Chronic Respiratory Disease最新文献

BackgroundDespite proposed aetiological mechanisms involving stress-induced inflammation and behaviour, population-level evidence linking social isolation and loneliness to asthma is lacking. Therefore, we aimed to examine the associations of social isolation, loneliness, and genetic predisposition with asthma risk in middle-aged and older adults, and to quantify the contribution of various risk factors.MethodsA total of 400,184 asthma-free participants were enrolled from the UK Biobank. Loneliness was evaluated using the short form of the Revised UCLA Loneliness Scale, and social isolation was assessed through a composite score based on key social network components. Asthma was evaluated using hospital inpatient records in UK Biobank. Genetic predisposition for asthma was characterized using weighted polygenic risk score (PRS). Cox proportional hazard models were utilized to assess the associations of social isolation and loneliness with the risk of asthma. The one-sample Mendelian randomization (MR) analysis was based on genome-wide association studies of UKB.ResultsOver an 11.6-years median follow-up, a total of 9453 new asthma cases were recorded. In the fully adjusted model, individuals with feelings of loneliness had a 1.27-fold higher risk of asthma (95% CI: 1.15-1.39) than those without. However, social isolation showed no significant association with asthma risk after several factor adjustments. No significant interactions of loneliness and asthma-PRS were detected. In the one-sample MR analyses, we observed suggestive genetic evidence supporting associations of feeling lonely, fewer leisure social activities, being willing to confide in others, and participating in more other group activities with asthma.ConclusionsOur findings suggest that loneliness, but not social isolation is a risk factor for asthma that is independent of various factors and genetic predisposition. Mendelian randomization provides suggestive evidence that loneliness and reduced social activity may be causal risk factors for asthma.

BackgroundHealth inequalities affect many respiratory diseases. However, little is known about the extent or impact amongst patients treated with home non-invasive ventilation (NIV). This study explored health inequalities faced by these patients and associations with respiratory healthcare burden.MethodsA retrospective cohort study was conducted on patients actively receiving home-NIV treatment. Data on patient demographics, hospital healthcare burden and NIV adherence was collected between 4 October 2021 to 4 October 2023, and their relationships were evaluated.Results187 patients met the inclusion criteria. Total hospital bed days was higher in females than in males, (11.7 ± 27.0 days vs 5.2 ± 12.5 days, p = 0.039), and increasing age was positively associated with higher number of respiratory-related hospital admissions (r = 0.146, p = 0.048). There was a weak correlation between deprivation rank and number of NIV care appointments missed (r = -0.163, p = 0.031). A higher BMI (>40 kg/m²) was associated with lower daily home-NIV use (68.7% ± 4.9% vs 83.0% ± 3.1% nights NIV used, p = 0.012).ConclusionPatients with higher BMI had lower NIV adherence, females required more hospital bed days, older patients had more hospital admissions, and more deprived patients missed more hospital appointments.

ObjectiveThis retrospective study in individuals with chronic respiratory diseases (CRDs) compared changes in quality of life, anxiety and depressive symptoms, and exercise capacity after a home pulmonary rehabilitation (PR) programme, based on the care manager's professional background.MethodsPR team was composed of nurses (Gr1, n = 989 patients), physiotherapists (Gr2, n = 466), one dietician and one sociomedical beautician (Gr3, n = 794) and one respiratory physician (Gr4, n = 201) who supervised one home session per week during 8 weeks. Quality of life, anxiety and depressive symptoms, dyspnea and exercise capacity were assessed at the beginning and end of PR, and at 12 months after the end of PR.Results2450 participants were included (females: 41.6%, age: 64.1 ± 13.0 years, FEV₁: 50.7 ± 25.2% of predicted, people with COPD: 51%, with ILD: 23%, with asthma: 10%). Gr 1, Gr 3 and Gr 4 improved all the assessments at short- and long-term (p < 0.01). Improvement in the Visual Simplified Respiratory Questionnaire in Gr2 was not maintained at long-term. According to the linear mixed models, changes over time were not statistically different between groups.ConclusionA personalised PR programme delivered by one care manager, led to similar short-term benefits regardless of the care manager's initial professional background.

BackgroundChronic respiratory disease burden in Nepal is high, although data from the Terai (lowlands) is limited.MethodsThrough a community outreach programme in Mechinagar, 3398 adults (mean age 49.6 years, 59% female) were recruited to complete spirometry and questionnaires to determine prevalences of airflow obstruction, breathlessness (MRC dyspnoea score ≥3) and self-reported chronic lung disease. Multivariate logistic regression examined associated demographic and lifestyle factors.ResultsPrevalences of airflow obstruction (15%) and breathlessness (13%) exceeded self-reported chronic lung disease (8%). Age (odds ratio = 1.06, 95% confidence interval = 1.05-1.07), body mass index (BMI) per 1 kg/m² (0.90, 0.88-0.93), physical inactivity (1.95, 1.07-3.84) and no formal education (1.46, 1.14-1.88) were associated with airflow obstruction. Smoking was only associated with airflow obstruction in females (1.90, 1.22-2.94) and adults ≥40 years (1.40, 1.05-1.86). Age (1.04, 1.03-1.05), airflow obstruction (2.43, 1.85-3.18), and male sex (0.63, 0.49-0.80) were associated with breathlessness. Only in females was breathlessness associated with BMI (1.08, 1.05-1.12) and mixed biomass use (2.65, 1.39-4.85). In men, labour/farming/agriculture work (3.30, 1.12-14.20) or unemployment (4.39, 1.43-19.30) was associated with breathlessness.ConclusionThere is likely underdiagnosis of chronic lung disease in the Terai. Addressing smoking, educational disparities, physical inactivity and environmental pollutant exposure are public health priorities to improve respiratory health in the region.

BackgroundAlthough the postbronchodilator FEV₁/FVC is the gold standard for diagnosing COPD, it is not easily obtainable due to various reasons. This study aims to investigate whether FEV₁/FEV₆ may serve as an easily accessible surrogate for FEV₁/FVC in detecting airway obstruction and COPD.MethodsEligible articles were screened from PubMed, Web of Science and Scopus. The Quality Assessment of Diagnostic Accuracy Studies-2 was applied for quality assessment. The pooled sensitivity, specificity, and area under the curve (AUC) of the summary receiver operating curve were calculated to evaluate the diagnostic performance of FEV₁/FEV₆ in detecting airway obstruction and COPD and to determine the optimal cutoff value. Sensitivity analyses, subgroup analyses and meta-regression were performed to explore the source of heterogeneity.ResultsWith 28 eligible articles and 65,744 subjects, the FEV₁/FEV₆ ratio showed good diagnostic performance in detecting both airway obstruction (sensitivity: 0.87, specificity: 0.94, AUC 0.95) and COPD (sensitivity: 0.83, specificity: 0.88, AUC 0.91). Further analyses of the optimal cutoff value suggested that an FEV₁/FEV₆<0.72 was the best criterion for detecting airway obstruction (sensitivity: 0.84, specificity: 0.97, AUC 0.96), whereas an FEV₁/FEV₆<0.74 was the best criterion for detecting COPD (sensitivity: 0.87, specificity: 0.89, AUC 0.93). The results of subgroup analyses and meta-regression suggested that study design and geographical location may affect the heterogeneity of both sensitivity and specificity in detecting airway obstruction and COPD.ConclusionThe FEV₁/FEV₆ may serve as an easily accessible alternative in detecting airway obstruction and COPD. However, application of FEV₁/FEV₆ may also be constrained by availability and affordability of devices. Further studies are required to determine the best-suited population for FEV₁/FEV₆ application.

IntroductionEffective management of pulmonary exacerbations (PEx) in cystic fibrosis (CF) is essential to minimise lung damage and reduce morbidity and mortality. Spirometry, the standard tool for lung function assessment in adult people with CF (pwCF), has limitations. Forced Oscillometry Technique (FOT) is an effort-independent method that assesses small airways disease and has been validated in other respiratory conditions. This study evaluated the feasibility and acceptability of implementing FOT during treatment for PEx in adult pwCF.MethodsTwelve adult pwCF underwent FOT and spirometry at the start and end of PEx treatment, and at clinically convenient intervals. FOT was also measured before and after physiotherapy-directed airway clearance. A questionnaire assessed patient satisfaction with FOT.ResultsAll patients had spirometry below baseline at PEx onset and small airways dysfunction on FOT. Treatment was associated with improvements in median FEV1pp (5.1%, p = 0.050) and X5 (0.2 cm H₂O/L/s, p = 0.023), with a significant association between FEV1pp and X5 (p = 0.004). There was no significant FOT change after airway clearance. Patients rated FOT more favourably than spirometry.DiscussionFOT is feasible, well-tolerated, and may complement spirometry in assessing adult pwCF during PEx. Further studies are warranted.

ObjectivesTreatable traits are identifiable and treatable features of disease. The primary objective was to evaluate whether a bronchiectasis clinic in a regional setting, implementing a treatable traits approach, would lead to improvements in quality of life. Secondary objectives were to evaluate clinic implementation outcomes, annual exacerbations and hospitalisation.MethodsAn implementation study. Adults with bronchiectasis attending an outpatient clinic in Rockhampton, Australia between 2021 and 2023 were recruited. Clinical care was implemented by a physiotherapist and nurses according to traits identified. Quality of life (QoL-Bronchiectasis respiratory symptom score (QoL-B rs), Leicester Cough Questionnaire (LCQ) total score) was evaluated at baseline, three and 12-months from first attendance. Implementation outcomes were determined by clinic appointment uptake and attendance and pulmonary rehabilitation uptake and completion at 12-months. Exacerbation frequency and hospitalisation for the 12-months before and after enrolment were compared.Results50 participants were recruited [mean (SD) age 71 (12) years; Bronchiectasis Severity Index (%) mild (22) moderate (44) severe (34)]. There was a significant improvement in QoL at three and 12-months from baseline (mean difference, 95% CI) [3 months: QoL-B rs 9.2 (3.2-15.2), LCQ 1.7 (0.6-2.8); 12-months: QoL-B rs 10.1 (3.9-16.3), LCQ 1.8 (0.8-2.8)]. Clinic uptake (91%), attendance (97%) and pulmonary rehabilitation uptake (74%) and completion (84%) were high. Exacerbation frequency [median (IQR) 1.0 (3.0) to 0.0 (1.0), p = 0.007], and hospitalisation decreased (18% vs 0%, p = 0.005).DiscussionA treatable traits approach improved quality of life, was feasible, including the achievement of high pulmonary rehabilitation uptake and completion, and reduced exacerbation frequency and hospitalisation.

Pressurised metered dose inhalers (pMDIs) release greenhouse gases with substantially higher carbon dioxide equivalent (CO₂e) emission than other inhalers. Data from the Pharmaceutical Benefits Scheme (PBS) from 2013-2023, showed 28.3% increase in inhalers prescribed. pMDIs account for 47.5% of inhalers prescribed, contributing to 95.6 of inhaler-related carbon emissions. Targeted strategies to optimise disease control and promote use of non-pMDI inhalers where clinically appropriate can significantly reduce emissions while maintaining high-quality care.

AimsTo estimate the global burden of chronic obstructive pulmonary disease (COPD) by age, gender and socioeconomic status from 2000 to 2021, and make a prediction until 2030.MethodsData were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. The burden of COPD, referred to absolute numbers of COPD case and age-standardized rates (ASRs) per 100,000 individuals per year. The temporal trends from 2000 to 2021 were examined using Joinpoint models. Bayesian age-period-cohort models were introduced to project the burden until 2030. Finally, a decomposition analysis was conducted to reveal the contributions of aging, population growth and epidemiological changes to trends in COPD burden.ResultsThe crude numbers of incident cases, prevalent cases, deaths, and disability-adjusted life years (DALYs) for COPD remained increasing from 2000 to 2021, and until 2030, worldwide. ASRs of incidence, prevalence, deaths, and DALYs were in decreasing trends, and would continue to decline until 2030. Additionally, in 2021, the ASR of COPD burden was higher in males than females, while the age-specific rate increased with age. The disease burden varied across different regions, with a high burden in low development-level regions. The increasing burden of COPD was primarily driven by rapid aging and population growth.ConclusionsThe global ASRs of COPD burden would remain declining, but the crude burden would continue to increase until 2030. This study has public health implications for population-based interventions against COPD with consideration of residents' age, gender and residing area as well as economic status.

ObjectivesHome-based pulmonary rehabilitation (PR) is increasingly offered as an alternative to centre-based PR. This study explores differences in the characteristics of people with COPD enrolling in home-based versus centre-based PR in England and Wales and assesses whether availability of home-based PR is associated with increased enrolment.MethodsThis study used data from the UK 2023-24 National Respiratory Audit Programme PR audit. Eligible people had a primary condition of COPD, complete mental health and geographic data, and attended an initial assessment at a centre that completed the clinical and organisational audit. For the primary analysis only, people were further restricted to those enrolled on a purely home-based or centre-based programme at a centre that offered both options. Enrolment was defined as having attended an initial assessment and having at least one scheduled PR session with a defined start date. Differences in characteristics were assessed using Chi-square and Kruskal-Wallis tests. The association between availability of home-based PR and enrolment was assessed using a mixed-effects logistic regression model.Results13719/29981 (45.8%) people were eligible for inclusion in the primary analysis and 25039/29981 (83.5%) were eligible for the secondary analysis. Those who enrolled in a home-based programme were more likely to: be female (58.6% vs 48.2%; p<0.001); be more deprived (55.7% versus 46.6% in IMD quintiles 1 or 2, p<0.001); have a greater mental health burden (28.2% versus 22.2% with at least 1 cognitive impairment recorded, p<0.001); and classified their symptom burden as more severe at assessment (CAT score 23 versus 22, p <0.001). Home-based PR was unavailable for 9099/25039 (36.3%) people. Availability of home-based PR was not associated with reduced non-enrolment in PR when compared with centres that did not offer home-based PR (adj-OR for non-enrolment: 0.79; 95%CI:0.51-1.23)).ConclusionHealthcare providers and those developing home-based PR digital applications should consider tailoring their approach to those who are most likely to opt in, who tend to be younger, female, and have a higher burden of respiratory symptoms and mental health comorbidities.