Chronic Respiratory Disease最新文献

Background: Health inequalities can affect access and uptake to pulmonary rehabilitation (PR). An individual's protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation) may contribute to health inequalities. Healthcare professionals (HCPs) experiences of the inclusivity and representativeness of PR services and knowledge of protected characteristics are unknown, however are vital for the identification and resolution of health inequalities. This qualitative study explored HCPs understanding of protected characteristics and their perception of the inclusivity, representativeness and equitable benefit of their PR services.

Methods: Semi-structured qualitative interviews were conducted in person or via videoconferencing with HCPs involved in PR from two healthcare providers. Interviews were analysed using reflexive thematic analysis.

Results: 12 interviews were conducted with physiotherapists (n = 6), occupational therapists (n = 2), nurses (n = 2) and exercise physiologists (n = 2). Participants had a median (IRQ) age of 43 (13) and 75% (n = 9) were female. Four themes were generated. 1: 'I don't really know as much as I should' [about protected characteristics]; 2: It's uncomfortable collecting protected characteristics…; 3: 'I don't think [service users] are as representative as they could be'; 4: A conventional rehabilitation programme does not meet the needs of all.

Conclusions: This study highlighted several challenges in HCPs understanding of protected characteristics and the representativeness of PR that must be addressed to ensure equity. Strategies, to understand barriers in accessing PR that limit representativeness should be explored.

Objectives: To assess the safety, reliability and acceptability of the modified incremental step test (MIST) supervised remotely via videoconferencing in adults with chronic respiratory disease.

Methods: Adults with chronic respiratory disease undertaking pulmonary rehabilitation were invited to undertake the MIST under two testing conditions: in-person supervision and remote supervision via video-conferencing. Test order was randomised.

Results: 38 participants (n = 18 Female; mean (SD) age 68 (10) years; 56% chronic obstructive pulmonary disease) undertook two MIST evaluations. There was excellent agreement between tests for total step count (ICC_2,1 0.93, 95%CI 0.86 to 0.96), despite higher counts with in-person supervision (MD 12 steps, 95%CI 1 to 24). There was very good agreement, and no difference between tests, for nadir oxygen saturation (ICC_2,1 0.797, 95%CI 0.643 to 0.889) and peak heart rate (ICC_2,1 0.782, 95%CI 0.620 to 0.880). Participant satisfaction with telehealth was high, and confidence was not different between testing conditions. There were no adverse events and remote testing was acceptable to participants.

Discussion: In this single centre cohort study MIST supervised remotely via video-conferencing was safe, reliable and acceptable to people with chronic respiratory disease.

Background: Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder requiring airway clearance techniques for mucus removal. We aimed to evaluate the feasibility and the effect of the active cycle of breathing technique (ACBT) versus oscillating positive expiratory pressure therapy (OPEP) in improving lung function and functional exercise capacity among children with PCD in Palestine. Methods: 32 PCD children (6-18 years) were included in a 12-week home-based feasibility study. They were assigned randomly into two groups: ACBT and OPEP. Data collection included spirometry measurements, and the six-minute walk test (6MWT). Results: After 12 weeks of regular airway clearance techniques (ACT), the FEV₁, MEF_25-75%, and the 6MWT demonstrated statistically significant differences (p = .02, p = .04, and p = .05 respectively) between the two groups, in favor of the OPEP group with the effect size of Cohen's d (0.86, 0.76, and 0.71) respectively. However, there was no significant difference (p > .05) between the two groups in FVC and FEV₁/FVC. Additionally, only in the OPEP group, significant differences were recorded between pre and post-tests for FEV1 and 6MWT (p < .05). Conclusion: The randomized study design comparing ACBT and OPEP was feasible and acceptable to patients. OPEP demonstrates potential for managing respiratory health; however, treatments should be individualized to address each patient's specific needs. Further research with larger cohorts is needed to assess the effectiveness of both methods.

IntroductionFibrotic interstitial lung disease (fILD) is characterized by scarring of the lungs, decline in lung function and compromised exercise capacity. People with fILD participate in less daily physical activity compared to healthy controls, however, the relative importance of physical activity components (volume, intensity, duration) is unknown. This study aimed to examine the relationship between the components of physical activity and established disease severity and impact measures in fILD.MethodsParticipant data were from baseline assessment of a randomized controlled trial recruiting people with fILD and exertional desaturation during exercise testing on room air. Physical activity components including volume (steps per day), intensity (light, moderate and vigorous) and duration (time spent in different physical activity intensities) were objectively assessed for 7 days using two physical activity monitors. Associations of these components with lung function (FVC, FEV₁, TLCO), functional exercise capacity (6-min walk distance, 6MWD) and dyspnea (Dyspnea-12 questionnaire) were investigated.Results106 participants with mild to severe fILD were included. Physical activity volume was not associated with 6MWD (r = 0.027, p = 0.78) and weakly associated with lung function (FVC r = 0.33, p = 0.001; FEV₁ r = 0.34, p = 0.001). Physical activity intensity and duration were weakly associated with 6MWD (light r = 0.22 p = 0.02; moderate r = 0.42, p < 0.001; vigorous r = 0.33, p = 0.01). Time spent in vigorous physical activity was weakly associated with lung function (FVC r = 0.19, p = 0.05; FEV₁ r = 0.18, p = 0.006). Dyspnea scores were not associated with any physical activity variables. Relationships remained consistent after adjusting for age, gender and disease severity, with the exception of vigorous physical activity which was no longer associated with lung function or 6MWD.ConclusionIn people with fILD, the physical activity components of volume, intensity and duration were associated with different measures of disease severity and impact. This highlights the importance of considering specific physical activity components when evaluating and promoting physical activity in this group.

BackgroundWhile telehealth has been used for specialist care during the COVID-19 pandemic, its benefits and barriers to use for delivering care in interstitial lung disease (ILD) remain unclear. We aimed to explore perspectives of patients and healthcare professionals (HCPs) towards telehealth use in ILD.MethodThis qualitative study using semi-structured interviews was undertaken in 18 patients with ILD from a single quaternary ILD centre and 18 HCPs of four different disciplines from various ILD centres around Australia. Interviews were transcribed verbatim and coded by two investigators independently using thematic analysis. Themes were developed by consensus.ResultsPatients and HCPs had experienced telehealth via video and telephone, predominantly for teleconsultation and/or telerehabilitation. For patients, benefits included provision of ongoing access to healthcare and significant reduction in travel. Healthcare professionals reported teleconsultations played an important role in patient follow-up rather than at initial contact. Concerns of suboptimal rapport and communication and a lack of physical examination were raised by both groups. Individual patient suitability, improvement in technological platform and support, and improved workflow for clinicians were important factors for utilisation of telehealth. Patients were open to the use of home monitoring devices, however, HCPs felt further research was required prior to clinical implementation.ConclusionThis study highlights positive and negative experiences of telehealth for patients and HCPs in the management of ILD . It also identifies areas for improvement to create a tailored telehealth model for ILD care.

BackgroundChronic respiratory diseases frequently cause a decrease in physical activity and lower exercise tolerance. Eccentric Cycling Training (ECT) offers a potential rehabilitation strategy. However, its effectiveness when combined with Helmet Ventilation (HV) is not fully established.MethodsThis nonblinded randomized controlled trial (RCT) investigated the effects of ECT with or without HV in individuals with chronic respiratory diseases. Participants were randomly assigned to the ECT, ECT-HV, or control group and underwent graded exercise testing. The ECT sessions spanned 9 weeks with gradually increasing intensity. The primary outcome was peak oxygen consumption (VO_2peak). Secondary outcomes included functional tests and symptom scores.ResultsForty-four patients with chronic respiratory diseases were enrolled and divided among the ECT (n = 13), ECT-HV (n = 15), and control (n = 13) groups. After 9 weeks, significant improvements in the 6-min walk test (6MWT) distance, energy expenditure index during the 6MWT, and timed up and go test were observed in both the ECT and ECT-HV groups compared to the control group. Reductions in initially high Borg leg fatigue were noted over time in these groups. VO_2peak at follow-up was 17.6 ± 2.9 ml/min/kg in the control group, 17.2 ± 4.5 ml/min/kg in the ECT group, and 18.2 ± 3.9 ml/min/kg in the ECT-HV group, with no significant differences among groups. No significant differences in achieving the targeted exercise intensity were found between the ECT and ECT-HV groups.ConclusionsOver a 9-week period, eccentric cycling training improved functional capacity and mobility in patients with chronic respiratory diseases, although no significant changes were observed in peak oxygen consumption or overall cardiopulmonary fitness.

Background: The use of non-invasive ventilation (NIV) in patients with advanced cystic fibrosis (CF) has increased in recent years. Research evidence supports its clinical benefits, but less is known about the patients' experience of its long-term use in a domiciliary setting.Objective: To investigate patients' lived experience of using long-term domiciliary NIV.Methods: Semi-structured, qualitative interviews were conducted with adults with CF using long-term domiciliary NIV for respiratory failure. The data collected were subject to thematic analysis.Results: Nine adults (6 female), 5 of whom were awaiting lung transplantation, with a mean age of 39 years and mean FEV₁ per cent predicted of 28%, were recruited. Data analysis revealed 2 themes: gratitude, and determination despite challenges. Patients identified some troubling side effects from NIV but were grateful for its symptomatic relief and were determined to continue using it to improve their quality of life.Conclusions: Participants reported experiences of NIV to be generally positive in terms of symptom relief and quality of life. These findings provide an initial insight into patients' experience of NIV and have the potential to help guide and improve care.

BackgroundDiagnosis of hypersensitivity pneumonitis (HP) or extrinsic allergic alveolitis requires a combination of tests with antibody testing playing a supportive role to identify exposures.ObjectivesWe conducted a scoping review on Aspergillus antibody testing in Aspergillus-related HP to identify the utility and diagnostic cutoffs proposed in the literature. We compared these cutoffs with studies of chronic pulmonary aspergillosis (CPA) and manufacturers' cutoffs.Eligibility criteriaOnly studies addressing the diagnostic value of Aspergillus IgG or precipitins for HP were included. Separately papers defining cutoffs for CPA were tabulated.Sources of evidencePublished papers were identified in literature searches in Embase, Web of Science, and Medline.ResultsWe identified 414 papers, of which 12 were included, all published between 1965 and 2005. Occupational HP linked to Aspergillus spp. exposure included Farmer's Lung, Malt-Worker's Lung, Esparto Worker's Lung, and Woodworker's lung (Sawmill-workers). No studies directly addressed serological testing in Tobacco Worker's lung, Compost Lung, or poultry workers. Among Aspergillus species exposure, A. fumigatus was most commonly described; others included A. umbrosus (now A. glaucus), A. clavatus, and A. niger. Antibody tests included ELISA, BALISA, precipitin tests and ImmunoCAP, with a higher sensitivity of ELISA and ImmunoCAP tests compared to precipitin tests. Patients with HP linked to Aspergillus exposures, were positive in 156/290 (53.8%) compared to 96/615 (15.6%) in those with similar occupational exposures without HP. In malt workers with HP 35/53 (66%) had detectable A. clavatus IgG antibody compared to 0/53 A. fumigatus IgG, and 13/74 (18%) exposed but unaffected workers, but are not commercially available.ConclusionsImproved means of establishing or ruling out Aspergillus exposure are required, given the negative consequences for patients of continued Aspergillus inhalation. Modern studies with commercially available Aspergillus IgG antibody assays are required to define appropriate cutoffs for HP, given numerous studies published for chronic pulmonary aspergillosis.

BackgroundFunctional status is a marker for evaluating fall risk and predicting mortality and hospitalisations in elderly and patients with COPD. Acute exacerbations of COPD result in sudden declines in exercise capacity, quadriceps force (QF) and physical activity (PA), but their impact on functional status remains unclear. This study aimed to (i) compare the functional status of patients with COPD to healthy controls and (ii) assess prospectively the impact of an exacerbation on functional status.MethodsHealthy controls and patients were assessed. Patients were followed up every 6 months and were tested again immediately if they reported an exacerbation. The short physical performance battery (SPPB), timed up and go test (TUG), 1-minute sit-to-stand test (1MSTS), 6-minute walking distance (6MWD), QF and PA (accelerometery) were measured.ResultsThirty-six patients (69 ± 7 years, 69% male) and 25 matched healthy controls (68 ± 7 years, 80% male) were included. Functional status was decreased in patients compared to healthy controls. Twelve patients were retested 10 ± 7 days after a moderate (n = 11) or severe (n = 1) exacerbation. The 1MSTS (∆-3 ± 3repetitions, p < 0.0001), 6MWD (∆-34 ± 46m, p < 0.0001) and QF (∆-9 ± 13Nm, p = 0.05) decreased after exacerbation onset. No changes in SPPB and PA were observed.ConclusionAn exacerbation negatively impacts the already reduced functional status in patients with COPD. The SPPB is not able to capture this decline.

ObjectivesGastroesophageal reflux-related chronic cough (GERC), an extraesophageal manifestation of gastroesophageal reflux disease (GERD). Although 24h MII-pH monitoring is the gold standard for diagnosing GERC, its invasiveness, high cost, and limited accessibility hinder widespread use in many clinical settings. This study aimed to develop a non-invasive machine learning model incorporating Peptest™ and GerdQ scores to facilitate GERC detection, particularly in primary care and resource-limited environments where MII-pH testing is not readily available.Methods210 chronic cough patients were enrolled between September 2022 and June 2024. GERC diagnosis followed established guidelines, and salivary pepsin levels were measured via Peptest™. Feature selection was performed using the Boruta algorithm (hereafter referred to as Boruta), a method based on random forest (RF), designed to identify relevant variables by comparing them to random shadow features. The selected optimal features were then evaluated using nine ML models, including logistic regression (LR), RF and others. Model performance was assessed through area under the curve (AUC), decision curve analysis (DCA), and calibration curves.Results73 (34.76%) patients had GERC. Peptest™ and GerdQ scores were key predictors. Logistic regression was selected for its balance of accuracy (AUC: 0.876) and clinical utility. The nomogram model showed excellent discrimination and calibration. DCA indicated high net benefit at prediction thresholds of 0.10-0.90. RCS analysis revealed non-linear relationships: GERC risk increased with GerdQ >8.66 and Peptest™ >54.791 ng/ml.ConclusionThe nomogram model provides a reliable, non-invasive tool for GERC diagnosis, aiding timely clinical intervention, especially for patients unsuitable for pH testing.