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Meischl T, Schmid-Scherzer K, Vafai-Tabrizi F, Wurzinger G, Traunmüller-Wurm E, Kutics K, Rauter M, Grabcanovic-Musija F, Müller S, Kaufmann N, Löffler-Ragg J, Valipour A, Funk GC. The impact of diagnostic delay on survival in alpha-1-antitrypsin deficiency: results from the Austrian Alpha-1 Lung Registry. Respir Res 2023; 24:34. [PMID: 36707810 PMCID: PMC9881325 DOI: 10.1186/s12931-023-02338-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Alpha-1-antitrypsin (AAT) deficiency (AATD) is a genetic disorder that can manifest as lung disease. A delay between onset of symptoms and diagnosis of AATD is common and associated with worse clinical status and more advanced disease stage but the influence on survival is unclear. OBJECTIVE We aimed to investigate the impact of diagnostic delay on overall survival (OS) and transplant-free survival (TS) in AATD patients. METHODS We analysed 268 AATD patients from the prospective multi-centre Austrian Alpha-1 Lung (AAL) Registry, employing descriptive statistics, Chi-square-test as well as univariable (Kaplan-Meier plots, log-rank test) and multivariable survival analysis (Cox regression). RESULTS The predominant phenotype was Pi*ZZ (82.1%). At diagnosis, 90.2% had an AAT level below 0.6 g/L. At inclusion, 28.2% had never smoked, 68.0% had quit smoking and 3.8% continued to smoke. Lung disease was diagnosed in 98.5%, thereof most patients were diagnosed with emphysema (63.8%) and/or chronic obstructive pulmonary disease (44.0%). Median diagnostic delay was 5.3 years (inter-quartile range [IQR] 2.2-11.5 years). In multivariable analysis (n = 229), a longer diagnostic delay was significantly associated with worse OS (hazard ratio [HR] 1.61; 95% CI 1.09-2.38; p = 0.016) and TS (HR 1.43; 95% CI 1.08-1.89; p = 0.011), independent from age, smoking status, body mass index (BMI), forced expiratory volume in one second (FEV1) and long-term oxygen treatment. Furthermore, BMI, age and active smoking were significantly associated with worse OS as well as BMI, active smoking and FEV1 were with worse TS. CONCLUSIONS A delayed diagnosis was associated with significantly worse OS and TS. Screening should be improved and efforts to ensure early AATD diagnosis should be intensified.
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Affiliation(s)
- Tobias Meischl
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,grid.22937.3d0000 0000 9259 8492Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Karin Schmid-Scherzer
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Medicine II With Pneumology, Klinik Ottakring, Vienna, Austria
| | - Florian Vafai-Tabrizi
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Medicine II With Pneumology, Klinik Ottakring, Vienna, Austria
| | - Gert Wurzinger
- Center of Pulmology, LKH Graz II, Standort Enzenbach, Gratwein-Strassengel, Austria
| | - Eva Traunmüller-Wurm
- grid.459707.80000 0004 0522 7001Department of Pulmology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Kristina Kutics
- grid.459707.80000 0004 0522 7001Department of Pulmology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Markus Rauter
- grid.415431.60000 0000 9124 9231Department of Pulmonology, Klinikum Klagenfurt Am Woerthersee, Klagenfurt, Austria
| | | | - Simona Müller
- Department of Pulmonology, Landeskrankenhaus Hohenems, Hohenems, Austria
| | - Norbert Kaufmann
- Division of Gastroenterology, Infectiology and Pneumology, Department of Medicine, LKH Graz II, Graz, Austria
| | - Judith Löffler-Ragg
- grid.5361.10000 0000 8853 2677Department of Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Arschang Valipour
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna, Austria
| | - Georg-Christian Funk
- grid.487248.50000 0004 9340 1179Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Ottakring, Montleartstraße 37, 1160 Vienna, Austria ,Department of Medicine II With Pneumology, Klinik Ottakring, Vienna, Austria
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Gaisberger M, Wass RE, Dobias H, Grabcanovic-Musija F, Weiss G, Lamprecht B, Kaiser B, Studnicka M, Hartl A. Acute Exposure to Environmental Tobacco Smoke: A Controlled Study in Adults with Asthma. Respiration 2020; 99:1-8. [PMID: 33296904 DOI: 10.1159/000508397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 05/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Short-term, indoor exposure to environmental tobacco smoke (ETS) is still highly prevalent; however, little is known about the acute lung response in adult asthma. OBJECTIVES We investigated whether acute, experimental ETS exposure influences symptoms, lung function, and inflammatory parameters. METHODS Human subjects with asthma (n = 23) were exposed for 180 min to either room air or ETS at 250, 450, or 850 µg/m3. Respiratory symptoms, lung function, and exhaled nitric oxide (FeNO) were measured. Additionally, blood samples were analyzed for pro- and anti-inflammatory cytokines. RESULTS Humans with asthma demonstrate an increase in respiratory symptoms at all levels of ETS exposure, while the forced expiratory volume in 1 s (FEV1) and FeNO decrease with increasing ETS. The anti-inflammatory cytokine interleukin (IL)-10 increases at intermediate ETS concentrations, whereas tumor necrosis factor (TNF)-α and IL-8 increase only at the highest ETS concentration. CONCLUSION Following 180 min of acute, experimental ETS exposure, we observed a significant increase in respiratory symptoms, a decrease in lung function, and an increase in inflammatory cytokines, indicating an acute lung response in asthma.
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Affiliation(s)
- Martin Gaisberger
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Salzburg, Austria
| | - Romana Elisabeth Wass
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
- Department of Pulmonary Medicine, General Hospital Linz (AKH), Linz, Austria
| | - Heidemarie Dobias
- Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
- Gastein Research Institute, Paracelsus Medical University, Salzburg, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Salzburg, Austria
| | | | - Gertraud Weiss
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, General Hospital Linz (AKH), Linz, Austria
| | - Bernhard Kaiser
- Department for Statistics, University of Linz, Linz, Austria
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University, Salzburg, Austria,
| | - Arnulf Hartl
- Institute of Ecomedicine, Paracelsus Medical University, Salzburg, Austria
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Grabcanovic-Musija F, Obermayer A, Stoiber W, Krautgartner WD, Steinbacher P, Winterberg N, Bathke AC, Klappacher M, Studnicka M. Neutrophil extracellular trap (NET) formation characterises stable and exacerbated COPD and correlates with airflow limitation. Respir Res 2015; 16:59. [PMID: 25994149 PMCID: PMC4455316 DOI: 10.1186/s12931-015-0221-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/13/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND COPD is a progressive disease of the airways that is characterized by neutrophilic inflammation, a condition known to promote the excessive formation of neutrophil extracellular traps (NETs). The presence of large amounts of NETs has recently been demonstrated for a variety of inflammatory lung diseases including cystic fibrosis, asthma and exacerbated COPD. OBJECTIVE We test whether excessive NET generation is restricted to exacerbation of COPD or whether it also occurs during stable periods of the disease, and whether NET presence and amount correlates with the severity of airflow limitation. PATIENTS, MATERIALS AND METHODS Sputum samples from four study groups were examined: COPD patients during acute exacerbation, patients with stable disease, and smoking and non-smoking controls without airflow limitation. Sputum induction followed the ECLIPSE protocol. Confocal laser microscopy (CLSM) and electron microscopy were used to analyse samples. Immunolabelling and fluorescent DNA staining were applied to trace NETs and related marker proteins. CLSM specimens served for quantitative evaluation. RESULTS Sputum of COPD patients is clearly characterised by NETs and NET-forming neutrophils. The presence of large amounts of NET is associated with disease severity (p < 0.001): over 90 % in exacerbated COPD, 45 % in stable COPD, and 25 % in smoking controls, but less than 5% in non-smokers. Quantification of NET-covered areas in sputum preparations confirms these results. CONCLUSIONS NET formation is not confined to exacerbation but also present in stable COPD and correlates with the severity of airflow limitation. We infer that NETs are a major contributor to chronic inflammatory and lung tissue damage in COPD.
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Affiliation(s)
- Fikreta Grabcanovic-Musija
- University Clinic of Pneumology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
| | - Astrid Obermayer
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Walter Stoiber
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Wolf-Dietrich Krautgartner
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Peter Steinbacher
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Nicole Winterberg
- Department of Mathematics, University of Salzburg, Salzburg, Austria.
| | | | - Michaela Klappacher
- Department of Cell Biology, Biomedical Ultrastructure Research Group, University of Salzburg, Salzburg, Austria.
| | - Michael Studnicka
- University Clinic of Pneumology, Paracelsus Medical University, Müllner Hauptstraße 48, A-5020, Salzburg, Austria.
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