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Mraz T, Asgari S, Karimi A, Breyer MK, Hartl S, Sunanta O, Ofenheimer A, Burghuber OC, Zacharasiewicz A, Lamprecht B, Schiffers C, Wouters EFM, Breyer-Kohansal R. Updated reference values for static lung volumes from a healthy population in Austria. Respir Res 2024; 25:155. [PMID: 38570835 PMCID: PMC10988832 DOI: 10.1186/s12931-024-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Reference values for lung volumes are necessary to identify and diagnose restrictive lung diseases and hyperinflation, but the values have to be validated in the relevant population. Our aim was to investigate the Global Lung Function Initiative (GLI) reference equations in a representative healthy Austrian population and create population-derived reference equations if poor fit was observed. METHODS We analysed spirometry and body plethysmography data from 5371 respiratory healthy subjects (6-80 years) from the Austrian LEAD Study. Fit with the GLI equations was examined using z-scores and distributions within the limits of normality. LEAD reference equations were then created using the LMS method and the generalized additive model of location shape and scale package according to GLI models. RESULTS Good fit, defined as mean z-scores between + 0.5 and -0.5,was not observed for the GLI static lung volume equations, with mean z-scores > 0.5 for residual volume (RV), RV/TLC (total lung capacity) and TLC in both sexes, and for expiratory reserve volume (ERV) and inspiratory capacity in females. Distribution within the limits of normality were shifted to the upper limit except for ERV. Population-derived reference equations from the LEAD cohort showed superior fit for lung volumes and provided reproducible results. CONCLUSION GLI lung volume reference equations demonstrated a poor fit for our cohort, especially in females. Therefore a new set of Austrian reference equations for static lung volumes was developed, that can be applied to both children and adults (6-80 years of age).
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Affiliation(s)
- Tobias Mraz
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Sanatoriumstrasse 2, Vienna, 1140, Austria.
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.
| | - Shervin Asgari
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Ahmad Karimi
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Marie-Kathrin Breyer
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Sanatoriumstrasse 2, Vienna, 1140, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | - Owat Sunanta
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Alina Ofenheimer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Otto C Burghuber
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Penzing, Sanatoriumstrasse 2, Vienna, 1140, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
| | | | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | | | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty of Medicine, Sigmund Freud Private University, Vienna, Austria
- School of Nutrition and Translational Research in Metabolism, NUTRIM, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Vienna Healthcare Group, Clinic Hietzing, Vienna, Austria
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Ofenheimer A, Breyer MK, Wouters EFM, Schiffers C, Hartl S, Burghuber OC, Krach F, Maninno DM, Franssen FME, Mraz T, Puchhammer P, Breyer-Kohansal R. The effect of body compartments on lung function in childhood and adolescence. Clin Nutr 2024; 43:476-481. [PMID: 38181525 DOI: 10.1016/j.clnu.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND There is an association between body composition and lung function, assessed by spirometry, but the effects of body compartments on static lung volumes and its changes during lung growth remain to be explored. We aimed to investigate the association of appendicular lean mass, reflecting skeletal muscle mass, and fat mass on forced and static lung function measures in childhood and adolescence. METHODS In total, 1489 children and adolescents (6-18 years) of the observational, longitudinal (first and second visit within 4 years), general population-based LEAD study have been investigated. The association of appendicular lean mass and fat mass indices (ALMI and FMI; assessed by dual-energy X-ray absorptiometry) on lung function by spirometry (FEV1, FVC) and body plethysmography (TLC, RV, FRC) was investigated cross-sectionally. Longitudinal associations between lung function and body compartment changes between the two visits were analyzed. FINDINGS The ALMI is positively associated with FEV1, FVC, and TLC. Contrary, FMI is inversely associated with lung function measures including FRC and RV. During the phase of lung growth, higher gain in muscle mass is associated with higher increases of FVC and TLC. INTERPRETATION This study demonstrates the different effects of muscle and fat mass on forced expiratory and static lung volumes. Achieving and maintaining muscle mass in childhood and adolescence might become an important preventive strategy for lung health in adulthood.
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Affiliation(s)
- Alina Ofenheimer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Health Care Group, Vienna, Austria
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Health Care Group, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Sigmund Freud University, Medical School, Vienna, Austria
| | - Florian Krach
- ETH Zürich, Department of Mathematics, Zurich, Switzerland
| | - David M Maninno
- University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Frits M E Franssen
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Research and Education, CIRO, Horn, the Netherlands
| | - Tobias Mraz
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Health Care Group, Vienna, Austria
| | | | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
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3
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Abozid H, Patel J, Burney P, Hartl S, Breyer-Kohansal R, Mortimer K, Nafees AA, Al Ghobain M, Welte T, Harrabi I, Denguezli M, Loh LC, Rashid A, Gislason T, Barbara C, Cardoso J, Rodrigues F, Seemungal T, Obaseki D, Juvekar S, Paraguas SN, Tan WC, Franssen FM, Mejza F, Mannino D, Janson C, Cherkaski HH, Anand MP, Hafizi H, Buist S, Koul PA, El Sony A, Breyer MK, Burghuber OC, Wouters EF, Amaral AF. Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study. EClinicalMedicine 2024; 68:102423. [PMID: 38268532 PMCID: PMC10807979 DOI: 10.1016/j.eclinm.2024.102423] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024] Open
Abstract
Background Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition. Methods We analysed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors. Findings The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job. Interpretation Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors. Funding Wellcome Trust.
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Affiliation(s)
- Hazim Abozid
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Jaymini Patel
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Sigmund Freud University, Faculty for Medicine, Vienna, Austria
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria
| | - Kevin Mortimer
- University of Cambridge, Cambridge, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Asaad A. Nafees
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Mohammed Al Ghobain
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Tobias Welte
- Department of Respiratory Medicine/Infectious Disease, Member of the German Centre for Lung Research, Hannover School of Medicine, Germany
| | - Imed Harrabi
- Ibn El Jazzar Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Meriam Denguezli
- Department of Pneumology, Faculty of Medicine Annaba, University Badji Mokhtar of Annaba, Annaba, Algeria
| | - Li Cher Loh
- Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Penang, Malaysia
| | - Abdul Rashid
- Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Penang, Malaysia
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Cristina Barbara
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Joao Cardoso
- Pulmonology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Nova University Lisbon, Lisboa, Portugal
| | - Fatima Rodrigues
- Serviço de Pneumologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Institute of Environmental Health, Associate Laboratory TERRA, Lisbon Medical School, Lisbon University, Lisbon, Portugal
| | - Terence Seemungal
- Faculty of Medical Sciences, University of West Indies, St Augustine, Trinidad and Tobago
| | - Daniel Obaseki
- Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Wan C. Tan
- University of British Columbia Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, BC, Canada
| | | | - Filip Mejza
- Centre for Evidence Based Medicine, 2nd Department of Internal Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - David Mannino
- University of Kentucky, Lexington, KY, USA
- COPD Foundation, Miami, FL, USA
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Hamid Hacene Cherkaski
- Department of Pneumology, Faculty of Medicine Annaba, University Badji Mokhtar of Annaba, Annaba, Algeria
| | | | - Hasan Hafizi
- Faculty of Medicine, Tirana University Hospital “Shefqet Ndroqi”, Tirana, Albania
| | - Sonia Buist
- Oregon Health & Science University, Portland, USA
| | - Parvaiz A. Koul
- Department of Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Marie-Kathrin Breyer
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Otto C. Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Sigmund Freud University, Faculty for Medicine, Vienna, Austria
| | - Emiel F.M. Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Andre F.S. Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, London, UK
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Perkmann T, Koller T, Perkmann-Nagele N, Ozsvar-Kozma M, Eyre D, Matthews P, Bown A, Stoesser N, Breyer MK, Breyer-Kohansal R, Burghuber OC, Hartl S, Aletaha D, Sieghart D, Quehenberger P, Marculescu R, Mucher P, Radakovics A, Klausberger M, Duerkop M, Holzer B, Hartmann B, Strassl R, Leitner G, Grebien F, Gerner W, Grabherr R, Wagner OF, Binder CJ, Haslacher H. Increasing test specificity without impairing sensitivity: lessons learned from SARS-CoV-2 serology. J Clin Pathol 2023; 76:770-777. [PMID: 36041815 DOI: 10.1136/jcp-2022-208171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Serological tests are widely used in various medical disciplines for diagnostic and monitoring purposes. Unfortunately, the sensitivity and specificity of test systems are often poor, leaving room for false-positive and false-negative results. However, conventional methods were used to increase specificity and decrease sensitivity and vice versa. Using SARS-CoV-2 serology as an example, we propose here a novel testing strategy: the 'sensitivity improved two-test' or 'SIT²' algorithm. METHODS SIT² involves confirmatory retesting of samples with results falling in a predefined retesting zone of an initial screening test, with adjusted cut-offs to increase sensitivity. We verified and compared the performance of SIT² to single tests and orthogonal testing (OTA) in an Austrian cohort (1117 negative, 64 post-COVID-positive samples) and validated the algorithm in an independent British cohort (976 negatives and 536 positives). RESULTS The specificity of SIT² was superior to single tests and non-inferior to OTA. The sensitivity was maintained or even improved using SIT² when compared with single tests or OTA. SIT² allowed correct identification of infected individuals even when a live virus neutralisation assay could not detect antibodies. Compared with single testing or OTA, SIT² significantly reduced total test errors to 0.46% (0.24-0.65) or 1.60% (0.94-2.38) at both 5% or 20% seroprevalence. CONCLUSION For SARS-CoV-2 serology, SIT² proved to be the best diagnostic choice at both 5% and 20% seroprevalence in all tested scenarios. It is an easy to apply algorithm and can potentially be helpful for the serology of other infectious diseases.
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Affiliation(s)
- Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Thomas Koller
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | | | - Maria Ozsvar-Kozma
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - David Eyre
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Abbie Bown
- Public Health England Porton Down, Salisbury, UK
| | - Nicole Stoesser
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marie-Kathrin Breyer
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Robab Breyer-Kohansal
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Sigmund Freud Private University Vienna, Vienna, Austria
| | - Slyvia Hartl
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Sigmund Freud Private University Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniela Sieghart
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Quehenberger
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Patrick Mucher
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Astrid Radakovics
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Miriam Klausberger
- Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Vienna, Austria
| | - Mark Duerkop
- Institute of Bioprocess Science and Engineering, Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Vienna, Austria
| | - Barba Holzer
- Institute for Veterinary Disease Control, Austrian Agency for Health and Food Safety (AGES), Moedling, Austria
| | - Boris Hartmann
- Institute for Veterinary Disease Control, Austrian Agency for Health and Food Safety (AGES), Moedling, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Gerda Leitner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Grebien
- Institute for Medical Biochemistry, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Wilhelm Gerner
- Institute of Immunology, University of Veterinary Medicine Vienna, Vienna, Austria
- Christian Doppler Laboratory for an Optimized Prediction of Vaccination Success in Pigs, University of Veterinary Medicine Vienna, Vienna, Austria
- The Pirbright Institute, Pirbright, UK (current)
| | - Reingard Grabherr
- Institute of Molecular Biotechnology, Department of Biotechnology, University of Natural Resources and Life Sciences (BOKU) Vienna, Vienna, Austria
| | - Oswald F Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Wien, Austria
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5
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Abozid H, Kirby M, Nasir N, Hartl S, Breyer-Kohansal R, Breyer MK, Burghuber OC, Bourbeau J, Wouters EFM, Tan W. CT airway remodelling and chronic cough. BMJ Open Respir Res 2023; 10:10/1/e001462. [PMID: 37173074 DOI: 10.1136/bmjresp-2022-001462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
RATIONALE Structural airway changes related to chronic cough (CC) are described in the literature, but so far reported data are rare and non-conclusive. Furthermore, they derive mainly from cohorts with small sample sizes. Advanced CT imaging not only allows airway abnormalities to be quantified, but also to count the number of visible airways. The current study evaluates these airway abnormalities in CC and assesses the contribution of CC in addition to CT findings on the progression of airflow limitation, defined as a decline in forced expiratory volume in 1 s (FEV1) over time. METHODS A total of 1183 males and females aged ≥40 years with thoracic CT scans and valid spirometry from Canadian Obstructive Lung Disease, a Canadian multicentre, population-based study has been included in this analysis. Participants were stratified into 286 never-smokers, 297 ever-smokers with normal lung function and 600 with chronic obstructive pulmonary disease (COPD) of different severity grades. Imaging parameters analyses included total airway count (TAC), airway wall thickness, emphysema as well as parameters for functional small airway disease quantification. RESULTS Irrespective of COPD presence, CC was not related to specific airway and lung structure features. Independent of TAC and emphysema score, CC was highly associated with FEV1 decline over time in the entire study population, particularly in ever-smokers (p<0.0001). CONCLUSION The absence of specific structural CT features independently from COPD presence indicate that other underlying mechanisms are contributing to the symptomatology of CC. On top of derived CT parameters, CC seems to be independently associated with FEV1 decline. TRIAL REGISTRATION NUMBER NCT00920348.
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Affiliation(s)
- Hazim Abozid
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
- Institute for Biomedical Engineering, Science and Technology (iBEST), Unity Health Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Neha Nasir
- Department of Physics, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Department of Respiratory and Pulmonary Diseases, Clinic Penzing, Vienna Healthcare Group, Vienna, Austria
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Faculty for Medicine, Sigmund Freud University, Vienna, Austria
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University, Montreal, Québec, Canada
| | - Emiel F M Wouters
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wan Tan
- Centre for Heart Lung Innovation, University of British Columbia, St Pauls's Hospital, Vancouver, British Columbia, Canada
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Urban MH, Stojkovic S, Demyanets S, Hengstenberg C, Valipour A, Wojta J, Burghuber OC. Soluble ST2 and All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease—A 10-Year Cohort Study. J Clin Med 2021; 11:jcm11010056. [PMID: 35011794 PMCID: PMC8745630 DOI: 10.3390/jcm11010056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is an inflammatory condition with constantly increasing mortality rates. Interleukin (IL)-33 and its decoy receptor, soluble suppression of tumorigenicity 2 (sST2), play a central role in the inflammatory response during infection. sST2 was suggested as a factor in the pathogenesis of COPD and emerged as a predictor of mortality in other non-communicable diseases. The role of sST2 as a predictor of mortality remains unclear in COPD yet. In this cohort study, we measured circulating concentrations of IL-33 and sST2 in the serum of patients with stable COPD (n = 59), patients with acute exacerbation of COPD (n = 29) and smoking (n = 20) and non-smoking controls (n = 20), using commercially available ELISAs, and investigated the prognostic role of sST2 in stable COPD. sST2 levels were significantly higher in COPD patients and smokers compared with non-smoking controls. We identified systolic blood pressure, forced expiratory volume in 1 s (FEV1% predicted), neutrophil count, lactate dehydrogenase and pack-years index as independent predictors of sST2 levels. During a median follow-up time of 10.6 years, 28 patients (47.5%) died. sST2 was an independent predictor of all-cause mortality in patients with COPD with a hazard ratio of 2.9 (95% CI 1.1–8.4, p = 0.035) per one standard deviation after adjustment for age, sex, pack-years, FEV1% predicted and C-reactive protein (CRP). sST2 concentrations are associated with severity of disease and long-term outcome in patients with COPD.
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Affiliation(s)
- Matthias H. Urban
- Department of Internal and Respiratory Medicine and Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (M.H.U.); (A.V.)
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria;
| | - Stefan Stojkovic
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (C.H.)
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria
| | - Svitlana Demyanets
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (C.H.)
| | - Arschang Valipour
- Department of Internal and Respiratory Medicine and Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (M.H.U.); (A.V.)
| | - Johann Wojta
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.S.); (C.H.)
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria
- Core Facilities, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +431-404-007-3500
| | - Otto C. Burghuber
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria;
- Medical School, Sigmund Freud University, 1020 Vienna, Austria
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7
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Ofenheimer A, Breyer-Kohansal R, Hartl S, Burghuber OC, Krach F, Franssen FME, Wouters EFM, Breyer MK. Using Body Composition Groups to Identify Children and Adolescents at Risk of Dyslipidemia. Children 2021; 8:children8111047. [PMID: 34828760 PMCID: PMC8625256 DOI: 10.3390/children8111047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/11/2022]
Abstract
The impact of body composition on the early origin of chronic diseases is an increasingly appreciated phenomenon. Little is known about the characteristics of children with varying body composition. The aim of this study was to investigate serum lipid profiles and other characteristics in relation to body composition. The data of 1394 participants (aged 6 to <18 years) of the observational general population-based Austrian LEAD Study have been analyzed. Body composition groups were defined by appendicular lean mass (ALMI) and fat mass (FMI) indices assessed by DXA. Serum lipid profiles (triglycerides, LDL-c, HDL-c) and other characteristics (e.g., prematurity, smoke exposure, physical activity, nutrition) were investigated in these body composition groups. Different body composition groups, which are not distinguishable by BMI, exist. Children with high ALMI and high FMI showed higher triglycerides and LDL-c, but lower HDL-c levels. In contrast, levels did not differ between those with high FMI but low (or normal) ALMI, and other body composition groups. BMI should be interpreted cautiously, and body composition should be measured by more precise techniques. In particular, children and adolescents with high FMI who have concomitantly high ALMI should be followed closely in future studies to investigate whether they are at increased risk of cardiovascular problems.
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Affiliation(s)
- Alina Ofenheimer
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (R.B.-K.); (S.H.); (O.C.B.); (E.F.M.W.); (M.-K.B.)
- NUTRIM, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands;
- Correspondence:
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (R.B.-K.); (S.H.); (O.C.B.); (E.F.M.W.); (M.-K.B.)
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, 1140 Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (R.B.-K.); (S.H.); (O.C.B.); (E.F.M.W.); (M.-K.B.)
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, 1140 Vienna, Austria
- Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Otto C. Burghuber
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (R.B.-K.); (S.H.); (O.C.B.); (E.F.M.W.); (M.-K.B.)
- Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Florian Krach
- Department of Mathematics, ETH Zürich, 8092 Zurich, Switzerland;
| | - Frits M. E. Franssen
- NUTRIM, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands;
- Department of Research and Education, CIRO, 6085 NM Horn, The Netherlands
| | - Emiel F. M. Wouters
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (R.B.-K.); (S.H.); (O.C.B.); (E.F.M.W.); (M.-K.B.)
- NUTRIM, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands;
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, 1140 Vienna, Austria; (R.B.-K.); (S.H.); (O.C.B.); (E.F.M.W.); (M.-K.B.)
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, 1140 Vienna, Austria
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8
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Allinson JP, Afzal S, Çolak Y, Jarvis D, Backman H, van den Berge M, Boezen HM, Breyer MK, Breyer-Kohansal R, Brusselle G, Burghuber OC, Faner R, Hartl S, Lahousse L, Langhammer A, Lundbäck B, Nwaru BI, Rönmark E, Vikjord SAA, Vonk JM, Wijnant SRA, Lange P, Nordestgaard BG, Olvera N, Agusti A, Donaldson GC, Wedzicha JA, Vestbo J, Vanfleteren LEGW. Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies. Lancet Respir Med 2021; 10:83-94. [PMID: 34619103 DOI: 10.1016/s2213-2600(21)00313-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements. METHODS In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20-94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV1, forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV1 and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV1/FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV1 and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year. FINDINGS Across the ten included studies, we included 243 465 European participants (mean age 51·4 years, 95% CI 51·4-51·5) in our analysis, of whom 136 275 (56·0%) were female and 107 190 (44·0%) were male. After full adjustment, FEV1 increased by 4·8 mL/birth year (95% CI 2·6-7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7-12·0; p<0·0001). Birth year-related increases in the FEV1 and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV1 and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV1/FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09-0·14; p<0·0001). INTERPRETATION If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity. FUNDING The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme.
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Affiliation(s)
- James P Allinson
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Yunus Çolak
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Helena Backman
- Department of Public Health and Clinical Medicine, The OLIN Unit, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Maarten van den Berge
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - H Marike Boezen
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Rosa Faner
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - Lies Lahousse
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, The OLIN Unit, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Sigrid A Aalberg Vikjord
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Levanger, Norway; Department of Medicine and Rehabilitation, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Sara R A Wijnant
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Peter Lange
- Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nuria Olvera
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain
| | - Alvar Agusti
- Càtedra Salut Respiratòria, Universitat Barcelona, Spain; Respiratory Institute, Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; North West Lung Centre, Manchester University National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lowie E G W Vanfleteren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; COPD Centre, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
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9
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Breyer MK, Breyer-Kohansal R, Hartl S, Kundi M, Weseslindtner L, Stiasny K, Puchhammer-Stöckl E, Schrott A, Födinger M, Binder M, Fiedler M, Wouters EFM, Burghuber OC. Low SARS-CoV-2 seroprevalence in the Austrian capital after an early governmental lockdown. Sci Rep 2021; 11:10158. [PMID: 33980950 PMCID: PMC8115109 DOI: 10.1038/s41598-021-89711-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/27/2021] [Indexed: 01/08/2023] Open
Abstract
We analyzed SARS-CoV-2 seroprevalence in a large, well-described representative Viennese cohort after an early governmental lockdown with respect to the occurrence of symptoms and household transmission. Participants of the LEAD Study, a population-based cohort study from Vienna, Austria, were invited along with their household members (April 20th to May20th 2020). Sera were analyzed using anti-SARS-CoV-2 immunoassay including a neutralization test as a confirmatory assay. A total of 12,419 individuals participated (5984 LEAD participants; 6435 household members), 163 (1.31%; 59 LEAD cohort members) of whom were SARS-CoV-2 antibody positive. The estimated number of COVID-19 cases projected from our findings by age and sex for Vienna was 21,504 (1.13%). Cumulative number of positively tested cases in Vienna until May 20th 2020 was 3020, hence 7.1 times (95% confidence interval 5.5-9.1) lower than projected. Relative risk (RR) of seropositivity by age was highest for children aged 6-9 years [RR compared to age group 20-49: 1.21 (CI 0.37-4.01)], lowest for ≥ 65 years [RR 0.47 (CI 0.21-1.03)]. Half of the positive individuals developed no or mild symptoms. In a multivariate analysis, taste and smell disturbances were most strongly related to SARS-CoV-2 positivity. Infection probability within households with one confirmed SARS-CoV-2-specific antibody-positive person was 31%. Although seroprevalence was very low (1.13%) for a central European capital city, due to an early governmental lockdown, SARS-CoV-2 infections were more prevalent than officially reported polymerase chain reaction-positive cases. Of note, seroprevalence was highest in young children. Half of SARS-CoV-2 antibody-positive subjects had no or only mild symptoms. Taste and smell disturbances were most prominent, possibly guiding clinicians in diagnosing SARS-CoV-2 infection.
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Affiliation(s)
- Marie-Kathrin Breyer
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria.
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.
- Ludwig Boltzmann Institute for Lung Health, The Austrian LEAD Study, Klink Penzing, Gebäude G, 2. Stock, Sanatoriumstrasse 2, 1140, Vienna, Austria.
| | - Robab Breyer-Kohansal
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine, Clinic Penzing, Vienna, Austria
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Sigmund Freud University, Faculty of Medicine, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | | | - Andrea Schrott
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Manuela Födinger
- Sigmund Freud University, Faculty of Medicine, Vienna, Austria
- Institute of Laboratory Diagnostics, Clinic Favoriten, Vienna, Austria
| | | | - Markus Fiedler
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | | | - Otto C Burghuber
- Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
- Sigmund Freud University, Faculty of Medicine, Vienna, Austria
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10
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Hackner K, Buder A, Hochmair MJ, Strieder M, Grech C, Fabikan H, Burghuber OC, Errhalt P, Filipits M. Detection of EGFR Activating and Resistance Mutations by Droplet Digital PCR in Sputum of EGFR-Mutated NSCLC Patients. Clin Med Insights Oncol 2021; 15:1179554921993072. [PMID: 33642890 PMCID: PMC7894584 DOI: 10.1177/1179554921993072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Background Proof of the T790M resistance mutation is mandatory if patients with EGFR-mutated non-small cell lung cancer (NSCLC) progress under first- or second-generation tyrosine kinase inhibitor therapy. In addition to rebiopsy, analysis of plasma circulating tumor DNA is used to detect T790M resistance mutation. We studied whether sputum is another feasible specimen for detection of EGFR mutations. Methods Twenty-eight patients with advanced EGFR-mutated NSCLC were included during stable and/or progressive disease. The initial activating EGFR mutations (exon 19 deletions or L858R mutations) at stable disease and at progressive disease (together with T790M) were assessed in simultaneously collected plasma and sputum samples and detected by droplet digital polymerase chain reaction (ddPCR). Results Activating EGFR mutations were detected in 47% of the plasma samples and 41% of sputum samples during stable disease, and in 57% of plasma samples and 64% of sputum samples during progressive disease. T790M was detected in 44% of the plasma samples and 66% of the sputum samples at progressive disease. In ddPCR T790M-negative results for both specimens (plasma and sputum), negativity was confirmed by rebiopsy in 5 samples. Concordance rate of plasma and sputum for T790M was 0.86, with a positive percent agreement of 1.0 and a negative percent agreement of 0.80. Conclusions We demonstrated that EGFR mutation analysis with ddPCR is feasible in sputum samples. Combination of plasma and sputum analyses for detection of T790M in NSCLC patients with progressive disease increases the diagnostic yield compared with molecular plasma analysis alone.
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Affiliation(s)
- Klaus Hackner
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Matthaeus Strieder
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Christina Grech
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hannah Fabikan
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University Medical School, Vienna, Austria
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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11
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Ofenheimer A, Breyer‐Kohansal R, Hartl S, Burghuber OC, Krach F, Schrott A, Franssen FME, Wouters EFM, Breyer M. Reference charts for body composition parameters by dual-energy X-ray absorptiometry in European children and adolescents aged 6 to 18 years-Results from the Austrian LEAD (Lung, hEart, sociAl, boDy) cohort. Pediatr Obes 2021; 16:e12695. [PMID: 32618143 PMCID: PMC7757249 DOI: 10.1111/ijpo.12695] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/04/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND DXA is a widely used technique to assess body composition. Reference values based on a large general population cohort of European children and adolescents were missing. The aim of this study was to provide age- and sex-specific reference percentiles of body composition parameters for European children and adolescents and to compare them to the American NHANES cohort. Additionally, exponents accounting best for height biases were analysed. METHODS DXA scans of 1573 participants, aged 6 to 18 years, recruited from 2011 to 2019 by the Austrian LEAD study, a representative population-based cohort, have been used to create reference charts using the LMS model. RESULTS Reference charts displaying percentile curves and the corresponding reference values are provided. Fat mass parameters were higher in females, while lean mass parameters were higher in males. Compared to the NHANES cohort medians of FMI and LMI were always lower. For FMI, BMI, LMI and ALMI the best fitting exponent were 2.5, 3, 3 and 3.5 respectively CONCLUSIONS: The present study provides reference charts for children and adolescents aged 6 to 18 years, for body composition parameters assessed by DXA. The charts enable comparison to a European general-population cohort and indicate that reference populations should be chosen with caution.
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Affiliation(s)
- Alina Ofenheimer
- NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht University Medical CenterMaastrichtThe Netherlands,Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyViennaAustria,Sigmund Freud UniversityMedical SchoolViennaAustria
| | - Robab Breyer‐Kohansal
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyViennaAustria,Department for Respiratory and Critical Care MedicineOtto Wagner HospitalViennaAustria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyViennaAustria,Sigmund Freud UniversityMedical SchoolViennaAustria,Department for Respiratory and Critical Care MedicineOtto Wagner HospitalViennaAustria
| | - Otto C. Burghuber
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyViennaAustria,Sigmund Freud UniversityMedical SchoolViennaAustria
| | - Florian Krach
- Department of MathematicsETH ZurichZurichSwitzerland
| | - Andrea Schrott
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyViennaAustria
| | - Frits M. E. Franssen
- NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht University Medical CenterMaastrichtThe Netherlands,Department of Research and EducationCIROHornThe Netherlands
| | - Emiel F. M. Wouters
- NUTRIM, School of Nutrition and Translational Research in MetabolismMaastricht University Medical CenterMaastrichtThe Netherlands,Department of Research and EducationCIROHornThe Netherlands
| | - Marie‐Kathrin Breyer
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyViennaAustria,Department for Respiratory and Critical Care MedicineOtto Wagner HospitalViennaAustria
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12
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Perkmann T, Perkmann-Nagele N, Breyer MK, Breyer-Kohansal R, Burghuber OC, Hartl S, Aletaha D, Sieghart D, Quehenberger P, Marculescu R, Mucher P, Strassl R, Wagner OF, Binder CJ, Haslacher H. Side-by-Side Comparison of Three Fully Automated SARS-CoV-2 Antibody Assays with a Focus on Specificity. Clin Chem 2020; 66:1405-1413. [PMID: 32777031 PMCID: PMC7454460 DOI: 10.1093/clinchem/hvaa198] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [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: 06/08/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the context of the COVID-19 pandemic, numerous new serological test systems for the detection of anti-SARS-CoV-2 antibodies rapidly have become available. However, the clinical performance of many of these is still insufficiently described. Therefore, we compared 3 commercial CE-marked, SARS-CoV-2 antibody assays side by side. METHODS We included a total of 1154 specimens from pre-COVID-19 times and 65 samples from COVID-19 patients (≥14 days after symptom onset) to evaluate the test performance of SARS-CoV-2 serological assays by Abbott, Roche, and DiaSorin. RESULTS All 3 assays presented with high specificities: 99.2% (98.6-99.7) for Abbott, 99.7% (99.2-100.0) for Roche, and 98.3% (97.3-98.9) for DiaSorin. In contrast to the manufacturers' specifications, sensitivities only ranged from 83.1% to 89.2%. Although the 3 methods were in good agreement (Cohen's Kappa 0.71-0.87), McNemar tests revealed significant differences between results obtained from Roche and DiaSorin. However, at low seroprevalences, the minor differences in specificity resulted in profound discrepancies of positive predictive values at 1% seroprevalence: 52.3% (36.2-67.9), 77.6% (52.8-91.5), and 32.6% (23.6-43.1) for Abbott, Roche, and DiaSorin, respectively. CONCLUSION We found diagnostically relevant differences in specificities for the anti-SARS-CoV-2 antibody assays by Abbott, Roche, and DiaSorin that have a significant impact on the positive predictive values of these tests.
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Affiliation(s)
- Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Marie-Kathrin Breyer
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Robab Breyer-Kohansal
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Otto C Burghuber
- Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria.,Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Daniel Aletaha
- Divison of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Daniela Sieghart
- Divison of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Quehenberger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Mucher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Oswald F Wagner
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Christoph J Binder
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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13
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Hochmair M, Weinlinger C, Schwab S, Naber J, Setinek U, Krenbek D, Urban MH, Fabikan H, Watzka S, Koger R, Fazekas A, Bitterlich E, Valipour A, Burghuber OC. Treatment of ALK-rearranged non-small-cell lung cancer with brigatinib as second or later lines: real-world observations from a single institution. Anticancer Drugs 2020; 30:e0787. [PMID: 31305295 DOI: 10.1097/cad.0000000000000787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The second-generation ALK tyrosine kinase inhibitor brigatinib has recently been approved in the European Union for use after crizotinib treatment in patients with EML4-ALK-rearranged lung cancer. In the current study, brigatinib was investigated as second-line or later-line treatment in 35 patients who had developed resistance to crizotinib, ceritinib, or alectinib. Most patients (68.6%) received brigatinib as second or third line (range: second to 12th line). In the total cohort, complete and partial responses were obtained for 9.1 and 75.8%, respectively. Overall median progression-free survival was 9.9 months, whereas the largest treatment cohort (brigatinib after crizotinib failure) showed a median progression-free survival of 8.4 months. Fifty-four percent of patients with baseline brain metastases responded to brigatinib treatment. Brigatinib was highly effective after crizotinib and ceritinib failure. Six patients had received alectinib as monotherapy, second-line, or third line before brigatinib; of these, four experienced partial responses and two progressed responses. Brigatinib treatment was well tolerated.
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Affiliation(s)
- Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Christoph Weinlinger
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Sophia Schwab
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Jakob Naber
- Department of Thoracic Surgery, Otto Wagner Hospital
| | - Ulrike Setinek
- Institute of Pathology and Clinical Microbiology, Wilhelminenspital, Vienna
| | - Dagmar Krenbek
- Institute of Pathology and Clinical Microbiology, Wilhelminenspital, Vienna
| | - Matthias H Urban
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Hannah Fabikan
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Stefan Watzka
- Department of Thoracic Surgery, Otto Wagner Hospital
| | - Renate Koger
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Andreas Fazekas
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Erwin Bitterlich
- Department of Pulmonology, Salzkammergut-Klinikum, Vocklabruck, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology
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14
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Burghuber OC, Kirchbacher K, Mohn-Staudner A, Hochmair M, Breyer MK, Studnicka M, Mueller MR, Feurstein P, Schrott A, Lamprecht B, Eckmayr J, Renner F, Bolitschek J, Pohl W, Schenk P, Errhalt P, Cerkl P, Baumgartner B, Kneussl M, Hartl S. Results of the Austrian National Lung Cancer Audit. Clin Med Insights Oncol 2020; 14:1179554920950548. [PMID: 32963472 PMCID: PMC7488615 DOI: 10.1177/1179554920950548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022]
Abstract
Objectives: The Austrian Lung Cancer Audit (ALCA) is a pilot study to evaluate clinical and organizational factors related to lung cancer care across Austria. Materials and methods: The ALCA is a prospective, observational, noninterventional cohort study conducted in 17 departments in Austria between September 2013 and March 2015. Participating departments were selected based on an annual case load of >50 patients with lung cancer. Results: The ALCA included 745 patients, representing 50.5% of all newly diagnosed cancer cases during that time period. In 75.8% of patients, diagnosis was based on histology, and in 24.2% on cytology; 83.1% had non-small-cell lung cancer, 16.9% small-cell lung cancer; and only 4.6% had to be classified as not otherwise specified cancers. The median time elapsed between first presentation at hospital and diagnosis was 8 days (interquartile range [IQR]: 4-15; range: 0-132); between diagnosis and start of treatment it was 15 days for chemotherapy (IQR: 9-27; range: 0-83), 21 days (IQR: 10-35; range: 0-69) for radiotherapy, and 24 days (IQR: 11-36; range: 0-138) for surgery, respectively. In 150 patients undergoing surgical treatment, only 3 (2.0%; n = 147, 3 missings) were seen with postoperative restaging indicating unjustified surgery. One-year follow-up data were available for 723 patients, indicating excellent 49.8% survival; however, a wide range of survival between departments (range: 37.8-66.7) was seen. Conclusions: The ALCA conducted in high case load departments indicated management of lung cancer in accordance with international guidelines, and overall excellent 1-year survival.
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Affiliation(s)
- Otto C Burghuber
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Klaus Kirchbacher
- Second Medical Department with Pneumology, Wilhelminenspital, Vienna, Austria
| | - Andrea Mohn-Staudner
- Second Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Maximilian Hochmair
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Marie-Kathrin Breyer
- Second Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Michael Studnicka
- Department of Pneumology, Salzburger Landeskliniken, Paracelsus Medical University, Salzburg, Austria
| | - Michael Rolf Mueller
- Medical School, Sigmund Freud University, Vienna, Austria.,Department of Thoracic Surgery and Karl Landsteiner Institute for Thoracic Oncology, Otto Wagner Hospital, Vienna, Austria
| | - Petra Feurstein
- Department of Radio-Oncology, Wilhelminenspital, Vienna, Austria
| | - Andrea Schrott
- First Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Bernd Lamprecht
- Department of Pneumology, General Hospital Linz, Linz, Austria
| | - Josef Eckmayr
- Department of Pneumology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Friedrich Renner
- Department of Internal Medicine, Krankenhaus der Barmherzigen Schwestern Ried/Innkreis, Ried im Innkreis, Austria
| | - Josef Bolitschek
- Department of Pneumology, Krankenhaus der Elisabethinen, Linz, Austria.,Department of Pneumology, Klinikum Steyr, Steyr, Austria
| | - Wolfgang Pohl
- Department of Pneumology and Respiratory Diseases, Krankenhaus Hietzing-Rosenhügel, Vienna, Austria
| | - Peter Schenk
- Department of Pulmonology, Landesklinikum Hochegg, Hochegg, Austria
| | - Peter Errhalt
- Clinical Department of Pneumology, Landesklinikum Krems, Krems, Austria
| | - Peter Cerkl
- Department of Pulmonology, Landeskrankenhaus Hohenems, Hohenems, Austria
| | - Bernhard Baumgartner
- Department of Pulmonology, Salzkammergut Klinikum Vöcklabruck, Vöcklabruck, Austria
| | - Meinhard Kneussl
- Second Medical Department with Pneumology, Wilhelminenspital, Vienna, Austria
| | - Sylvia Hartl
- Second Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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15
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Horner A, Burghuber OC, Hartl S, Studnicka M, Merkle M, Olschewski H, Kaiser B, Wallner EM, Lamprecht B. Discordant perception of global health between COPD outpatients and their physicians – real world data from the CLARA project. Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.2599] [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: 11/05/2022]
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16
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Ofenheimer A, Breyer-Kohansal R, Hartl S, Burghuber OC, Altziebler J, Schrott A, Franssen FM, Wouters EF, Harreiter J, Kautzky-Willer A, Breyer MK. Metabolic syndrome and visceral adipose tissue (VAT) are associated with obstructive and restrictive lung function impairment. Epidemiology 2020. [DOI: 10.1183/13993003.congress-2020.2065] [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: 11/05/2022]
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17
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Urban MH, Kreibich N, Gleiss A, Funk GC, Hartl S, Burghuber OC. Effects of roflumilast on arterial stiffness in COPD (ELASTIC): A randomized trial. Respirology 2020; 26:153-160. [PMID: 32725799 DOI: 10.1111/resp.13914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Cardiovascular risk is substantially increased in patients with COPD and can be quantified via arterial stiffness. The PDE-IV inhibitor roflumilast revealed a potential reduction of COPD-related cardiovascular risk. We aimed to investigate the effects of roflumilast on arterial stiffness by quantification of pulse wave velocity (PWV) in stable COPD. METHODS In this randomized placebo-controlled trial, 80 COPD patients received roflumilast or placebo for 24 weeks. The primary outcome was the change in cf-PWV. Secondary outcomes comprised markers of vascular function (e.g. Aix and RHI), systemic inflammation (e.g. IL-6 and TNF-α) and clinical characteristics of COPD (e.g. CAT and 6MWT). RESULTS A total of 33 and 34 patients completed the roflumilast and placebo arm, respectively (age, median (IQR): 64.5 (61-69.5) vs 64.5 (56-72) years; FEV1 , median (IQR): 34.5 (25.5-48.6) vs 35.3 (27-46.8) % predicted; 6MWT, median (IQR): 428 (340-558) vs 456 (364-570) m). Change from baseline PWV did not show a significant difference between roflumilast and placebo (+5.0 (95% CI: -2.0 to +13.0) vs 0.0 (95% CI: -7.0 to +7.0)%, P = 0.268). Roflumilast did not improve markers of vascular function or systemic inflammation. We observed a significant improvement in change from baseline 6MWT with roflumilast versus placebo (+53.0 (95% CI: +19.1 to +86.9) vs -0.92 (95% CI: -35.1 to +33.3) m, P = 0.026). CONCLUSION Our study revealed no beneficial effects of roflumilast on arterial stiffness. Further studies are needed to test a potential improvement of exercise capacity with roflumilast in COPD.
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Affiliation(s)
- Matthias H Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord - Klinik Floridsdorf and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Nicole Kreibich
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Internal and Respiratory Medicine, Wilhelminenspital, Vienna, Austria.,Karl-Landsteiner Institute for Respiratory Research and Pneumological Oncology, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Hospital and Sigmund Freud University, Medical School, Vienna, Austria
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18
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Breyer-Kohansal R, Faner R, Breyer MK, Ofenheimer A, Schrott A, Studnicka M, Wouters EFM, Burghuber OC, Hartl S, Agusti A. Factors Associated with Low Lung Function in Different Age Bins in the General Population. Am J Respir Crit Care Med 2020; 202:292-296. [DOI: 10.1164/rccm.202001-0172le] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Robab Breyer-Kohansal
- Otto Wagner HospitalVienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyVienna, Austria
| | - Rosa Faner
- CIBER Enfermedades RespiratoriasBarcelona, Spain
- Institut d’Investigacions Biomediques August Pi I SunyerBarcelona, Spain
| | - Marie-Kathrin Breyer
- Otto Wagner HospitalVienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyVienna, Austria
| | - Alina Ofenheimer
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyVienna, Austria
- Sigmund Freud UniversityVienna, Austria
- Maastricht University Medical CenterMaastricht, the Netherlands
| | - Andrea Schrott
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyVienna, Austria
| | | | | | - Otto C. Burghuber
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyVienna, Austria
- Sigmund Freud UniversityVienna, Austria
| | - Sylvia Hartl
- Otto Wagner HospitalVienna, Austria
- Ludwig Boltzmann Institute for COPD and Respiratory EpidemiologyVienna, Austria
- Sigmund Freud UniversityVienna, Austria
| | - Alvar Agusti
- CIBER Enfermedades RespiratoriasBarcelona, Spain
- Institut d’Investigacions Biomediques August Pi I SunyerBarcelona, Spain
- Hospital Clinic, University of BarcelonaBarcelona, Spain
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19
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Horner A, Burghuber OC, Hartl S, Studnicka M, Merkle M, Olschewski H, Kaiser B, Wallner EM, Lamprecht B. Quality of Life and Limitations in Daily Life of Stable COPD Outpatients in a Real-World Setting in Austria - Results from the CLARA Project. Int J Chron Obstruct Pulmon Dis 2020; 15:1655-1663. [PMID: 32764911 PMCID: PMC7367938 DOI: 10.2147/copd.s252033] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background COPD patients suffer from respiratory symptoms and limitations in daily life. We aimed to characterize the impact of disease on overall health, daily life, and perceived well-being in COPD outpatients. Methods We conducted a national, cross-sectional study among pulmonologists and general practitioners (GPs). The St. George’s Respiratory Questionnaire for COPD patients (SGRQ-C) was used. Inclusion criteria were a physician’s diagnosis of COPD and age ≥40 years. Subjects with a history of lung surgery, lung cancer or COPD exacerbation within the last four weeks were excluded. Results Sixty-seven pulmonologists and 6 GPs enrolled 1175 COPD patients. Two hundred forty-eight of those did not fulfill GOLD criteria for COPD (FEV1/FVC <0.7) and 77 were excluded due to missing data. Finally, 850 patients (62.8% men; mean age 66.2 ± 0.3 (SE) years; mean FEV1%pred. 51.5 ± 0.6 (SE)) were analyzed. Last year, 55.4% reported at least one exacerbation, and 12.7% were hospitalized for COPD exacerbation. Mean SGRQ-C total score was 43.1 ± 0.83 (SE) and mean component scores for symptoms, activity and impacts were 55.6, 55.4 and 30.5, respectively. Half of the patients (50.3%) reported not being able to do any sports and 78.7% stated that their respiratory symptoms did not allow them doing anything they would like to do. In patients with less severe COPD (FEV1pred ≥50% and non-frequent exacerbations), global health status was overrated, ie, estimated as better by the physician than by the patient, while it was underrated in more severe COPD. Conclusion In Austria, the burden of disease in COPD outpatients tends to be underestimated in patients with milder airway obstruction and less exacerbations and overestimated in patients with more severe airway obstruction and frequent exacerbations. Our finding suggests that validated assessment of global health status might decrease these differences of perception.
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Affiliation(s)
- Andreas Horner
- Department of Pulmonology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria.,Institute of General, Family and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Otto C Burghuber
- First Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Sylvia Hartl
- Second Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Monika Merkle
- Specialist Office for Pulmonology Dr. Merkle, Vienna, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Bernhard Kaiser
- Department of Pulmonology, Kepler University Hospital, Linz, Austria
| | | | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Linz, Austria.,Faculty of Medicine, Johannes Kepler University, Linz, Austria
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20
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Hartl S, Breyer MK, Burghuber OC, Ofenheimer A, Schrott A, Urban MH, Agusti A, Studnicka M, Wouters EFM, Breyer-Kohansal R. Blood eosinophil count in the general population: typical values and potential confounders. Eur Respir J 2020; 55:13993003.01874-2019. [PMID: 32060069 DOI: 10.1183/13993003.01874-2019] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/28/2020] [Indexed: 01/30/2023]
Abstract
There is growing interest in blood eosinophil counts in the management of chronic respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Despite this, typical blood eosinophil levels in the general population, and the impact of potential confounders on these levels have not been clearly defined.We measured blood eosinophil counts in a random sample of 11 042 subjects recruited from the general population in Austria. We then: 1) identified factors associated with high blood eosinophil counts (>75th percentile); and 2) excluded subjects with these factors to estimate median blood eosinophil counts in a "healthy" sub-population (n=3641).We found that: 1) in the entire cohort, age ≤18 years (OR 2.41), asthma (OR 2.05), current smoking (OR 1.72), positive skin prick test (OR 1.64), COPD (OR 1.56), metabolic syndrome (OR 1.41), male sex (OR 1.36) and obesity (OR 1.16) were significantly (p<0.05) associated with high blood eosinophil counts (binary multivariable logistic regression analysis), and had an additive effect; and 2) after excluding these factors, in those older than 18 years, blood eosinophil counts were higher in males than in females (median 120 (5%-95% CI: 30-330) versus 100 (30-310) cells·µL-1, respectively) and did not change with age.Median blood eosinophil counts in adults are considerably lower than those currently regarded as normal, do not change with age beyond puberty, but are significantly influenced by a variety of factors which have an additive effect. These observations will contribute to the interpretation of blood eosinophil levels in clinical practice.
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Affiliation(s)
- Sylvia Hartl
- Second Dept of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria .,Sigmund Freud Medical University, Vienna, Austria
| | - Marie-Kathrin Breyer
- First Dept of Respiratory Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Otto C Burghuber
- Sigmund Freud Medical University, Vienna, Austria.,First Dept of Respiratory Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | | | - Andrea Schrott
- Second Dept of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Matthias H Urban
- First Dept of Respiratory Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona and National Spanish Network for Respiratory Research (CIBERES), Barcelona, Spain
| | - Michael Studnicka
- Dept of Respiratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Emiel F M Wouters
- Dept of Respiratory Medicine, MUMC, Maastricht University, Maastricht, The Netherlands
| | - Robab Breyer-Kohansal
- Second Dept of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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21
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Ofenheimer A, Breyer-Kohansal R, Hartl S, Burghuber OC, Krach F, Schrott A, Wouters EFM, Franssen FME, Breyer MK. Reference values of body composition parameters and visceral adipose tissue (VAT) by DXA in adults aged 18-81 years-results from the LEAD cohort. Eur J Clin Nutr 2020; 74:1181-1191. [PMID: 32123345 PMCID: PMC7402993 DOI: 10.1038/s41430-020-0596-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
Abstract
Background Increasing attention has been drawn on the assessment of body composition phenotypes, since the distribution of soft tissue influences cardio-metabolic risk. Dual-energy X-ray absorptiometry (DXA) is a validated technique to assess body composition. European reference values from population-based cohorts are rare. Aims To provide age- and sex-related reference values of body composition parameters and visceral adipose tissue (VAT) mass, and for lean mass index (LMI) with regard to fat mass index (FMI) quantities and BMI categories. Methods GE-Lunar Prodigy DXA scans of 10.894 participants, aged 18–81 years, recruited from 2011 to 2019 by the Austrian LEAD study, a population-based cohort study, have been used to construct reference curves using the LMS method. Parameters assessed are FMI, LMI, appendicular LMI, fat mass ratios android/gynoid and trunk/limbs, and VAT. Results All lean mass and fat mass parameters indicating central fat accumulation were higher in men, whereas other fat mass indices were higher in women. LMI differed between each FMI subgroup (low vs. normal, low vs. high, normal vs. high), and BMI category in all ages and LMI increased with FMI and BMI classes. VAT mass was higher in men compared with women and increased across all age groups within both sexes. Conclusion The present study provides age- and sex-related reference values for European adults aged 18–81 years for body composition parameters and VAT mass for Lunar Prodigy DXA. In addition, this study reports LMI reference values with regard to fat mass quantities, showing a positive association with increasing FMI percentiles and BMI categories.
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Affiliation(s)
- Alina Ofenheimer
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.,Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Robab Breyer-Kohansal
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.,Department for Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria.,Department for Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Otto C Burghuber
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
| | - Florian Krach
- Department of Mathematics, ETH Zurich, Zurich, Switzerland
| | - Andrea Schrott
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Emiel F M Wouters
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Research and Education, CIRO, Horn, the Netherlands
| | - Frits M E Franssen
- NUTRIM, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Research and Education, CIRO, Horn, the Netherlands
| | - Marie-Kathrin Breyer
- Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria. .,Department for Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria.
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22
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Breyer MK, Ofenheimer A, Altziebler J, Hartl S, Burghuber OC, Studnicka M, Purin D, Heinzle C, Drexel H, Franssen FME, Wouters EFM, Harreiter J, Kautzky-Willer A, Breyer-Kohansal R. Marked differences in prediabetes- and diabetes-associated comorbidities between men and women-Epidemiological results from a general population-based cohort aged 6-80 years-The LEAD (Lung, hEart, sociAl, boDy) study. Eur J Clin Invest 2020; 50:e13207. [PMID: 31997311 DOI: 10.1111/eci.13207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 12/29/2019] [Accepted: 01/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Based on biological and behavioural diversity sex and gender may affect comorbidities associated with prediabetes and diabetes. Besides evaluating the prevalence of prediabetes and diabetes (using fasting plasma glucose and HbA1c levels), the primary aim of the study is to investigate sex and gender differences in the prevalence of comorbidities in subjects with prediabetes and diabetes and to identify possible risk factors associated with prediabetes and diabetes. DESIGN This observational, population-based cohort study included 11.014 subjects aged 6-80 years. Examinations included blood samples, ankle-brachial index, ECG, dual-energy X-ray absorptiometry scan and an interviewer-administered questionnaire. RESULTS Across all ages, prevalence of prediabetes was 20.2% (male 23.6%; female 17.1%), and 5.4% for diabetes (male 7.3%; female 3.7%). The prevalence of prediabetes ranged from 4.4% (6-<10 years) up to 40.4% (70+ years) in men and from 4.8% up to 42.3% in women. Comorbidity profile was markedly different between male and female, particularly in those with prediabetes: women more often suffered from arrhythmia, noncoronary artery disease, osteoporosis, increased systemic inflammatory biomarkers and depression, while men with prediabetes more often showed angina pectoris, myocardial infarction and media sclerosis. CONCLUSIONS The unexpected 4.6% prevalence of prediabetes in children aged 6-10 underscores the need for population-based studies across all ages and the onset of prevention of diabetes at a young age. Marked differences have been found in comorbidities as men with prediabetes and diabetes more often suffer from cardiovascular disease, while women more often show arrhythmia, noncoronary artery disease, increased systemic inflammatory biomarkers and depression.
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Affiliation(s)
- Marie-Kathrin Breyer
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Alina Ofenheimer
- Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Julia Altziebler
- Karl Landsteiner University, Human Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria.,Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Otto C Burghuber
- Sigmund Freud University, Medical School and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | - Michael Studnicka
- Department of Respiratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Daniela Purin
- Vivit-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christine Heinzle
- Vivit-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Heinz Drexel
- Vivit-Institute, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Frits M E Franssen
- Department of Respiratory Medicine+, MUMC+, Maastricht University, Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Respiratory Medicine+, MUMC+, Maastricht University, Maastricht, The Netherlands
| | - Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Robab Breyer-Kohansal
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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23
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Buder A, Setinek U, Hochmair MJ, Schwab S, Kirchbacher K, Keck A, Burghuber OC, Pirker R, Filipits M. EGFR Mutations in Cell-free Plasma DNA from Patients with Advanced Lung Adenocarcinoma: Improved Detection by Droplet Digital PCR. Target Oncol 2020; 14:197-203. [PMID: 30810887 PMCID: PMC6453866 DOI: 10.1007/s11523-019-00623-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Analysis of cell-free DNA from blood could provide an alternative method for identifying genomic changes in the tumors of patients with advanced lung adenocarcinoma. Objective We compared the performance of droplet digital PCR (ddPCR) and Cobas® EGFR Mutation Test v2 (Cobas) for detecting EGFR mutations in cell-free plasma DNA. Patients and Methods Plasma samples from patients with advanced EGFR-mutated lung adenocarcinoma were analyzed for EGFR T790M, exon 19 deletions, and L858R mutations by both ddPCR and Cobas. Results T790M testing was performed in 354 plasma samples collected from 129 patients. The concordance rate between ddPCR and Cobas for T790M, sensitivity, and specificity were 86, 100, and 85%, respectively. Exon 19 deletions were analyzed in 196 plasma samples obtained from 71 of the 129 patients using both platforms. The concordance rate between ddPCR and Cobas for exon 19 deletions, sensitivity, and specificity were 90, 92, and 89%, respectively. L858R mutations were studied in 124 plasma samples obtained from 44 of the 129 patients using both assays. The concordance rate between ddPCR and Cobas for L858R, sensitivity, and specificity were 90, 91, and 89%, respectively. In patients who progressed under treatment with an EGFR TKI (n = 50), the T790M positivity rate was 66% using ddPCR, but only 24% using Cobas. Conclusions We observed a high concordance between ddPCR and Cobas in detecting EGFR mutations in plasma samples of patients with advanced EGFR-mutated lung adenocarcinoma, but ddPCR was more sensitive than Cobas.
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Affiliation(s)
- Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Ulrike Setinek
- Institute for Pathology and Bacteriology, Otto Wagner Hospital, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Sophia Schwab
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | | | | | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Robert Pirker
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria.
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24
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Hochmair MJ, Buder A, Schwab S, Burghuber OC, Prosch H, Hilbe W, Cseh A, Fritz R, Filipits M. Liquid-Biopsy-Based Identification of EGFR T790M Mutation-Mediated Resistance to Afatinib Treatment in Patients with Advanced EGFR Mutation-Positive NSCLC, and Subsequent Response to Osimertinib. Target Oncol 2019; 14:75-83. [PMID: 30539501 PMCID: PMC6403194 DOI: 10.1007/s11523-018-0612-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acquired epidermal growth factor receptor (EGFR) T790M mutation is the primary resistance mechanism to first-generation EGFR tyrosine kinase inhibitors (TKIs) used in advanced, EGFR mutation-positive non-small-cell lung cancer (NSCLC). Available data, predominantly in Asian patients, suggest that this mutation is also the major cause of resistance to the irreversible ErbB family blocker, afatinib. For EGFR T790M-positive patients who progress on EGFR TKI therapy, osimertinib is an effective treatment option. However, data on osimertinib use after afatinib are, to date, scarce. OBJECTIVE To identify the prevalence of EGFR T790M mutations in predominantly Caucasian patients with stage IV EGFR mutation-positive NSCLC who progressed on afatinib, and to investigate the subsequent response to osimertinib. PATIENTS AND METHODS In this single-center, retrospective analysis, EGFR T790M mutation status after afatinib failure was assessed using liquid biopsy and tissue rebiopsy. EGFR T790M-positive patients subsequently received osimertinib. RESULTS Sixty-seven patients received afatinib in the first-, second-, or third-line (80.6%, 14.9%, and 4.5%, respectively). After afatinib failure, the T790M mutation was identified in 49 patients (73.1%). Liquid biopsy and tissue rebiopsy were concordant in 79.4% of cases. All patients with T790M-positive tumors received osimertinib (73.5% after first-line afatinib); 37 (75.5%) of these had an objective response (complete response: 22.4%; partial response: 53.1%). Response rate was independent of T790M copy number. CONCLUSION EGFR T790M mutation is a major mechanism of acquired resistance to afatinib. Osimertinib confers high response rates after afatinib failure in EGFR T790M-positive patients and its use in sequence potentially allows extended chemotherapy-free treatment.
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria.
| | - Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Sophia Schwab
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria
- Cardiothoracic and Vascular Center, Sigmund Freud University, Kelsenstrasse 2, 1030, Vienna, Austria
| | - Helmut Prosch
- Department of Radiology, Comprehensive Cancer Center, Medical University of Vienna, Währingergürtel 18-22, 1090, Vienna, Austria
| | - Wolfgang Hilbe
- Department of Internal Medicine 1, Wilhelminen Hospital, Montleartstraße 37, 1160, Vienna, Austria
| | - Agnieszka Cseh
- Boehringer Ingelheim RCV GmbH & Co. KG, Doktor-Boehringer-Gasse 5-11, 1120, Vienna, Austria
| | - Richard Fritz
- Boehringer Ingelheim RCV GmbH & Co. KG, Doktor-Boehringer-Gasse 5-11, 1120, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
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25
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Buder A, Hochmair MJ, Schwab S, Bundalo T, Schenk P, Errhalt P, Mikes RE, Absenger G, Patocka K, Baumgartner B, Setinek U, Burghuber OC, Prosch H, Pirker R, Filipits M. Cell-Free Plasma DNA-Guided Treatment With Osimertinib in Patients With Advanced EGFR-Mutated NSCLC. J Thorac Oncol 2018; 13:821-830. [PMID: 29505901 DOI: 10.1016/j.jtho.2018.02.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/04/2018] [Accepted: 02/24/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Osimertinib is standard treatment for patients with advanced EGFR T790M-mutated non-small-cell lung cancer who have been pre-treated with EGFR-tyrosine kinase inhibitors (TKIs). We studied whether cell-free plasma DNA for T790M detection can be used to select patients for osimertinib treatment in the clinical routine. METHODS From April 2015 to November 2016, we included 119 patients with advanced EGFR-mutated non-small-cell lung cancer who had progressed under treatment with an EGFR-TKI. The T790M mutation status was assessed in cell-free plasma DNA by droplet digital polymerase chain reaction in all patients and by tissue analyses in selected patients. RESULTS T790M mutations were detected in 85 (93%) patients by analyses of cell-free plasma DNA and in 6 (7%) plasma-negative patients by tumor re-biopsy. Eighty-nine of 91 T790M-positive patients received osimertinib. Median progression-free survival (PFS) was 10.1 months (95% confidence interval [CI]: 8.1-12.1). Median survival was not reached and the 1-year survival was 64%. The response rate was 70% in T790M-positive patients (n = 91) in the intention-to-treat population. PFS trended to be shorter in patients with high T790M copy number (≥10 copies/mL) compared to those with low T790M copy number (<10 copies/mL) (hazard ratio for PFS = 1.72, 95% CI: 0.92-3.2, p = 0.09). A comparable trend was observed for overall survival (hazard ratio for overall survival = 2.16, 95% CI: 0.89-5.25, p = 0.09). No difference in response rate was observed based on T790M copy numbers. CONCLUSION Plasma genotyping using digital polymerase chain reaction is clinically useful for the selection of patients who had progressed during first-line EGFR-TKI therapy for treatment with osimertinib.
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Affiliation(s)
- Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical Center of Vienna, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Sophia Schwab
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | | | - Peter Schenk
- Department of Pneumology, LKH Hochegg, Hochegg, Austria
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Krems, Austria
| | - Romana E Mikes
- Department of Pulmonary Medicine, University Clinic Salzburg, Salzburg, Austria
| | - Gudrun Absenger
- Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Kurt Patocka
- Department of Pneumology, Hietzing Hospital, Vienna, Austria
| | | | - Ulrike Setinek
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Helmut Prosch
- Department of Radiology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Robert Pirker
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical Center of Vienna, Vienna, Austria.
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26
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Migliori GB, Bel E, Joos G, Elliott M, Rohde G, Holgate ST, Gratziou C, Smyth D, Gaga M, Cordeiro CR, Burghuber OC, Brusselle G, Martin-Burrieza F, Bill W, Sax B, Vestbo J. The European Respiratory Society evaluates its 2013–2018 strategic plan implementation. Eur Respir J 2016; 47:693-8. [DOI: 10.1183/13993003.02110-2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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27
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Breyer-Kohansal R, Breyer MK, Hartl S, Burghuber OC. [The Austrian LEAD (Lung hEart sociAL boDy) Study: Background of the Austrian Longitudinal Cohort Study]. Pneumologie 2015; 69:459-62. [PMID: 26258419 DOI: 10.1055/s-0034-1392516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
More research is needed to elucidate natural history and underlying pathomechanisms of the most common airway diseases, Asthma and COPD. In the last decade risk factors affecting the natural history of lung function, defined by the decline of lung function over time, have been evaluated. Moreover, scientific methods have been extended and novel biomarkers, genetics, metabolomics, and epidemiology are dominant tools for investigating the natural history of lung function and potential risk factors. Evidence shows that lung function in childhood is a predictor for lung function in adulthood and risk factors starting in utero contribute to lung function decline during life. Therefore, recently it has been hypothesized that COPD begins in childhood. Thus, prospective investigation of lung function changes including novel scientific methodology has been advocated. The Austrian LEAD study has been initiated in the general population 2012 to investigate the natural history of obstructive airway diseases.
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Affiliation(s)
- R Breyer-Kohansal
- Ludwig Boltzmann Institut für COPD und pneumologische Epidemiologie, Wien, Österreich
| | - M K Breyer
- Ludwig Boltzmann Institut für COPD und pneumologische Epidemiologie, Wien, Österreich
| | - S Hartl
- Ludwig Boltzmann Institut für COPD und pneumologische Epidemiologie, Wien, Österreich
| | - O C Burghuber
- Ludwig Boltzmann Institut für COPD und pneumologische Epidemiologie, Wien, Österreich
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28
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Firlinger I, Setinek U, Koller H, Feurstein P, Prosch H, Burghuber OC, Valipour A. A case of tracheobronchial amyloidosis treated with endoscopic debulking and external beam radiation therapy. Pneumologie 2013; 67:398-400. [PMID: 23828166 DOI: 10.1055/s-0033-1344186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report on a 55-year-old patient who was admitted to hospital because of recurrent pneumonia. CT imaging provided airway narrowing and mural thickening of the distal trachea and mainstem bronchi, compatible with endobronchial polypoid, toric-shaped changes of the distal tracheal wall spreading into both the left and right bronchial system. Bronchoscopy was performed and biopsies revealed the diagnosis of tracheobronchial amyloidosis. We performed a combination of bronchoscopic debulking and consecutive external beam radiation therapy with the result of no further progression of the disease, stable endobronchial situation, and functional improvements at a follow up at 6 months.
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Affiliation(s)
- I Firlinger
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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29
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Firlinger I, Stubenberger E, Müller MR, Burghuber OC, Valipour A. Endoscopic one-way valve implantation in patients with prolonged air leak and the use of digital air leak monitoring. Ann Thorac Surg 2013; 95:1243-9. [PMID: 23434254 DOI: 10.1016/j.athoracsur.2012.12.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Revised: 12/06/2012] [Accepted: 12/07/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prolonged alveolar-pleural air leaks are associated with increased morbidity and mortality. Endoscopic valve therapy has been recently introduced as a potential less invasive treatment option. We aimed at quantifying the effects of valve therapy on air leak flow and clinical outcomes in patients with prolonged air leaks. METHODS We report on a series of 16 patients with high comorbidity and evidence of continuous air leak flow in whom chest tubes remained in place for at least 7 days. After identification of the source of the air leak by use of the balloon occlusion technique, endobronchial one-way valves were implanted. Digital chest tube monitoring was used to assess air leak flow before, during, and after valve implantation until chest tube removal. RESULTS The source of the air leak was endoscopically identified in 13 patients (81%). After valve implantation, air leak flow decreased significantly from 871±551 mL/min to 61±72 mL/min immediately after the intervention (p<0.001). The mean duration of chest tube drainage was 18±8 days before and 9±6 days after the intervention (p<0.01). Ten patients were considered responders, and 3 patients were nonresponders. Responders demonstrated consistent air leak flow levels below 100 mL/min until chest tube removal. Long-term follow-up was available for 9 patients. No adverse events related to the valve implants were reported at follow-up. Seven patients underwent valve removal without any further complications. CONCLUSIONS Endoscopic implantation of one-way valves leads to a significant reduction in air leakage flow and may thus be a valuable treatment option in patients with prolonged air leakage.
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Affiliation(s)
- Irene Firlinger
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
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30
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Nemeth J, Rumetshofer R, Winkler HM, Burghuber OC, Müller C, Winkler S. Active tuberculosis is characterized by an antigen specific and strictly localized expansion of effector T cells at the site of infection. Eur J Immunol 2012; 42:2844-50. [DOI: 10.1002/eji.201242678] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 06/19/2012] [Accepted: 07/17/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Johannes Nemeth
- Department of Internal Medicine I; Division of Infectious Diseases and Tropical Medicine; Medical University of Vienna; Vienna Austria
- Division of Infectious Diseases and Hospital Epidemiology; University Hospital Zurich; Zurich Switzerland
| | - Rudolf Rumetshofer
- Department of Respiratory and Critical Care Medicine; Otto-Wagner-Hospital; Vienna Austria
| | - Heide-Maria Winkler
- Department of Internal Medicine I; Division of Infectious Diseases and Tropical Medicine; Medical University of Vienna; Vienna Austria
| | - Otto C. Burghuber
- Department of Respiratory and Critical Care Medicine; Otto-Wagner-Hospital; Vienna Austria
| | - Catharina Müller
- Department of Internal Medicine I; Division of Infectious Diseases and Tropical Medicine; Medical University of Vienna; Vienna Austria
| | - Stefan Winkler
- Department of Internal Medicine I; Division of Infectious Diseases and Tropical Medicine; Medical University of Vienna; Vienna Austria
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31
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Spruit MA, Chavannes NH, Herth FJ, Poletti V, Ley S, Burghuber OC, Clini E, Cottin V. Clinical highlights from the 2011 ERS Congress in Amsterdam. Eur Respir J 2012; 39:1501-10. [PMID: 22408196 PMCID: PMC3365251 DOI: 10.1183/09031936.00217111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 11/05/2022]
Abstract
This article reports on selected papers pertinent to the most important clinical problems in the field of respiratory medicine. Expert authors from the Clinical Assembly of the European Respiratory Society (ERS) have selected updated reports related to presentations given at the 2011 ERS Annual Congress, which was held in Amsterdam (the Netherlands) and attended by more than 20,000 participants. The hot topics and selected abstracts from the scientific groups of the Clinical Assembly are discussed here in the context of recent literature.
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MESH Headings
- Bronchoscopy/methods
- Exercise Therapy
- Female
- Humans
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/diagnostic imaging
- Lung Diseases, Interstitial/drug therapy
- Lung Diseases, Interstitial/rehabilitation
- Lung Diseases, Interstitial/surgery
- Male
- Pneumonectomy/methods
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/diagnostic imaging
- Pulmonary Disease, Chronic Obstructive/drug therapy
- Pulmonary Disease, Chronic Obstructive/rehabilitation
- Pulmonary Disease, Chronic Obstructive/surgery
- Severity of Illness Index
- Tomography, X-Ray Computed/methods
- Treatment Outcome
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Affiliation(s)
- Martijn A. Spruit
- Program Development Centre of CIRO+, Centre of Expertise for Chronic Organ Failure, Horn
| | - Niels H. Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Sebastian Ley
- Dept of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Dept of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Otto C. Burghuber
- Dept of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Enrico Clini
- DAI Oncology Haematology and Respiratory Diseases – Ospedale Villa Pineta, University of Modena-Reggio Emilia, Modena, Italy
| | - Vincent Cottin
- Hospices Civils de Lyon, Hôpital Louis Pradel, Centre National de Référence des Maladies Pulmonaires Rares
- Université de Lyon, Université Lyon I Claude Bernard, INRA, UMR754 INRA-Vetagrosup EPHE IFR 128, Lyon, France
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32
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Nemeth J, Winkler HM, Zwick RH, Müller C, Rumetshofer R, Boeck L, Burghuber OC, Winkler S. Peripheral T cell cytokine responses for diagnosis of active tuberculosis. PLoS One 2012; 7:e35290. [PMID: 22523581 PMCID: PMC3327656 DOI: 10.1371/journal.pone.0035290] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 03/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A test for diagnosis of active Tuberculosis (TB) from peripheral blood could tremendously improve clinical management of patients. METHODS Of 178 prospectively enrolled patients with possible TB, 60 patients were diagnosed with pulmonary and 27 patients with extrapulmonary TB. The frequencies of Mycobacterium tuberculosis (MTB) specific CD4(+) T cells and CD8(+) T cells producing cytokines were assessed using overnight stimulation with purified protein derivate (PPD) or early secretory antigenic target (ESAT)-6, respectively. RESULTS Among patients with active TB, an increased type 1 cytokine profile consisting of mainly CD4(+) T cell derived interferon (IFN)-γ was detectable. Despite contributing to the cytokine profile as a whole, the independent diagnostic performance of one cytokine producing T cells as well as polyfunctional T cells was poor. IFN-γ/Interleukin(IL)-2 cytokine ratios discriminated best between active TB and other diseases. CONCLUSION T cells producing one cytokine and polyfunctional T cells have a limited role in diagnosis of active TB. The significant shift from a "memory type" to an "effector type" cytokine profile may be useful for further development of a rapid immune-diagnostic tool for active TB.
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Affiliation(s)
- Johannes Nemeth
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Heide-Maria Winkler
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Ralph H. Zwick
- Department of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital, Vienna, Austria
| | - Catharina Müller
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Rudolf Rumetshofer
- Department of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital, Vienna, Austria
| | - Lucas Boeck
- Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland
| | - Otto C. Burghuber
- Department of Respiratory and Critical Care Medicine, Otto-Wagner-Hospital, Vienna, Austria
| | - Stefan Winkler
- Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
- * E-mail:
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33
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Seyfried U, Firlinger I, Reiter M, Katz-Papatheophilou E, Koller H, Burghuber OC, Valipour A. [A leak in the lung: endobronchial one-way valve placement as treatment for a persistent bronchopleural fistula]. Pneumologie 2012; 66:188-91. [PMID: 22287057 DOI: 10.1055/s-0031-1291615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Patients with bronchopleural fistula are at an increased risk of morbidity and mortality. Treatment of the air leak includes intrathoracic drainage, antibiotic therapy and closure of the fistula, which conventionally has been performed via surgical means. In patients with limited respiratory capacity, less-invasive alternatives are required. Here we report on a 62-year-old patient with underlying severe COPD, who was admitted with a lung abscess and consecutively developed a persistent bronchopleural fistula. Treatment involved antibiotic therapy and endobronchial one-way valve placement, which resulted in termination of the air leak and full recovery.
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Affiliation(s)
- U Seyfried
- I. Interne Lungenabteilung, Ludwig-Boltzmann-Institut für COPD und Pneumologische Epidemiologie, Otto-Wagner-Spital, Wien
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34
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Maio S, Sherrill DL, MacNee W, Lange P, Costabel U, Dahlén SE, Sybrecht GW, Burghuber OC, Stevenson R, Tønnesen P, Haeussinger K, Hedlin G, Bauer TT, Riedler J, Nicod L, Carlsen KH, Viegi G. The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction. Eur Respir J 2012; 39:1458-67. [PMID: 22267757 DOI: 10.1183/09031936.00111910] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to raise public awareness of the importance of early detection of airway obstruction and to enable many people who had not been tested previously to have their lung function measured, the European Lung Foundation and the European Respiratory Society (ERS) organised a spirometry testing tent during the annual ERS Congresses in 2004-2009. Spirometry was performed during the ERS Congresses in volunteers; all participants answered a simple, brief questionnaire on their descriptive characteristics, smoking and asthma. Portable spirometers were freely provided by the manufacturer. Nurses and doctors from pulmonary departments of local hospitals/universities gave their service for free. Lower limit of normal (LLN) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for diagnosing and grading airway obstruction were used. Of 12,448 participants in six congress cities, 10,395 (83.5%) performed acceptable spirometry (mean age 51.0 ± 18.4 yrs; 25.5% smokers; 5.5% asthmatic). Airway obstruction was present in 12.4% of investigated subjects according to LLN criteria and 20.3% according to GOLD criteria. Through multinomial logistic regression analysis, age, smoking habits and asthma were significant risk factors for airway obstruction. Relative risk ratio and 95% confidence interval for LLN stage I, for example, was 2.9 (2.0-4.1) for the youngest age (≤ 19 yrs), 1.9 (1.2-3.0) for the oldest age (≥ 80 yrs), 2.4 (2.0-2.9) for current smokers and 2.8 (2.2-3.6) for reported asthma diagnosis. In addition to being a useful advocacy tool, the spirometry tent represents an unusual occasion for early detection of airway obstruction in large numbers of city residents with an important public health perspective.
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Affiliation(s)
- Sara Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
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Breyer MK, Breyer-Kohansal R, Funk GC, Dornhofer N, Spruit MA, Wouters EFM, Burghuber OC, Hartl S. Nordic walking improves daily physical activities in COPD: a randomised controlled trial. Respir Res 2010; 11:112. [PMID: 20727209 PMCID: PMC2933683 DOI: 10.1186/1465-9921-11-112] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 08/22/2010] [Indexed: 11/14/2022] Open
Abstract
Background In patients with COPD progressive dyspnoea leads to a sedentary lifestyle. To date, no studies exist investigating the effects of Nordic Walking in patients with COPD. Therefore, the aim was to determine the feasibility of Nordic Walking in COPD patients at different disease stages. Furthermore we aimed to determine the short- and long-term effects of Nordic Walking on COPD patients' daily physical activity pattern as well as on patients exercise capacity. Methods Sixty COPD patients were randomised to either Nordic Walking or to a control group. Patients of the Nordic Walking group (n = 30; age: 62 ± 9 years; FEV1: 48 ± 19% predicted) underwent a three-month outdoor Nordic Walking exercise program consisting of one hour walking at 75% of their initial maximum heart rate three times per week, whereas controls had no exercise intervention. Primary endpoint: daily physical activities (measured by a validated tri-axial accelerometer); secondary endpoint: functional exercise capacity (measured by the six-minute walking distance; 6MWD). Assessment time points in both groups: baseline, after three, six and nine months. Results After three month training period, in the Nordic Walking group time spent walking and standing as well as intensity of walking increased (Δ walking time: +14.9 ± 1.9 min/day; Δ standing time: +129 ± 26 min/day; Δ movement intensity: +0.40 ± 0.14 m/s2) while time spent sitting decreased (Δ sitting time: -128 ± 15 min/day) compared to baseline (all: p < 0.01) as well as compared to controls (all: p < 0.01). Furthermore, 6MWD significantly increased compared to baseline (Δ 6MWD: +79 ± 28 meters) as well as compared to controls (both: p < 0.01). These significant improvements were sustained six and nine months after baseline. In contrast, controls showed unchanged daily physical activities and 6MWD compared to baseline for all time points. Conclusions Nordic Walking is a feasible, simple and effective physical training modality in COPD. In addition, Nordic Walking has proven to positively impact the daily physical activity pattern of COPD patients under short- and long-term observation. Clinical trial registration Nordic Walking improves daily physical activities in COPD: a randomised controlled trial - ISRCTN31525632
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Affiliation(s)
- Marie-Kathrin Breyer
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstreet 2, 1140 Vienna, Austria.
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Burghuber OC, Valipour A. Knowing chronic obstructive pulmonary disease by heart: cumulating evidence of systemic vascular dysfunction. Am J Respir Crit Care Med 2009; 180:487-8. [PMID: 19734349 DOI: 10.1164/rccm.200907-1037ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Funk GC, Anders S, Breyer MK, Burghuber OC, Edelmann G, Heindl W, Hinterholzer G, Kohansal R, Schuster R, Schwarzmaier-D'Assie A, Valentin A, Hartl S. Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 2009; 35:88-94. [PMID: 19541716 DOI: 10.1183/09031936.00056909] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Weaning from mechanical ventilation was categorised as simple, difficult or prolonged by an international task force of the American Thoracic Society/European Respiratory Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine/Sociéte de Réanimation de Langue Française in 2007. This new classification has not been tested in clinical practice. The objective of the present study was to determine the incidence and outcome of weaning according to the new categories. We included medical and surgical patients who required mechanical ventilation in a prospective, multicentre, 6-month cohort study. From an initial cohort of 510 patients, 257 intubated patients started weaning. Of these patients, the cumulative incidences of simple, difficult, and prolonged weaning were 152 (59%), 68 (26%) and 37 (14%), respectively. Hospital mortality was increased in patients with prolonged (32%) but not difficult (9%) weaning in comparison with those with simple weaning (13%), overall p = 0.0205. In a multivariate logistic regression model, prolonged but not difficult weaning was associated with an increased risk of death. Ventilator-free days and intensive care unit (ICU)-free days were decreased in both difficult and prolonged weaning. In conclusion, the new weaning category prolonged weaning is associated with increased mortality and morbidity in the ICU. The new category difficult to wean was associated with increased morbidity, but not mortality.
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Affiliation(s)
- G-C Funk
- Dept of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD, Otto-Wagner Hospital, Vienna, Austria
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Zwick RH, Burghuber OC, Dovjak N, Hartl S, Kössler W, Lichtenschopf A, Müller R, Zwick H. [The effect of one year outpatient pulmonary rehabilitation on patients with COPD]. Wien Klin Wochenschr 2009; 121:189-95. [PMID: 19412748 DOI: 10.1007/s00508-008-1066-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 09/09/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD). METHODS A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation. RESULTS 100 patients (42 female/58 male) with COPD (COPD IV-N=36, COPD III-N=42, COPD II-N=22), a mean age of 60.5+/-9.6 years, BMI 25.8+/-6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P<0.05), modified Bruce Test (from 13+/-7 Min to 18+/-9 Min; P<0.001), upper limb (from 39.9+/-3 to 52.9+/-8 kg; P<0.001) and lower limb strength increased significantly (from 85.3+/-45 to 131.5+/-57 kg; P<0.001). The maximal inspiratory pressure rose from 81.1 mbar to 108.8 mbar (p<0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2+/-3.6 to 26.5+/-2.8; P<0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P=0.006) and the number of hospitalization days (from 27.3 to 3.3, P<0.001). CONCLUSIONS One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.
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Affiliation(s)
- Ralf H Zwick
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for Chronic Obstructive Pulmonary Disease, Otto Wagner Hospital, Wien, Austria
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Kaufmann M, Hartl S, Geyer K, Breyer MK, Burghuber OC. Measuring FEV(6) for detecting early airway obstruction in the primary care setting. Quality and utility of the new PiKo-6 device. ACTA ACUST UNITED AC 2009; 78:161-7. [PMID: 19174602 DOI: 10.1159/000197466] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 11/12/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of asthma and chronic obstructive pulmonary disease (COPD) is high ( approximately 7.4-18%) in the general population, but less than half are diagnosed. Several studies have shown FEV(6) as a good surrogate marker for forced vital capacity (FVC) to detect airflow limitations. OBJECTIVES The aim of this study was to evaluate if it is possible to simplify and improve the diagnosis of so far undiagnosed asthma or COPD in the primary care setting by measuring FEV(6) with a new simple screening device (PiKo-6). METHODS 507 patients were recruited from three general practices from May to June 2005. Patients with any known pulmonary disease were excluded by questionnaire. FEV(1), FEV(6) and FEV(1)/FEV(6) were determined using a PiKo-6 device. Patients with an FEV(1)/FEV(6) <80% (PiKo positive) were invited to a standardized pulmonary function test to confirm or rule out airflow limitation. RESULTS 401 (79.1%) patients showed FEV(1)/FEV(6) > or =80% (PiKo negative), and 106 (20.9%) patients were PiKo positive. Of the 106 PiKo-positive patients, 74 patients (14.7% of total) agreed to further studies and 18 patients (3.6%) of them suffered from COPD [COPD 0: 5 (1.0%); COPD I: 9 (1.8%); COPD II: 4 (0.8%), and none with COPD III or IV] and 14 patients (2.8%) suffered from bronchial hyperresponsiveness or asthma. In 42 patients (8.3%), the pulmonary function test was normal. CONCLUSIONS Measurement of FEV(6) using a new simple screening device (PiKo-6) may improve the detection rate of undiagnosed airflow limitation in the primary care setting. However, patients should be carefully selected.
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Affiliation(s)
- M Kaufmann
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD, Otto Wagner Hospital, Vienna, Austria.
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Nemeth J, Winkler HM, Zwick RH, Rumetshofer R, Schenk P, Burghuber OC, Graninger W, Ramharter M, Winkler S. Recruitment of Mycobacterium tuberculosis specific CD4+ T cells to the site of infection for diagnosis of active tuberculosis. J Intern Med 2009; 265:163-8. [PMID: 18793244 DOI: 10.1111/j.1365-2796.2008.02012.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Accurate and early diagnosis of active tuberculosis (TB) is problematic as current diagnostic methods show low sensitivity (acid-fast bacilli smears), are time-consuming (culture of biological samples) or show variable results [Mycobacterium tuberculosis (MTB)-specific PCR]. OBJECTIVES In the course of infection, MTB-specific T cells clonally expand at the site of infection and may thus be used as diagnostic marker for active disease. DESIGN In this cohort study, the frequency of MTB-specific, interferon (IFN)-gamma expressing CD4(+) T cells obtained from peripheral blood and the site of disease in 25 patients with suspected TB was assessed (n = 11, bronchoalveolar lavage; n = 7, pleural fluid; n = 1, ascites; n = 1, joint fluid; n = 5, cerebrospinal fluid). RESULTS Amongst 15 patients who showed proven active TB infection, a striking increase of MTB-specific T cells was detected at the site of infection compared with peripheral blood (median increase: 28.5-fold, range: 7.25-531 fold; median of IFN-gamma-producing CD4(+) T cells from blood: 0.02%, range: 0-0.52%; median of IFN-gamma-producing CD4(+) T cells from the site of infection: 1.81%, range: 0.29-6.55%, P < 0.001). MAIN OUTCOME MEASURE Recruitment of MTB-specific T cells to the site of infection yielded a sensitivity of 100% and specificity of 90%, irrespective of the compartment affected. CONCLUSIONS The accumulation of MTB-specific T cells at the site of infection may prove as useful diagnostic marker for an accurate and rapid diagnosis of active TB.
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Affiliation(s)
- J Nemeth
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria.
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Pitta F, Breyer MK, Hernandes NA, Teixeira D, Sant'Anna TJP, Fontana AD, Probst VS, Brunetto AF, Spruit MA, Wouters EFM, Burghuber OC, Hartl S. Comparison of daily physical activity between COPD patients from Central Europe and South America. Respir Med 2008; 103:421-6. [PMID: 19006659 DOI: 10.1016/j.rmed.2008.09.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 09/20/2008] [Accepted: 09/24/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND In healthy elderly and adults, lower physical activity level in daily life has been associated with lower socio-economic level and non-Caucasian race. The objective of this study was to determine if this is also applicable in chronic obstructive pulmonary disease (COPD) by comparing physical activity levels in daily life in stable patients from two countries (Austria and Brazil) with different socio-economic and ethnic characteristics. METHODS Physical activity in daily life was objectively assessed in 40 Austrian and 40 Brazilian COPD patients. Groups were matched for age, gender, body mass index, disease severity, smoking history, presence of concomitant heart disease, lung function, dyspnea and functional exercise capacity. In addition, climatic conditions were similar during the period of data collection in the two groups. RESULTS In comparison to Brazilian patients, Austrian patients had a significantly lower walking time (p=0.04), higher sitting time (p=0.02) and lower movement intensity (p=0.0001). The proportion of patients who did not reach an average of 30min of walking per day was 48% in the Austrian group and 23% in the Brazilian group. CONCLUSIONS Austrian patients with COPD showed a significantly lower daily physical activity level in comparison to matched Brazilian patients. Socio-economic and ethnic factors appear to influence stable COPD patients differently than described in previous studies including healthy subjects.
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Affiliation(s)
- Fábio Pitta
- Departamento de Fisioterapia, Universidade Estadual de Londrina, Brazil.
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Eickhoff P, Valipour A, Kiss D, Schreder M, Cekici L, Geyer K, Kohansal R, Burghuber OC. Determinants of systemic vascular function in patients with stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008; 178:1211-8. [PMID: 18836149 DOI: 10.1164/rccm.200709-1412oc] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Impaired vascular reactivity is an important factor in the pathogenesis of cardiovascular disease. OBJECTIVES We sought to assess vascular reactivity in patients with chronic obstructive pulmonary disease (COPD) and respective control subjects, and to investigate the relation between vascular function and airflow obstruction and systemic inflammation. METHODS We studied 60 patients with stable COPD; 20 smokers with normal lung function matched for age, sex, and body weight; and 20 similarly matched nonsmokers. Patients with cardiovascular comorbidities were excluded. The endothelium-dependent and endothelium-independent function of the vasculature was measured using flow-mediated and nitrogen-mediated dilation of the brachial artery, respectively. Systemic inflammatory markers, including C-reactive protein, fibrinogen, and interleukin (IL)-6, were determined in serum. MEASUREMENTS AND MAIN RESULTS Both flow-mediated and nitrogen-mediated dilation of the brachial artery were significantly lower in patients with stable COPD than in smoking and nonsmoking control subjects. Levels of inflammatory mediators such as IL-6 and fibrinogen were higher in patients than they were in control subjects. In patients with COPD, stepwise multiple regression analysis showed that age, sex, baseline brachial artery diameter, C-reactive protein level, leukocyte count, blood glucose level, and percentage of predicted forced expiratory volume in 1 s were independent predictors of flow-mediated dilation. There was no relation between flow-mediated dilation and pack-years of smoking. Baseline brachial artery diameter was the only independent predictor of nitrogen-mediated dilation in patients with COPD. CONCLUSIONS Both endothelium-dependent and endothelium-independent vasodilation is significantly impaired in patients with stable COPD. Airflow obstruction and systemic inflammation may increase the risk of cardiovascular disease in patients with COPD.
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Zwick RH, Dovjak N, Lichtenschopf A, Muller O, Hartl S, Burghuber OC, Zwick H. ONE YEAR OUTPATIENT PULMONARY REHABILITATION FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A SINGLE CENTER EXPERIENCE. Chest 2007. [DOI: 10.1378/chest.132.4_meetingabstracts.472] [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
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Zwick RH, Mutzbacher P, Dovjak N, Heinzle C, Burghuber OC, Zwick H. EXERCISE IN ADDITION TO NICOTINE REPLACEMENT THERAPY IMPROVES SUCCESS RATES IN SMOKING CESSATION. Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.145s-c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Schenk P, Stiebellehner L, Burghuber OC, Kneussl M, Lang IM. Untersuchung des Lungenkreislaufes mittels Rechtsherzkatheter: Positionspapier des Kardiopulmonalen Arbeitskreises der Österreichischen Gesellschaft für Pneumologie und der Österreichischen Gesellschaft für Kardiologie. Wien Klin Wochenschr 2005; 117:651-62. [PMID: 16416349 DOI: 10.1007/s00508-005-0437-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Peter Schenk
- Intensivstation, Universitätsklinik für Innere Medizin IV, Medizinische Universität Wien, Wien, Osterreich.
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Prebio M, Katz-Papatheophilou E, Heindl W, Gelbmann H, Burghuber OC. [Reduction of pressure sores during prone positioning of ventilated intensive care patients by the prone-head support system: a pilot study]. Wien Klin Wochenschr 2005; 117:98-105. [PMID: 15773424 DOI: 10.1007/s00508-004-0299-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/25/2022]
Abstract
OBJECTIVE Prone positioning in patients with adult respiratory distress syndrome is a well-known method to improve oxygenation. The aim of our study was to evaluate a new device for prone positioning, the prone-head support system (PHS system), with regard to reduction of cutaneous pressure sores. METHODS In a pilot study we randomized 8 patients with ARDS in two groups: 180 degrees standard prone positioning (group without mask) and prone positioning with the PHS system (group with mask). The PHS system consists of a facemask support, which is connected to an adapted air suspension bed. The patients of both groups were intermittently proned for several days. We evaluated the pressure sores on head and neck before turning the patients prone for the first time and after each period of prone positioning. We documented the quantity, the size, the type and the localization of the pressure sores. RESULTS There was no significant difference in the mean duration of prone positioning (27.1+/-14.7 hours in the group with mask versus 24.5+/-18.7 h in the group without mask). In the group with mask there were 1.5+/-0.8 new pressure sores by each proning, whereas in the group without mask there were 2.37+/-1.6 new pressure sores, which was lower, but not significantly. The overall area of pressure sores (798 mm2 versus 3184 mm2, p=0.004), the area of pressure sores per patient (199.5+/-104.7 mm2 versus 796+/-478 mm2, p=0.03) and the increase of the area of pressure sores per proning (79.8+/-52.0 mm2 versus 398.0+/-214.3 mm2, p=0.004) were significantly lower in the group with mask in comparison to the group without mask. The lips were the most effected localization in both groups. The pressure sores in the group with mask were less severe and showed a homogenous distribution in comparison to the group without mask. Blisters dominated in the group with mask in comparison to erosions, necrosis and ulcers in the group without mask. CONCLUSION The PHS system with its face mask is able to reduce the extent and the severity of pressure sores in patients ventilated in prone position. Controlled randomized studies with large study populations seem justified.
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Affiliation(s)
- Michael Prebio
- Intensivstation, 1. Lungenabteilung, Otto-Wagner-Spital, Wien, Osterreich.
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Hartl S, Burghuber OC. The diagnosis of COPD. Wien Med Wochenschr 2005; 155:90-4. [PMID: 15884488 DOI: 10.1007/s10354-005-0154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lung function testing (spirometry) is crucial for the diagnosis of COPD, as irreversible airway obstruction is the main feature of chronic airway inflammation. Spirometry not only is essential in making the diagnosis but also in grading the disease according to FEV1 measurements. Therapeutic interventions and prognostic evaluations are made according to the grading of the disease. Diagnostic procedures aim to evaluate symptoms and disability in the course of COPD. The most important influence on the course of the disease are acute exacerbations. The diagnosis of acute exacerbations is based on clinical observations of sputum production, cough and dyspnoea. Grading of exacerbations according to the severity of symptoms is important for the treatment and in particular for the need of hospitalisation. Exclusion of other lung diseases with similar symptoms necessitates a number of other examinations. Optimal treatment of COPD needs clinical and objective documentation of the course of the disease. Not only spirometry but also quantification of clinical symptoms and exercise capacity measurements are appropriate approaches to follow this chronic disease.
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Affiliation(s)
- Sylvia Hartl
- Interne Lungenabteilung und Luwig Boltzmann Institut für chronisch obstruktive Lungenkrankheiten, Otto Wagner Spital, Wien, Osterreich.
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Valipour A, Cozzarini W, Burghuber OC. Non-invasive pressure support ventilation in patients with respiratory failure due to severe acute cardiogenic pulmonary edema. Respiration 2004; 71:144-51. [PMID: 15031569 DOI: 10.1159/000076675] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Accepted: 09/18/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent studies suggest the use of non-invasive pressure support ventilation (NIPSV) in patients with acute cardiogenic pulmonary edema (ACPE). However, it remains unclear whether all patients with ACPE benefit from NIPSV. OBJECTIVES To investigate short-term effects of NIPSV on respiratory, hemodynamic and oxygenation parameters in patients with respiratory failure due to severe ACPE and to identify factors predicting the need for intubation and in-hospital mortality. METHODS In a prospective, uncontrolled, open study, 28 patients admitted with signs and symptoms of severe respiratory distress due to ACPE were given NIPSV in addition to standardized pharmacological treatment. Physiological parameters were obtained before and after NIPSV, and intubation rate and in-hospital mortality were recorded. RESULTS NIPSV increased arterial oxygenation from paO2 54.2 +/- 12.4 to 76.9 +/- 12.6 mm Hg (p = 0.0001) and decreased respiratory frequency from 40.1 +/- 8.2 to 22.4 +/- 4.9 breaths/min (p = 0.0001). Significant improvements were also noted for heart rate, blood pressure and the paO2/FiO2 ratio. Four patients (14%) required intubation despite NIPSV. Patients who required intubation had lower paCO2 levels (p = 0.0002), lower serum bicarbonate concentrations (p = 0.04) and lower systolic blood pressure (p = 0.045) than patients who were successfully treated with NIPSV. Eight patients (28.5%) died during hospitalization. In patients with a paCO2 < or =35 mm Hg on admission, the in-hospital mortality was 87%, but in patients with a paCO2 >35 mm Hg the in-hospital mortality was 6%. CONCLUSIONS NIPSV improves oxygenation and alleviates respiratory distress in patients with respiratory failure due to severe ACPE. However, a subgroup of patients with hypocapnia on admission might have a poor prognosis, with a higher risk of intubation and in-hospital mortality.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD Research, Otto Wagner Hospital, Pulmonary Center Vienna, Vienna, Austria.
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Block LH, Burghuber OC, Hartl S, Zwick H. Österreichische Gesellschaft für Lungenerkrankungen und Tuberkulose: Konsensus zum Management der chronisch obstruktiven Lungenerkrankungen (COPD). Wien Klin Wochenschr 2004; 116:268-78. [PMID: 15143868 DOI: 10.1007/bf03041059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lutz H Block
- Klinische Abteilung für Pulmologie, Universitätsklinik für Innere Medizin IV, AKH Wien, Wien, Osterreich
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