neoplasm associated with mTOR-activating tuberous sclerosis gene mutations, lymphadenopathy, metastatic spread, and pulmonary cyst formation. We used data from the Multicenter International Lymphangioleiomyomatosis Efficacy of Sirolimus (MILES) trial to assess the usefulness of serum VEGF-D concentration as a marker of severity and therapeutic response to sirolimus in patients with lymphangioleiomyomatosis. METHODS In the MILES trial, patients with lymphangioleiomyomatosis who had forced expiratory volume in 1 second (FEV1) of 70% or less of predicted were randomly assigned (1:1) to 12 months masked treatment with sirolimus or placebo. Serum VEGF-D concentrations were measured at baseline, 6 months, and 12 months. We used a linear regression model to assess associations of baseline VEGF-D concentrations with markers of disease severity, and a linear mixed effects model to assess the associations of VEGF-D concentrations with between-group differences in clinical, physiological, and patient-reported outcomes. FINDINGS We included 42 patients from the placebo group and 45 from the sirolimus group in our analysis. Baseline VEGF-D concentrations in individual patients varied from 0·34 ng/mL to 16·7 ng/mL. Baseline VEGF-D concentrations were higher in patients who needed supplemental oxygen than in those who did not need supplemental oxygen (1·7 ng/mL [IQR 0·99–3·36] vs 0·84 ng/mL [0·52–1·39]; p<0·0001) and in those who had a bronchodilator response than in those who did not (2·01 ng/mL [0·99–2·86] vs 1·00 ng/mL [0·61–2·15]; 0·0273). Median serum VEGF-D concentrations were similar at baseline in the sirolimus and placebo groups, and fell from baseline at 6 and 12 months in the sirolimus group but remained roughly stable in the placebo group. Each one-unit increase in baseline log(VEGF-D) was associated with a between-group difference in baseline-to-12-month FEV1 change of 134 mL (p=0·0007). In the sirolimus group, improvement in baseline-to-12-month FEV1 occurred in 15 of 23 (65%) VEGF-D responders (ie, those in whom baseline-to-12-month VEGF-D concentrations decreased by more than they did in any patients in the placebo group) and four of 15 (27%) VEGF-D non-responders (p=0·0448). INTERPRETATION Serum VEGF-D is a biologically plausible and useful biomarker in lymphangioleiomyomatosis that correlates with disease severity and treatment response. Measurement of serum VEGF-D concentrations could inform the risk–benefit analysis of sirolimus therapy in patients with lymphangioleiomyomatosis and reduce the numbers of patients needed for clinical trials. FUNDING National Institutes of Health, US Department of Defense.
Collapse
|
14
|
Barker AF. Inhaled antibiotics: potential and pitfalls. Pneumologie 2016. [DOI: 10.1055/s-0036-1592225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
15
|
French CT, Diekemper RL, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning BJ, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Feinstein A, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lim K, Malesker MA, Mazzone P, Mazzone S, McCrory DC, McGarvey L, Molasiotis A, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Vertigan AE, Wang G, Weinberger M, Weir K. Assessment of Intervention Fidelity and Recommendations for Researchers Conducting Studies on the Diagnosis and Treatment of Chronic Cough in the Adult: CHEST Guideline and Expert Panel Report. Chest 2015; 148:32-54. [PMID: 25764280 DOI: 10.1378/chest.15-0164] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Successful management of chronic cough has varied in the primary research studies in the reported literature. One of the potential reasons relates to a lack of intervention fidelity to the core elements of the diagnostic and/or therapeutic interventions that were meant to be used by the investigators. METHODS We conducted a systematic review to summarize the evidence supporting intervention fidelity as an important methodologic consideration in assessing the effectiveness of clinical practice guidelines used for the diagnosis and management of chronic cough. We developed and used a tool to assess for five areas of intervention fidelity. Medline (PubMed), Scopus, and the Cochrane Database of Systematic Reviews were searched from January 1998 to May 2014. Guideline recommendations and suggestions for those conducting research using guidelines or protocols to diagnose and manage chronic cough in the adult were developed and voted upon using CHEST Organization methodology. RESULTS A total of 23 studies (17 uncontrolled prospective observational, two randomized controlled, and four retrospective observational) met our inclusion criteria. These articles included 3,636 patients. Data could not be pooled for meta-analysis because of heterogeneity. Findings related to the five areas of intervention fidelity included three areas primarily related to the provider and two primarily related to the patients. In the area of study design, 11 of 23 studies appeared to be underpinned by a single guideline/protocol; for training of providers, two of 23 studies reported training, and zero of 23 reported the use of an intervention manual; and for the area of delivery of treatment, when assessing the treatment of gastroesophageal reflux disease, three of 23 studies appeared consistent with the most recent guideline/protocol referenced by the authors. For receipt of treatment, zero of 23 studies mentioned measuring concordance of patient-interventionist understanding of the treatment recommended, and zero of 23 mentioned measuring enactment of treatment, with three of 23 measuring side effects and two of 23 measuring adherence. The overall average intervention fidelity score for all 23 studies was poor (20.74 out of 48). CONCLUSIONS Only low-quality evidence supports that intervention fidelity strategies were used when conducting primary research in diagnosing and managing chronic cough in adults. This supports the contention that some of the variability in the reporting of patients with unexplained or unresolved chronic cough may be due to lack of intervention fidelity. By following the recommendations and suggestions in this article, researchers will likely be better able to incorporate strategies to address intervention fidelity, thereby strengthening the validity and generalizability of their results that provide the basis for the development of trustworthy guidelines.
Collapse
|
16
|
Vertigan AE, Murad MH, Pringsheim T, Feinstein A, Chang AB, Newcombe PA, Rubin BK, McGarvey LP, Weir K, Altman KW, Weinberger M, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Blackhall F, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning BJ, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Feinstein A, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lim K, Malesker MA, Mazzone P, Mazzone S, McCrory DC, McGarvey L, Molasiotis A, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Vertigan AE, Wang G, Weinberger M, Weir K, Wiener RS. Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report. Chest 2015; 148:24-31. [PMID: 25856777 DOI: 10.1378/chest.15-0423] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. METHODS We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. RESULTS The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria (Diagnostic and Statistical Manual of Mental Disorders, 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. CONCLUSIONS Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.
Collapse
|
17
|
Gupta N, Meraj R, Tanase D, James LE, Seyama K, Lynch DA, Akira M, Meyer CA, Ruoss SJ, Burger CD, Young LR, Almoosa KF, Veeraraghavan S, Barker AF, Lee AS, Dilling DF, Inoue Y, Cudzilo CJ, Zafar MA, McCormack FX. Accuracy of chest high-resolution computed tomography in diagnosing diffuse cystic lung diseases. Eur Respir J 2015; 46:1196-9. [PMID: 26160866 DOI: 10.1183/13993003.00570-2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/06/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Riffat Meraj
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Daniel Tanase
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Laura E James
- Research Dept, Shriners Hospital for Children - Cincinnati, Cincinnati, OH, USA
| | - Kuniaki Seyama
- Dept of Respiratory Medicine, Juntendo University, Tokyo, Japan
| | - David A Lynch
- Dept of Radiology, National Jewish Health, Denver, CO, USA
| | - Masanori Akira
- Dept of Radiology, National Kinki-Chuo Chest Medical Center, Osaka, Japan
| | | | - Stephen J Ruoss
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Charles D Burger
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Lisa R Young
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Khalid F Almoosa
- Division of Critical Care Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Srihari Veeraraghavan
- Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - Alan F Barker
- Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR, USA
| | - Augustine S Lee
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Yoshikazu Inoue
- Dept of Diffuse Lung Diseases and Respiratory Failure, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Corey J Cudzilo
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Muhammad A Zafar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
18
|
Lewis SZ, Diekemper RL, French CT, Gold PM, Irwin RS, Adams TM, Altman KW, Barker AF, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Canning B, Chang AB, Coeytaux R, Cowley T, Davenport P, Diekemper RL, Ebihara S, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Gibson P, Gold P, Gould MK, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Keogh KA, Lane AP, Lewis SZ, Lim K, Malesker MA, Mazzone P, McCrory DC, McGarvey L, Murad MH, Newcombe P, Nguyen HQ, Oppenheimer J, Prezant D, Pringsheim T, Restrepo MI, Rosen M, Rubin B, Ryu JH, Smith J, Tarlo SM, Turner RB, Vertigan A, Weir K, Wiener RS. Methodologies for the Development of the Management of Cough. Chest 2014; 146:1395-1402. [DOI: 10.1378/chest.14-1484] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
19
|
Quittner AL, Marciel KK, Salathe MA, O'Donnell AE, Gotfried MH, Ilowite JS, Metersky ML, Flume PA, Lewis SA, McKevitt M, Montgomery AB, O'Riordan TG, Barker AF. A preliminary quality of life questionnaire-bronchiectasis: a patient-reported outcome measure for bronchiectasis. Chest 2014; 146:437-448. [PMID: 24626872 DOI: 10.1378/chest.13-1891] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The Quality of Life Questionnaire-Bronchiectasis (QOL-B) is the first disease-specific, patient-reported outcome measure for patients with bronchiectasis. Content validity, cognitive testing, responsivity to open-label treatment, and psychometric analyses are presented. METHODS Reviews of literature, existing measures, and physician input were used to generate the initial QOL-B. Modifications following preliminary cognitive testing (N = 35 patients with bronchiectasis) generated version (V) 1.0. An open-ended patient interview study (N = 28) provided additional information and was content analyzed to derive saturation matrices, which summarized all disease-related topics mentioned by each participant. This resulted in QOL-B V2.0. Psychometric analyses were carried out using results from an open-label phase 2 trial, in which 89 patients were enrolled and treated with aztreonam for inhalation solution. Responsivity to open-label treatment was observed. Additional analyses generated QOL-B V3.0, with 37 items on eight scales: respiratory symptoms; physical, role, emotional, and social functioning; vitality; health perceptions; and treatment burden. For each scale, scores are standardized on a 0-to-100-point scale; higher scores indicate better health-related quality of life. No total score is calculated. A final cognitive testing study (N = 40) resulted in a minor change to one social functioning scale item (QOL-B V3.1). RESULTS Content validity, cognitive testing, responsivity to open-label treatment, and initial psychometric analyses supported QOL-B items and structure. CONCLUSIONS This interim QOL-B is a promising tool for evaluating the efficacy of new therapies for patients with bronchiectasis and for measuring symptoms, functioning, and quality of life in these patients on a routine basis. A final psychometric validation study is needed and is forthcoming. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT00805025; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Alexandra L Quittner
- Department of Psychology and Pediatrics, Department of Medicine, University of Miami, Coral Gables, FL.
| | - Kristen K Marciel
- Department of Psychology and Pediatrics, Department of Medicine, University of Miami, Coral Gables, FL
| | - Matthias A Salathe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Miami, Coral Gables, FL
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Georgetown University, Washington, DC
| | - Mark H Gotfried
- Pulmonary Associates, Phoenix, AZ; University of Arizona, Phoenix, AZ
| | - Jonathan S Ilowite
- Department of Medicine, Division of Pulmonary and Critical Care, Winthrop University Hospital, Mineola, NY
| | - Mark L Metersky
- Division of Pulmonary and Critical Care, University of Connecticut School of Medicine, University of Connecticut, Farmington, CT
| | - Patrick A Flume
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | | | | | | | - Thomas G O'Riordan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Georgetown University, Washington, DC; Gilead Sciences, Seattle, WA; Seattle, WACardeas Pharma, Seattle, WA
| | - Alan F Barker
- Department of Medicine, Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, OR
| |
Collapse
|
20
|
Quittner AL, O'Donnell AE, Salathe MA, Lewis SA, Li X, Montgomery AB, O'Riordan TG, Barker AF. Quality of Life Questionnaire-Bronchiectasis: final psychometric analyses and determination of minimal important difference scores. Thorax 2014; 70:12-20. [PMID: 25323621 DOI: 10.1136/thoraxjnl-2014-205918] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Quality of Life-Bronchiectasis (QOL-B), a self-administered, patient-reported outcome measure assessing symptoms, functioning and health-related quality of life for patients with non-cystic fibrosis (CF) bronchiectasis, contains 37 items on 8 scales (Respiratory Symptoms, Physical, Role, Emotional and Social Functioning, Vitality, Health Perceptions and Treatment Burden). METHODS Psychometric analyses of QOL-B V.3.0 used data from two double-blind, multicentre, randomised, placebo-controlled, phase III trials of aztreonam for inhalation solution (AZLI) in 542 patients with non-CF bronchiectasis and Gram-negative endobronchial infection. RESULTS Excellent internal consistency (Cronbach's α ≥0.70) and 2-week test-retest reliability (intraclass correlation coefficients ≥0.72) were demonstrated for each scale. Convergent validity with 6 min walk test was observed for Physical and Role Functioning scores. No floor or ceiling effects (baseline scores of 0 or 100) were found for the Respiratory Symptoms scale (primary endpoint of trials). Baseline Respiratory Symptoms scores discriminated between patients based on baseline FEV₁% predicted in only one trial. The minimal important difference score for the Respiratory Symptoms scale was 8.0 points. AZLI did not show efficacy in the two phase III trials. QOL-B responsivity to treatment was assessed by examining changes from baseline QOL-B scores at study visits at which protocol-defined pulmonary exacerbations were reported. Mean Respiratory Symptoms scores decreased 14.0 and 14.2 points from baseline for placebo-treated and AZLI-treated patients with exacerbations, indicating that worsening respiratory symptoms were reflected in clinically meaningful changes in QOL-B scores. CONCLUSIONS Previously established content validity, reliability and responsivity of the QOL-B are confirmed by this final validation study. The QOL-B is available for use in clinical trials and routine clinical practice.
Collapse
Affiliation(s)
- Alexandra L Quittner
- Department of Psychology & Pediatrics, University of Miami, and Behavioral Health Sciences Research, Coral Gables, Florida, USA
| | - Anne E O'Donnell
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Matthias A Salathe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Miami, Miami, Florida, USA
| | | | - Xiaoming Li
- Gilead Sciences Inc., Seattle, Washington, USA
| | | | | | - Alan F Barker
- Department of Medicine, Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
21
|
Bilton D, Tino G, Barker AF, Chambers DC, De Soyza A, Dupont LJA, O'Dochartaigh C, van Haren EHJ, Vidal LO, Welte T, Fox HG, Wu J, Charlton B. Inhaled mannitol for non-cystic fibrosis bronchiectasis: a randomised, controlled trial. Thorax 2014; 69:1073-9. [PMID: 25246664 DOI: 10.1136/thoraxjnl-2014-205587] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
RATIONALE Bronchiectasis is characterised by excessive production of mucus and pulmonary exacerbations. Inhaled osmotic agents may enhance mucociliary clearance, but few long-term clinical trials have been conducted. OBJECTIVES To determine the impact of inhaled mannitol on exacerbation rates in patients with non-cystic fibrosis (CF) bronchiectasis. Secondary endpoints included time to first exacerbation, duration of exacerbations, antibiotic use for exacerbations and quality of life (QOL) (St George's Respiratory Questionnaire, SGRQ). METHODS Patients with non-CF bronchiectasis and a history of chronic excess production of sputum and ≥2 pulmonary exacerbations in the previous 12 months were randomised (1:1) to 52 weeks treatment with inhaled mannitol 400 mg or low-dose mannitol control twice a day. Patients were 18-85 years of age, baseline FEV1 ≥40% and ≤85% predicted and a baseline SGRQ score ≥30. MAIN RESULTS 461 patients (233 in the mannitol and 228 in the control arm) were treated. Baseline demographics were similar in the two arms. The exacerbation rate was not significantly reduced on mannitol (rate ratio 0.92, p=0.31). However, time to first exacerbation was increased on mannitol (HR 0.78, p=0.022). SGRQ score was improved on mannitol compared with low-dose mannitol control (-2.4 units, p=0.046). Adverse events were similar between groups. CONCLUSIONS Mannitol 400 mg inhaled twice daily for 12 months in patients with clinically significant bronchiectasis did not significantly reduce exacerbation rates. There were statistically significant improvements in time to first exacerbation and QOL. Mannitol therapy was safe and well tolerated. TRIAL REGISTRATION NUMBER NCT00669331.
Collapse
Affiliation(s)
- Diana Bilton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Gregory Tino
- Department of Pulmonary, Allergy and Critical Care Division, University of Pennsylvania Medical Centre, Philadelphia, Pennsylvania, USA
| | - Alan F Barker
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel C Chambers
- Queensland Lung Transplant Service, The Prince Charles Hospital, Chermside, Queensland, Australia School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Anthony De Soyza
- Institute of Cellular Medicine Newcastle University & Sir William Leech Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | - Conor O'Dochartaigh
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
| | | | - Luis Otero Vidal
- Hospital Interzonal Especializado en Agudos y Cronicos "Dr Antonio A. Cetrangolo", Partido de Vicente Lopez Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Tobias Welte
- Medizinische Hochschule Hannover, Klinik fur Pneumologie, Hannover, Germany
| | - Howard G Fox
- Pharmaxis Ltd, Frenchs Forest, Sydney, NSW, Australia
| | - Jian Wu
- Pharmaxis Ltd, Frenchs Forest, Sydney, NSW, Australia
| | | | | |
Collapse
|
22
|
Affiliation(s)
- Alan F Barker
- From the Division of Pulmonary and Critical Care, Department of Medicine, Oregon Health and Science University, Portland (A.F.B.); Service de Pneumologie; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris (A.B.); Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, New York (W.N.R.); and Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota, Minneapolis (M.I.H.)
| | | | | | | |
Collapse
|
23
|
Dickens JA, Tan L, DeMeo DL, Miranda E, Perez J, Rashid ST, Day J, Ordonez A, Marciniak SJ, Haq I, Barker AF, Campbell EJ, Eden E, McElvaney NG, Rennard SI, Sandhaus RA, Stocks JM, Stoller JK, Strange C, Turino G, Rouhani FN, Brantly M, Lomas DA. S64 Circulating polymers are found in alpha-1-antitrypsin deficiency and are associated with lung disease. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
24
|
Siedlinski M, Klanderman B, Sandhaus RA, Barker AF, Brantly ML, Eden E, McElvaney NG, Rennard SI, Stocks JM, Stoller JK, Strange C, Turino GM, Campbell EJ, Demeo DL. Association of cigarette smoking and CRP levels with DNA methylation in α-1 antitrypsin deficiency. Epigenetics 2012; 7:720-8. [PMID: 22617718 DOI: 10.4161/epi.20319] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Alpha-1 antitrypsin (AAT) deficiency and tobacco smoking are confirmed risk factors for Chronic Obstructive Pulmonary Disease. We hypothesized that variable DNA methylation would be associated with smoking and inflammation, as reflected by the level of C-Reactive Protein (CRP) in AAT-deficient subjects. Methylation levels of 1,411 autosomal CpG sites from the Illumina GoldenGate Methylation Cancer Panel I were analyzed in 316 subjects. Associations of five smoking behaviors and CRP levels with individual CpG sites and average methylation levels were assessed using non-parametric testing, linear regression and linear mixed effect models, with and without adjustment for age and gender. Univariate linear regression analysis revealed that methylation levels of 16 CpG sites significantly associated with ever-smoking status. A CpG site in the TGFBI gene was the only site associated with ever-smoking after adjustment for age and gender. No highly significant associations existed between age at smoking initiation, pack-years smoked, duration of smoking, and time since quitting smoking as predictors of individual CpG site methylation levels. However, ever-smoking and younger age at smoking initiation associated with lower methylation level averaged across all sites. DNA methylation at CpG sites in the RUNX3, JAK3 and KRT1 genes associated with CRP levels. The most significantly associated CpG sites with gender and age mapped to the CASP6 and FZD9 genes, respectively. In summary, this study identified multiple potential candidate CpG sites associated with ever-smoking and CRP level in AAT-deficient subjects. Phenotypic variability in Mendelian diseases may be due to epigenetic factors.
Collapse
Affiliation(s)
- Mateusz Siedlinski
- Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Halvorson SAC, Ricker MA, Barker AF, Patton PE, Harrison RA, Hunter AJ. Thoracic endometriosis unmasked by ovarian hyperstimulation for in vitro fertilization. J Gen Intern Med 2012; 27:603-7. [PMID: 22234445 PMCID: PMC3326110 DOI: 10.1007/s11606-011-1959-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/02/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
Thoracic endometriosis syndrome is a well-described, rare manifestation of endometriosis. We present a case of a 35-year old woman undergoing controlled ovarian stimulation prior to in vitro fertilization (IVF) who developed bilateral hemorrhagic pleural effusions. She was initially diagnosed with ovarian hyperstimulation syndrome, a complication of infertility therapy; however, she was later found to have occult thoracic endometriosis. We describe ovarian hyperstimulation syndrome and review the manifestations of thoracic endometriosis syndrome. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low.
Collapse
Affiliation(s)
- Stephanie A C Halvorson
- OHSU Division of Hospital Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd BTE-119, Portland, Oregon 97239, USA.
| | | | | | | | | | | |
Collapse
|
27
|
McCormack FX, Inoue Y, Moss J, Singer LG, Strange C, Nakata K, Barker AF, Chapman JT, Brantly ML, Stocks JM, Brown KK, Lynch JP, Goldberg HJ, Young LR, Kinder BW, Downey GP, Sullivan EJ, Colby TV, McKay RT, Cohen MM, Korbee L, Taveira-DaSilva AM, Lee HS, Krischer JP, Trapnell BC. Efficacy and safety of sirolimus in lymphangioleiomyomatosis. N Engl J Med 2011; 364:1595-606. [PMID: 21410393 PMCID: PMC3118601 DOI: 10.1056/nejmoa1100391] [Citation(s) in RCA: 719] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) is a progressive, cystic lung disease in women; it is associated with inappropriate activation of mammalian target of rapamycin (mTOR) signaling, which regulates cellular growth and lymphangiogenesis. Sirolimus (also called rapamycin) inhibits mTOR and has shown promise in phase 1-2 trials involving patients with LAM. METHODS We conducted a two-stage trial of sirolimus involving 89 patients with LAM who had moderate lung impairment--a 12-month randomized, double-blind comparison of sirolimus with placebo, followed by a 12-month observation period. The primary end point was the difference between the groups in the rate of change (slope) in forced expiratory volume in 1 second (FEV(1)). RESULTS During the treatment period, the FEV(1) slope was -12±2 ml per month in the placebo group (43 patients) and 1±2 ml per month in the sirolimus group (46 patients) (P<0.001). The absolute between-group difference in the mean change in FEV(1) during the treatment period was 153 ml, or approximately 11% of the mean FEV(1) at enrollment. As compared with the placebo group, the sirolimus group had improvement from baseline to 12 months in measures of forced vital capacity, functional residual capacity, serum vascular endothelial growth factor D (VEGF-D), and quality of life and functional performance. There was no significant between-group difference in this interval in the change in 6-minute walk distance or diffusing capacity of the lung for carbon monoxide. After discontinuation of sirolimus, the decline in lung function resumed in the sirolimus group and paralleled that in the placebo group. Adverse events were more common with sirolimus, but the frequency of serious adverse events did not differ significantly between the groups. CONCLUSIONS In patients with LAM, sirolimus stabilized lung function, reduced serum VEGF-D levels, and was associated with a reduction in symptoms and improvement in quality of life. Therapy with sirolimus may be useful in selected patients with LAM. (Funded by the National Institutes of Health and others; MILES ClinicalTrials.gov number, NCT00414648.).
Collapse
|
28
|
Barker AF. Alpha-1 Antitrypsin Deficiency Identification and Management: It is the Team More than the Genes. COPD 2010; 7:162-3. [DOI: 10.3109/15412555.2010.487042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
29
|
Brown LK, Angus DC, Marin MG, Balmes JR, Barker AF, Ewart G, Halbower AC, Lutz PO, Mularski RA, Nathanson IT, Sanders MH, Stewart GL, Upson DJ. An official American thoracic society statement: position statement on ATS activities for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States. Am J Respir Crit Care Med 2009; 180:1023-9. [PMID: 19897774 DOI: 10.1164/rccm.200709-1339st] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The 1997 American Thoracic Society (ATS) statement "A Framework for Health Care Policy in the United States" outlined core principles for the Society's activities in the public health arena. In the succeeding 10 years, profound changes have taken place in the United States health care environment. In addition, the 2005 publication of the Society's Vision highlighted some differences between the original Statement and our current priorities. Therefore, the Health Policy Committee embarked on a re-analysis and re-statement of the Society's attitudes and strategies with respect to health and public policy. This Statement reflects the findings of the Committee. PURPOSE To outline the key aspects of an internal ATS strategy for the promotion of respiratory and sleep/wake health and the care of the critically ill in the United States. METHODS Committee discussion and consensus-building occurred both before and after individual members performed literature searches and drafted sections of the document. Comments were solicited on the draft document from ATS committee and assembly chairs and the Executive Committee, resulting in substantive revisions of the final document. RESULTS Specific strategies are suggested for the ATS in the arenas of research, training and education, patient care, and advocacy so as to enhance the delivery of health care in the fields of respiratory medicine, sleep medicine, and critical care. CONCLUSIONS The American Thoracic Society's Mission, Core Principles, and Vision provide clear guidance for the formulation of specific strategies that will serve to promote improved respiratory health and care of the critically ill in the United States.
Collapse
|
30
|
Castaldi PJ, DeMeo DL, Kent DM, Campbell EJ, Barker AF, Brantly ML, Eden E, McElvaney NG, Rennard SI, Stocks JM, Stoller JK, Strange C, Turino G, Sandhaus RA, Griffith JL, Silverman EK. Development of predictive models for airflow obstruction in alpha-1-antitrypsin deficiency. Am J Epidemiol 2009; 170:1005-13. [PMID: 19726494 DOI: 10.1093/aje/kwp216] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Alpha-1-antitrypsin deficiency is a genetic condition associated with severe, early-onset chronic obstructive pulmonary disease (COPD). However, there is significant variability in lung function impairment among persons with the protease inhibitor ZZ genotype. Early identification of persons at highest risk of developing lung disease could be beneficial in guiding monitoring and treatment decisions. Using a multicenter, family-based study sample (2002-2005) of 372 persons with the protease inhibitor ZZ genotype, the authors developed prediction models for forced expiratory volume in 1 second (FEV(1)) and the presence of severe COPD using demographic, clinical, and genetic variables. Half of the data sample was used for model development, and the other half was used for model validation. In the training sample, variables found to be predictive of both FEV(1) and severe COPD were age, sex, pack-years of smoking, bronchodilator responsiveness, chronic bronchitis symptoms, and index case status. In the validation sample, the predictive model for FEV(1) explained 50% of the variance in FEV(1), and the model for severe COPD exhibited excellent discrimination (c statistic = 0.88).
Collapse
Affiliation(s)
- P J Castaldi
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
DeMeo DL, Campbell EJ, Brantly ML, Barker AF, Eden E, McElvaney NG, Rennard SI, Stocks JM, Stoller JK, Strange C, Turino G, Sandhaus RA, Silverman EK. Heritability of lung function in severe alpha-1 antitrypsin deficiency. Hum Hered 2008; 67:38-45. [PMID: 18931508 DOI: 10.1159/000164397] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 12/23/2007] [Indexed: 11/19/2022] Open
Abstract
Severe alpha-1 antitrypsin (AAT) deficiency is a proven genetic risk factor for COPD, but there is marked variation in the development of COPD among AAT deficient subjects. To investigate familial aggregation of lung function in subjects with AAT deficiency, we estimated heritability for forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) in 378 AAT deficient subjects from 167 families in the AAT Genetic Modifiers Study; all subjects were verified homozygous for the Z AAT deficiency allele. Heritability was evaluated for models that included and excluded an ascertainment correction, as well as for models that excluded, included and were stratified by a cigarette smoking covariate. In models without an ascertainment correction, and in all models without a covariate for smoking, no evidence for familial aggregation of lung function was observed. In models conditioned on the index proband with covariates for smoking, post-bronchodilator FEV1/FVC demonstrated significant heritability (0.26 +/- 0.14, p = 0.03). When we limited the analysis to subjects with a smoking history, post-bronchodilator FEV1 demonstrated significant heritability (0.47 +/- 0.21, p = 0.02). Severity rate phenotypes were also assessed as potential phenotypes for genetic modifier studies. Significant heritability was found with all age-of-onset threshold models that included smoking and ascertainment adjustments. Using the t-distribution, the heritability estimates ranged from 0.43 to 0.64, depending on the age-of-onset of FEV1 decline used for the severity rate calculation. Correction for ascertainment and consideration of gene-by-smoking interactions will be crucial for the identification of genes that may modify susceptibility for COPD in families with AAT deficiency.
Collapse
Affiliation(s)
- D L DeMeo
- Channing Laboratory and Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Haranath SP, Kovacsovics T, Dunn A, Palmbach GR, Park B, Barker AF. DEPENDENCE OF THE HEMATOPOIETIC CELL TRANSPLANTATION-COMORBIDITY INDEX ON DLCO (CARBON MONOXIDE DIFFUSING CAPACITY) AND FEV1 (FORCED EXPIRATORY VOLUME IN ONE SECOND) PREDICTION EQUATIONS. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
33
|
Demeo DL, Campbell EJ, Barker AF, Brantly ML, Eden E, McElvaney NG, Rennard SI, Sandhaus RA, Stocks JM, Stoller JK, Strange C, Turino G, Silverman EK. IL10 polymorphisms are associated with airflow obstruction in severe alpha1-antitrypsin deficiency. Am J Respir Cell Mol Biol 2007; 38:114-20. [PMID: 17690329 PMCID: PMC2176135 DOI: 10.1165/rcmb.2007-0107oc] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Severe alpha(1)-antitrypsin (AAT) deficiency is a proven genetic risk factor for chronic obstructive pulmonary disease (COPD), especially in individuals who smoke. There is marked variability in the development of lung disease in individuals homozygous (PI ZZ) for this autosomal recessive condition, suggesting that modifier genes could be important. We hypothesized that genetic determinants of obstructive lung disease may be modifiers of airflow obstruction in individuals with severe AAT deficiency. To identify modifier genes, we performed family-based association analyses for 10 genes previously associated with asthma and/or COPD, including IL10, TNF, GSTP1, NOS1, NOS3, SERPINA3, SERPINE2, SFTPB, TGFB1, and EPHX1. All analyses were performed in a cohort of 378 PI ZZ individuals from 167 families. Quantitative spirometric phenotypes included forced expiratory volume in one second (FEV(1)) and the ratio of FEV(1)/forced vital capacity (FVC). A qualitative phenotype of moderate-to-severe COPD was defined for individuals with FEV(1) </= 50 percent predicted. Six of 11 single-nucleotide polymorphisms (SNPs) in IL10 (P = 0.0005-0.05) and 3 of 5 SNPs in TNF (P = 0.01-0.05) were associated with FEV(1) and/or FEV(1)/FVC. IL10 SNPs also demonstrated association with the qualitative COPD phenotype. When phenotypes of individuals with a physician's diagnosis of asthma were excluded, IL10 SNPs remained significantly associated, suggesting that the association with airflow obstruction was independent of an association with asthma. Haplotype analysis of IL10 SNPs suggested the strongest association with IL10 promoter SNPs. IL10 is likely an important modifier gene for the development of COPD in individuals with severe AAT deficiency.
Collapse
Affiliation(s)
- Dawn L Demeo
- Brigham and Women's Hospital, Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Demeo DL, Sandhaus RA, Barker AF, Brantly ML, Eden E, McElvaney NG, Rennard S, Burchard E, Stocks JM, Stoller JK, Strange C, Turino GM, Campbell EJ, Silverman EK. Determinants of airflow obstruction in severe alpha-1-antitrypsin deficiency. Thorax 2007; 62:806-13. [PMID: 17389752 PMCID: PMC2117297 DOI: 10.1136/thx.2006.075846] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Severe alpha(1)-antitrypsin (AAT) deficiency is an autosomal recessive genetic condition associated with an increased but variable risk for chronic obstructive pulmonary disease (COPD). A study was undertaken to assess the impact of chronic bronchitis, pneumonia, asthma and sex on the development of COPD in individuals with severe AAT deficiency. METHODS The AAT Genetic Modifier Study is a multicentre family-based cohort study designed to study the genetic and epidemiological determinants of COPD in AAT deficiency. 378 individuals (age range 33-80 years), confirmed to be homozygous for the SERPINA1 Z mutation, were included in the analyses. The primary outcomes of interest were a quantitative outcome, forced expiratory volume in 1 s (FEV(1)) percentage predicted, and a qualitative outcome, severe airflow obstruction (FEV(1) <50% predicted). RESULTS In multivariate analysis of the overall cohort, cigarette smoking, sex, asthma, chronic bronchitis and pneumonia were risk factors for reduced FEV(1 )percentage predicted and severe airflow obstruction (p<0.01). Index cases had lower FEV(1) values, higher smoking histories and more reports of adult asthma, pneumonia and asthma before age 16 than non-index cases (p<0.01). Men had lower pre- and post-bronchodilator FEV(1) percentage predicted than women (p<0.0001); the lowest FEV(1) values were observed in men reporting a history of childhood asthma (26.9%). This trend for more severe obstruction in men remained when index and non-index groups were examined separately, with men representing the majority of non-index individuals with airflow obstruction (71%). Chronic bronchitis (OR 3.8, CI 1.8 to 12.0) and a physician's report of asthma (OR 4.2, CI 1.4 to 13.1) were predictors of severe airflow obstruction in multivariate analysis of non-index men but not women. CONCLUSION In individuals with severe AAT deficiency, sex, asthma, chronic bronchitis and pneumonia are risk factors for severe COPD, in addition to cigarette smoking. These results suggest that, in subjects severely deficient in AAT, men, individuals with symptoms of chronic bronchitis and/or a past diagnosis of asthma or pneumonia may benefit from closer monitoring and potentially earlier treatment.
Collapse
Affiliation(s)
- Dawn L Demeo
- Channing Laboratory, 181 Longwood Avenue, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Linden A, Biuso TJ, Allada G, Barker AF, Cigarroa J, Haranath SP, Rinkevich D, Stajduhar K. Consensus Development and Application of ICD-9-CM Codes for Defining Chronic Illnesses and their Complications. ACTA ACUST UNITED AC 2007. [DOI: 10.2165/00115677-200715050-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
36
|
Eden E, Hammel J, Rouhani FN, Brantly ML, Barker AF, Buist AS, Fallat RJ, Stoller JK, Crystal RG, Turino GM. Asthma features in severe alpha1-antitrypsin deficiency: experience of the National Heart, Lung, and Blood Institute Registry. Chest 2003; 123:765-71. [PMID: 12628876 DOI: 10.1378/chest.123.3.765] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To describe asthma features in a cohort with alpha(1)-antitrypsin (AAT) deficiency, and determine the impact of asthma on FEV(1) decline. BACKGROUND Asthma may be common in those with AAT deficiency, and may lead to accelerated airflow obstruction. DESIGN Analysis of data obtained from a 5-year, prospective National Heart, Lung, and Blood Institute registry. SETTING A multicenter registry consisting of 37 clinical centers, a central phenotyping laboratory, and a data analysis center. PARTICIPANTS A cohort of 1,052 subjects with AAT deficiency. MEASUREMENTS AND RESULTS Asthma was defined as reversible airflow obstruction, recurrent attacks of wheezing, and a reported diagnosis of asthma or allergy with or without an elevated serum IgE level. FEV(1) decline was calculated by least-square means with adjustments for covariables. Asthma was present in 21% of the cohort and in 12.5% of those with a normal FEV(1). Attacks of wheezing were reported in 66%, the first attack occurring at a mean +/- SD age of 31 +/- 16 years. Allergy and asthma was reported in 29% and 38%, respectively. An elevated IgE level occurred in 17% and was significantly associated with signs and symptoms of asthma and an allergy history. Unadjusted FEV(1) decline was less in the group without asthma and a normal IgE level (- 48.5 mL/yr) vs the groups with asthma features (> or = 64 mL/yr) [p = 0.002]. Multivariable analysis showed that bronchodilator response, age, and smoking were significant predictors for FEV(1) decline but not asthma. CONCLUSIONS Symptoms and signs of asthma are common in AAT deficiency and may start at the age of most rapid FEV(1) loss. Adjusting for other risk factors such as bronchodilator response, asthma as defined does not lead to an accelerated FEV(1) decline. In AAT deficiency, augmentation therapy is not more effective in preventing the loss of lung function in those with asthma compared to those without.
Collapse
Affiliation(s)
- Edward Eden
- James P. Mara Center for Lung Disease, St Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Affiliation(s)
- Alan F Barker
- Pulmonary and Critical Care Division, Department of Medicine, Oregon Health and Science University, Portland 97201, USA.
| |
Collapse
|
38
|
Barker AF, Couch L, Fiel SB, Gotfried MH, Ilowite J, Meyer KC, O'Donnell A, Sahn SA, Smith LJ, Stewart JO, Abuan T, Tully H, Van Dalfsen J, Wells CD, Quan J. Tobramycin solution for inhalation reduces sputum Pseudomonas aeruginosa density in bronchiectasis. Am J Respir Crit Care Med 2000; 162:481-5. [PMID: 10934074 DOI: 10.1164/ajrccm.162.2.9910086] [Citation(s) in RCA: 268] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a placebo-controlled, double-blind, randomized study to evaluate the microbiological efficacy and safety of inhaled tobramycin for treatment of patients with bronchiectasis and Pseudomonas aeruginosa. Patients were randomly assigned to receive either tobramycin solution for inhalation (TSI) (n = 37) or placebo (n = 37), which was self-administered twice daily for 4 wk and followed by 2-wk off-drug. At Week 4, the TSI group had a mean decrease in P. aeruginosa density of 4.54 log(10) colony-forming units (cfu)/g sputum compared with no change in the placebo group (p < 0.01). At Week 6, P. aeruginosa was eradicated in 35% of TSI patients but was detected in all placebo patients. Investigators indicated that 62% of TSI patients showed an improved medical condition compared with 38% of placebo patients (odds ratio = 2.7, 95% confidence interval [CI] 1.1 to 6.9). Tobramycin-resistant P. aeruginosa strains developed in 11% of TSI patients and 3% of placebo patients (p = 0.36). The mean percent change in FEV(1) percent predicted from Week 0 to Week 4 was similar for the TSI and placebo groups (p = 0.41). More TSI-treated patients than placebo patients reported increased cough, dyspnea, wheezing, and noncardiac chest pain, but the symptoms did not limit therapy. Additional study is warranted to further evaluate TSI in bronchiectasis patients.
Collapse
Affiliation(s)
- A F Barker
- Pulmonary and Critical Care Division, Oregon Health Sciences University, Portland, Oregon, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Schluchter MD, Stoller JK, Barker AF, Buist AS, Crystal RG, Donohue JF, Fallat RJ, Turino GM, Vreim CE, Wu MC. Feasibility of a clinical trial of augmentation therapy for alpha(1)-antitrypsin deficiency. The Alpha 1-Antitrypsin Deficiency Registry Study Group. Am J Respir Crit Care Med 2000; 161:796-801. [PMID: 10712324 DOI: 10.1164/ajrccm.161.3.9906011] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined the feasibility of a randomized clinical trial of intravenous augmentation therapy for individuals with alpha 1-antitrypsin (alpha1AT) deficiency, basing calculations on newly available data obtained from the NHLBI Registry of Patients with Severe Deficiency of Alpha 1-Antitrypsin. Using rate of FEV(1) decline as the primary outcome and adjusting for noncompliance, a study of subjects with Stage II chronic obstructive pulmonary disease (COPD) (initial FEV(1) 35 to 49% predicted) with biannual spirometry measures obtained over 4 yr of follow-up would require 147 subjects per treatment arm to detect a difference in FEV(1) decline of 23 ml/yr (i.e., a 28% reduction), the difference observed in the NHLBI Registry (1-sided test, alpha = 0.05, 90% power). To detect a 40% reduction in mortality in a 5-year study of subjects with baseline FEV(1) 35 to 49% predicted, recruited over the first 2 yr and then followed an additional 3 yr, 342 subjects per treatment arm would be needed. Though significant impediments to carrying out a clinical trial exist, including the cost of such a trial and the potential difficulties in recruiting patients for a placebo-controlled trial, we recommend a randomized controlled trial as the best method to evaluate the efficacy of intravenous augmentation therapy and of possible future treatments.
Collapse
Affiliation(s)
- M D Schluchter
- Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
O'Donnell AE, Barker AF, Ilowite JS, Fick RB. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. rhDNase Study Group. Chest 1998; 113:1329-34. [PMID: 9596315 DOI: 10.1378/chest.113.5.1329] [Citation(s) in RCA: 267] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To study the safety and efficacy of aerosolized recombinant human DNase I in the treatment of idiopathic bronchiectasis. DESIGN Double-blind, randomized, placebo-controlled, multicenter study. POPULATIONS Three hundred forty-nine adult outpatients in stable condition with idiopathic bronchiectasis from 23 centers in North America, Great Britain, and Ireland. INTERVENTIONS AND MEASUREMENTS Study patients received aerosolized rhDNase or placebo twice daily for 24 weeks. Primary end points were incidence of pulmonary exacerbations and mean percent change in FEV1 from baseline over the treatment period. RESULTS Pulmonary exacerbations were more frequent and FEV1 decline was greater in patients who received rhDNase compared with placebo during this 24-week trial. CONCLUSIONS rhDNase was ineffective and potentially harmful in this group of adult outpatients in stable condition with idiopathic bronchiectasis. This contrasts with previously published results that demonstrated efficacy of rhDNase in patients with cystic fibrosis bronchiectasis.
Collapse
Affiliation(s)
- A E O'Donnell
- Division of Pulmonary Medicine, Georgetown University Medical Center, Washington, DC, USA
| | | | | | | |
Collapse
|
41
|
Abstract
OBJECTIVES To ascertain how long 120 mg/kg alpha1-antitrypsin concentrate (alpha1-AT-C), administered I.V. every 2 weeks, can maintain alpha1-antitrypsin (alpha1-AT) serum levels above 70 to 80 mg/dL. Secondary objectives were to summarize the nature, severity, and relationship of a plasma-derived alpha1-AT-C infusion to any side effects. METHODS This was an open-label uncontrolled pharmacokinetic study. Alpha1-AT-C was administered I.V. every 2 weeks for 10 infusions in 23 patients with PIZ alpha1-AT deficiency. Serum alpha1-AT levels and neutralizing elastase activity were measured preinfusion, postinfusion, and at nadir. During two infusion periods, daily serum alpha1-AT and neutralizing elastase activities were measured on the seventh to 14th days. Five patients received BAL assays for alpha1-AT and neutralizing elastase activity. Adverse events were recorded in a patient diary and by a nurse at each infusion visit. RESULTS The 120-mg/kg dose of alpha1-AT-C could not maintain nadir serum protective levels above 70 or 80 mg/dL for the entire 14-day dosing interval in most patients. None of the patients had alpha1-AT levels above 80 mg/dL for all 14 days. The serum alpha1-AT and neutralizing elastase levels correlated suggesting functional activity. The BAL alpha1-AT and neutralizing elastase activities were low and did not correlate with serum levels. CONCLUSION Alpha1-AT-C at 120 mg/kg administered every 2 weeks did not maintain nadir serum alpha1-AT levels above 70 to 80 mg/dL for a 14-day dosing interval. Higher doses every 2 weeks or decreased interval between infusions may be required.
Collapse
Affiliation(s)
- A F Barker
- Department of Medicine, Oregon Health Sciences University, Portland, USA
| | | | | | | |
Collapse
|
42
|
Turino GM, Barker AF, Brantly ML, Cohen AB, Connelly RP, Crystal RG, Eden E, Schluchter MD, Stoller JK. Clinical features of individuals with PI*SZ phenotype of alpha 1-antitrypsin deficiency. alpha 1-Antitrypsin Deficiency Registry Study Group. Am J Respir Crit Care Med 1996; 154:1718-25. [PMID: 8970361 DOI: 10.1164/ajrccm.154.6.8970361] [Citation(s) in RCA: 131] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This report describes the clinical characteristics of a group of 59 individuals with the PI*SZ phenotype and alpha 1-antitrypsin (alpha 1-AT) deficiency, identified during recruitment of a registry for subjects with severe alpha 1-antitrypsin deficiency. Currently, 1,129 individuals with levels of alpha 1-AT of 11 microM or below have been enrolled in this registry. Individuals with the SZ phenotype whose alpha 1-AT levels are at or below 11 microM will be followed in the registry; those whose levels exceeded 11 microM had baseline studies and are included in this report. Baseline pulmonary function tests included spirometry before and after an inhaled bronchodilator, diffusing capacity for carbon monoxide (DLCO), and chest roentgenograms. Among nonsmokers, subjects with the SZ phenotype demonstrated airflow obstruction less frequently than those with with the ZZ phenotype. Among ex- and current smokers, the frequency and severity of airflow obstruction was similar between SZ and ZZ subjects. Individuals with the SZ phenotype reported respiratory symptoms less frequently than did ZZ subjects. Overall, airflow obstruction was less common and milder among PI*SZ than PI*ZZ subjects. Cigarette smoking correlated more strongly with airflow obstruction among PI*SZ than PI*ZZ subjects. These observations indicate that in smokers, the PI*SZ phenotype confers a significant risk of the development of chronic obstructive pulmonary disease (COPD). Of itself, except in rare instances in nonsmoking individuals, the PI*SZ phenotype may confer little or no added risk of developing COPD.
Collapse
Affiliation(s)
- G M Turino
- Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians & Surgeons, New York, NY 10019, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Barker AF. Bronchiectasis. Semin Thorac Cardiovasc Surg 1995; 7:112-8. [PMID: 7612755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Bronchiectasis is a chronic suppurative respiratory disease of declining prevalence but continuing morbidity due to recurrent respiratory infections and bronchial bleeding. Literature was reviewed through a Medline search for the past 4 years. Almost all reports are retrospective case summaries. This review focuses on the clinical assessment, stressing the recognition of an impaired host and infectious contributions. High-resolution computed tomography has supplanted bronchography as a key diagnostic tool. Treatment includes prompt attention to acute bacterial infections, aerosol bronchodilators and inflammatory agents, and bronchial hygiene. The role of surgery has declined at least by the number of literature reports. Except for cures for local bronchiectasis, surgical resection is now used to palliate disease activity by removing the most affected segments and lobes.
Collapse
Affiliation(s)
- A F Barker
- Division of Pulmonary and Critical Care Medicine, Oregon Health Sciences University, Portland 97201, USA
| |
Collapse
|
44
|
Barker AF, Siemsen F, Pasley D, D'Silva R, Buist AS. Replacement therapy for hereditary alpha1-antitrypsin deficiency. A program for long-term administration. Chest 1994; 105:1406-10. [PMID: 8181327 DOI: 10.1378/chest.105.5.1406] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This retrospective chart review describes the efficacy and safety of long-term administration of intravenous alpha1-antitrypsin (AAT) in 14 patients with hereditary AAT deficiency and COPD. During the 12- to 48-month observation period, 12 to 14 patients had stabilization of functional status; 4 patients had reductions in hospitalizations. Thirteen of 14 patients had no decline in pulmonary function. Three patients had self-limited adverse reactions to the AAT with one patient requiring a brief hospitalization.
Collapse
Affiliation(s)
- A F Barker
- Department of Pulmonary and Critical Care Medicine, Oregon Health Sciences University, Portland
| | | | | | | | | |
Collapse
|
45
|
Affiliation(s)
- A F Barker
- Oregon Health Sciences University, Portland 97201
| | | | | |
Collapse
|
46
|
Abstract
Twelve of 123 patients with atopic dermatitis (AD) were screened by questionnaire and spirometry for the absence of smoking, hay fever, and respiratory disorders. Seven of these 12 patients had a positive methacholine challenge test. None of eight patients with another skin disorder, psoriasis, screened in a similar fashion, had a positive methacholine challenge. We conclude that hyperresponsive airways are a frequent finding in patients with AD and that similar mechanisms may account for the cutaneous physiologic and pharmacologic abnormalities that have been observed in AD.
Collapse
Affiliation(s)
- A F Barker
- Department of Internal Medicine, Oregon Health Services University, Portland
| | | | | | | |
Collapse
|
47
|
|
48
|
Barker AF, Moseley JR, Glidewell BL. Components of a smoke-free hospital program. Arch Intern Med 1989; 149:1357-9. [PMID: 2730253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hospitals have the responsibility to provide leadership in the area of cigarette-smoking cessation and indoor-smoking elimination. A multidisciplinary committee of the Oregon Health Sciences University, Portland, planned and initiated a smoke-free hospital and clinic facility in 1987. The key planning steps for the patient and visitor ban included involvement of many representatives of the hospital staff, 2 months lead time for the ban, personal interviews with all inpatient smokers on the eve of the ban, and distribution of survival kits. Employees were offered free smoking cessation classes, gum with instructions in use, and a protected outdoor smoking area. The ban has been well accepted by patients and visitors. A questionnaire survey of employees at 6 months has indicated a modest reduction in personal cigarette smoking.
Collapse
Affiliation(s)
- A F Barker
- Department of Internal Medicine, Oregon Health Sciences University, Portland 97201
| | | | | |
Collapse
|
49
|
Barker AF. Strategies in managing asthma. West J Med 1989; 150:303-8. [PMID: 2660411 PMCID: PMC1026452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The management of adult asthma involves a concerted effort to identify and remove or mollify inciting or triggering stimuli such as respiratory tract infections, gastric reflux, aspirin, beta-antagonists, and environmental agents; educate patients, using written treatment plans and pulmonary function monitoring; and properly use the antiasthmatic medications including beta-agonists, theophylline, anticholinergics, and corticosteroids, with an emphasis on aerosol delivery and the use of corticosteroids during exacerbations. This strategy is summarized with suggestions on therapy in emergency departments, during the transition from hospital to ambulatory care, before exercise, and during pregnancy.
Collapse
|
50
|
Affiliation(s)
- A F Barker
- Department of Medicine, Oregon Health Sciences University, Portland 97201
| | | |
Collapse
|